When behavioral therapies and mutual-help groups (such as A.A.) fail, many patients suffering through the woes of alcoholism will turn to certain medications in treating their condition. A study funded by the Department of Health and Human Services has revealed the obscure medications acamprosate and oral naltrexone are effective in treating alcohol use disorders (AUDs), while the more prominent drug disulfiram has little to no effect.

"When clinicians decide to use one of the medications, a number of factors may help with choosing which medication to prescribe, including the medication's efficacy, administration frequency, cost, adverse events, and availability," the authors concluded in a statement.

A research team led by Dr. Daniel E. Jonas of the University of North Carolina reviewed 123 studies evaluating the possible benefits and harmful side effects involved with using AUD medication. The FDA-approved medications included in this meta-analysis were disulfiram, acamprostate, both injectable and oral naltrexone, nalmefene, and topiramate. Considering its availability since the 1950s, disulfiram is a more recognizable treatment for physicians and patients compared to acamprosate and naltrexone.

The effectiveness for each medication was represented by a number needed to treat (NNT) point system, meaning the average number of patients who need to be treated to see a benefit in one patient. Acamprostate yielded an NNT of 12 for preventing a return to any drinking compared to oral naltrexone at 20. Oral naltrexone also scored a 12 NNT for preventing a return to heavy drinking. Researchers found no evidence supporting injectable naltrexone or disilfiram’s ability to prevent a return to any drinking or heavy drinking. Off-label medications nalmefene and topiramate, drugs that are usually prescribed to treat different conditions, showed some success in improving consumption outcomes.

"Treatment of AUD is considered an essential health benefit under health care reform,” said Dr. Katharine A. Bradley from the Group Health Research Institute and Dr. Daniel R. Kivlahan from the Veterans Health Administration in an accompanying editorial. “More patients with AUDs will have insurance, which could increase their access to evidence-based treatments for AUDs. The article by Jonas and colleagues should encourage patients and their clinicians to engage in shared decision making about AUD treatment options.”

According to the National Institute on Alcohol Abuse and Alcoholism, upward of 18 million people in the United States suffer from an alcohol use disorder, including alcohol dependence (alcoholism) or alcohol abuse. Doctors tend to diagnose patients with an AUD when their drinking causes distress or harm. The most severe form of AUD, alcoholism, is characterized by craving, loss of control, dependence, and tolerance.

“By identifying 4 effective medications for AUD [naltrexone, acamprosate, topiramate, and nalmefene], the authors highlight treatment options for a common medical condition for which patient-centered care is not currently the norm,” Bradley and Kivlahan added. “Patients with AUDs should be offered options, including medications, evidence-based behavioral treatments, and mutual support for recovery. Moreover, patients should expect shared decision making about the best options for them.”

Source: Jonas D, et al. Study Examines Effectiveness of Medications to Treat Alcohol Use Disorders. JAMA. 2014.