MEDICAL MANAGEMENT OF ALCOHOL DEPENDENCE: CLINICAL USE AND LIMITATIONS OF NALTREXONE TREATMENT

Historically, pharmacological and psychosocial treatments foralcohol dependence have demonstrated only modest effectivenessin reducing alcohol drinking. However, the recent US Food andDrug Administration approval of naltrexone for the treatmentof alcohol dependence offers a new, safe and effective medicationto reduce relapse following alcohol detoxification. This paperreviews the various psychosocial and pharmacological treatmentscurrently available and the effectiveness of these treatments.This paper also reviews precinical research which demonstratesthe involvement of the opioid system in the reinforcing effectsof alcohol. This research led to clinical trials on the useof the opioid antagonist, naltrexone, to reduce alcohol's pleasurableeffects and enhance the effectiveness of psychosocial therapy.In two randomized clinical trials, naltrexone treatment reducedrates of alcohol relapse, number of drinking days and alcoholcraving. The clinical efficacy of all pharmacological treatmentsfor substance abuse are limited by compliance with taking themedication. Also, pharmacological treatment does not addressthe psychosocial complications which often result from chronicalcohol dependence. Therefore, the integration of medicationssuch as naltrexone and psychosocial therapies may offer thebest treatment. The further development and investigation ofnew pharmacological agents will enable matching of patient populationswith specific treatments, offering more successful treatmentoutcomes.