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?
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
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
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