State-of-the-art behavioral and pharmacological treatments for alcohol use disorder

Abstract

Background: Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. Objective: This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. Method: This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. Scientific Significance: One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, Cognitive Behavioral Therapy (CBT) has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so called “silver bullet” for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field; although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.

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“…Specific CBT techniques include training coping skills, drug‐refusal skills, and increasing nonuse‐related activities . CBT is most consistently shown to increase abstinence in AUD and is supported by an RCT and observational studies in ALD …”

“…The strategy of mutual support is based on creating a reliable, healthy social network that fosters a “sober environment” where the patient can enjoy positive associations with social experiences that do not include alcohol. Specific examples include Alcoholics Anonymous, Smart Recovery, and religious group meetings, which are accessible therapies in terms of cost and expertise . Mutual support has the added benefit of social support that is not as prominent in CBT and MI/MET.…”

“…Although less time‐consuming and more intuitive, there is little evidence for brief interventions in moderate‐to‐severe AUD. Compared with more structured sessions, brief interventions are less likely to help in ALD …”

“…7 CBT is most consistently shown to increase abstinence in AUD and is supported by an RCT and observational studies in ALD. 5,8,9 Motivational Interviewing and Motivational Enhancement Therapy…”

“…Specific examples include Alcoholics Anonymous, Smart Recovery, and religious group meetings, which are accessible therapies in terms of cost and expertise. 8 Mutual support has the added benefit of social support that is not as prominent in CBT and MI/MET. Mutual support is often the standard of care for AUD and is the cornerstone of usual care in most RCTs.…”