Question: In adults (>18 years old) with moderate to severe alcohol dependence, how effective are pharmacological treatments (in particular, oral naltrexone, disulfiram and acamprosate) compared to any other treatments, in improving consumption-related outcomes?

Answer:

Plain language summary

Limited evidence suggests that oral naltrexone and acamprosate are effective in improving consumption-related outcomes in alcohol dependent adults. However more high quality trials are needed to adequately assess the effectiveness of pharmacological treatments in this area.

Clinical and research implications

Evidence from one high quality systematic review indicated that oral naltrexone and acamprosate are similarly effective in improving consumption related outcomes in people with alcohol dependence. These results were partially supported by the findings of a second, smaller, poor quality systematic review. Evidence about the effectiveness of disulfiram was sparse and inconsistent.

More research needs to be done as to which subsets of service users these medications would be most appropriate for. The effects of different population characteristics (e.g. degree of dependence, genetic factors) in influencing the response to pharmacological treatment need to be examined further (1). Longer term follow-ups would mean that more data on health outcomes (e.g. morbidity, mortality) can be collected (1,2) and the true effect of the drug examined after its novelty effect has worn off. Jonas et al. suggests for more research to look at the benefits for those groups whose aim is controlled drinking, rather than total abstinence (2). Further research into how medications and psychosocial treatments compare with each other as well as combinations that could work well could be considered as well (1,2). Besides this, more studies on cost effectiveness and risk of side effects would be useful. NICE has also recommended for research into understanding and tackling non-compliance (3). Looking at the bigger picture, more research needs to go into preventative measures at the population level, in light of the deeply socially embedded drinking culture.

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