Yonsei Med J.  2006 Apr;47(2):167-178. 10.3349/ymj.2006.47.2.167.

Pharmacotherapy for Alcohol Dependence: Anticraving Medications for Relapse Prevention

• Jung YC
• Namkoong K

• KMID: 1110738
• DOI: http://doi.org/10.3349/ymj.2006.47.2.167

Abstract

Alcohol dependence is a chronic disorder that results from a variety of genetic, psychosocial, and environmental factors. Relapse prevention for alcohol dependence has traditionally involved psychosocial and psychotherapeutic interventions. Pharmacotherapy, however, in conjunction with behavioral therapy, is generating interest as another modality to prevent relapse and enhance abstinence. Naltrexone and acamprosate are at the forefront of the currently available pharmacological options. Naltrexone is an opioid receptor antagonist and is thought to reduce the rewarding effect of alcohol. Acamprosate normalizes the dysregulation of N-methyl-D-aspartate (NMDA)-mediated glutamatergic excitation that occurs in alcohol withdrawal and early abstinence.These different mechanisms of action and different target neurotransmitter systems may endow the two drugs with efficacy for different aspects of alcohol use behavior. Since not all patients seem to benefit from naltrexone and acamprosate, there are ongoing efforts to improve the treatment outcomes by examining the advantages of combined pharmacotherapy and exploring the variables that might predict the response of the medications. In addition, novel medications are being investigated to assess their efficacy in preventing relapse and increasing abstinence.

Keyword

Alcohol dependence; pharmacotherapy; naltrexone; acamprosate

MeSH Terms

gamma-Aminobutyric Acid/metabolism
Taurine/analogs & derivatives/therapeutic use
Recurrence
Receptors, Opioid, mu/genetics/metabolism
Receptors, Opioid/antagonists & inhibitors
Polymorphism, Genetic
Neurons/metabolism
Naltrexone/therapeutic use
N-Methylaspartate/metabolism
Models, Neurological
Models, Biological
Humans
Glutamine/metabolism
Disulfiram/therapeutic use
Alcoholism/*drug therapy
Alcohol Deterrents/*therapeutic use

Figure

• 

  Fig. 1 A representation of the neuroadaptive model of craving and possible mechanisms of naltrexone and acamprosate.

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