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New APA guidelines aim to improve treatment outcomes for alcohol use disorder
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The American Psychiatric Association has released new practice guidelines for the treatment of alcohol use disorder that focus on improving treatment outcomes and quality of care for patients, according to a press release issued by the organization.
The new guidelines offer clinicians recommendations on evidence-based pharmacological treatments for alcohol use disorder and on the assessment and treatment planning necessary to treat patients using pharmacotherapy.
“This new guideline is an important step in bringing effective, evidence-based treatments for alcohol use disorder to many more people and in helping address the public health burden of alcohol use,” Anita Everett, MD, APA president, said in the press release.
Alcohol use disorder remains undertreated, with fewer than one in 10 people in the U.S. with a 12-month diagnosis of alcohol use disorder receiving treatment and an estimated lifetime prevalence rate of 29%, according to the release. An expert panel led by Victor I. Reus, MD, chair of the APA Practice Guideline Writing Group, created these guidelines to help patients with alcohol use disorder receive the best treatment.
The guidelines recommend:
- naltrexone and acamprosate to treat patients with moderate-to-severe alcohol use disorder when nonpharmacological approaches have no effect or when patients prefer them;
- topiramate and gabapentin for patients with moderate-to-severe alcohol use disorder, but usually after trying naltrexone and acamprosate first; and
- disulfiram, but not generally as a first-line treatment.
The guidelines also include evidence-based psychotherapeutic treatments for alcohol use disorder, such as cognitive-behavioral therapy, 12-step facilitation and motivational enhancement therapy, according to the release. In addition, they suggest that community-based peer support groups, including Alcoholics Anonymous, can help patients. – by Savannah Demko
References:
Reus VI, et al. Amer J Psychiatry. 2018;doi:10.1176/appi.ajp.2017.1750101.
Disclosures: Everett is APA president. Reus is chair of the APA Practice Guideline Writing Group.
Perspective
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Frances Levin, MD
Updated guidelines for the treatment of alcohol use disorder (AUD) are long overdue. The APA guidelines for AUD is an important resource for clinicians wanting to provide state-of-the-art treatments for AUD. The guidelines are meant to serve as an educational resource based on current scientific and clinical information. Attention is paid to assessment strategies and the use of physiologic measures to identify use. To date, psychotherapeutic approaches still remain the mainstay of treatment. The guidelines systematically review the benefits and harms of all the pharmacologic interventions that are commonly used to treat AUD, and the empirical data support their use. Unfortunately, most clinicians, even addiction specialists, do not utilize pharmacologic interventions as a first-line treatment for AUD or when psychotherapeutic interventions fail. While there is a comprehensive review of FDA-approved interventions, the guidelines also address how off-label medications might be used. The data supporting the use of pharmacologic approaches are presented in a balanced, lucid fashion. Moreover, common clinical situations, such as use of medication when there is hepatic dysfunction or concomitant opioid use, is discussed. The expert panel also puts forth where there are holes in the literature requiring further research. This is a masterful overview of how to best approach the assessment and treatment of AUD with pharmacotherapies and is recommended reading for the general, as well as the addiction, specialist.
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