Addiction Disorders

New APA Guideline Recommendation for Treatment of Alcohol Use Disorder

Laurel Ranger
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man sitting with glass of liquor in his hand
man sitting with glass of liquor in his hand
The new guideline focuses on evidence-based pharmacologic treatments in alcohol use disorder and includes recommendations about naltrexone, acamprosate, disulfiram, topiramate, and gabapentin.

The American Psychiatric Association (APA) announced the release of a new practice guideline in the treatment of alcohol use disorder.

“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,” said APA President Anita Everett, MD.

Approximately 29% of the US population suffers from an alcohol use disorder at some point in their life. The disorder is a significant burden for individuals, their families, and the public healthcare system. Despite the availability of evidence-based interventions, alcohol use disorder remains undertreated. Less than 10% of individuals in the United States with a 12-month diagnosis of alcohol use disorder receive any kind of treatment.

The new guideline recommendation focuses on evidence-based pharmacologic treatments in alcohol use disorder and includes the following:

  • Naltrexone and acamprosate are recommended for moderate to severe alcohol use disorder in specific circumstances, such as when nonpharmacological approaches are not effective or when patients prefer to use one of these medications
  • Disulfiram produces physical reactions (eg, flushing) if alcohol is consumed within 12 to 24 hours of medication use; it is generally not used as a first-line treatment
  • Topiramate and gabapentin are also suggested in moderate to severe alcohol use disorder, but typically only after trying naltrexone and acamprosate first

An executive summary of the guideline is available on the APA website.

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Evidence-based psychotherapeutic treatments are also covered in this new guideline, including cognitive-behavioral therapy, 12-step facilitation, and motivational enhancement therapy, all of which play a major role in treatment. Community-based peer support groups such as Alcoholics Anonymous (AA) and other programs may be helpful for patients as well, but the guideline does not make specific recommendations regarding these treatments.

Reference

APA releases new practice guideline on treatment of alcohol use disorder. American Psychiatric Association. www.psychiatry.org/newsroom/news-releases/apa-releases-new-practice-guideline-on-treatment-of-alcohol-use-disorder. Published January 5, 2018. Accessed February 1, 2018.