CARE Series - Treating Alcohol Use Disorder Across Clinical Settings

Review of:

• Assessing severity of alcohol use disorder (AUD)
• Assessment of withdrawal and outpatient detoxification
• Medications for treating AUD
• Integrating medication and behavioral treatments
• Treating AUD in patients receiving medications for opioid use disorder
• Treating AUD in older adults

Presenter

Henry Kranzler, MD
Professor of Psychiatry and Director of the Center for Studies of Addiction
University of Pennsylvania’s Perelman School of Medicine

1. List three symptoms of Alcohol Withdrawal.
2. Compare outcomes for two FDA approved or commonly used medications to treat Alcohol Use Disorder (AUD).
3. Recall one clinical consideration for AUD medication treatment in older adults.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

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Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours.

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Bibliographic Sources

• Anton RF, O’Malley SS, Ciraulo DA, et al. Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A Randomized Controlled Trial. JAMA. 2006;295(17):2003–2017. doi:10.1001/jama.295.17.2003
  
  
• Blodgett JC, Del Re AC, Maisel NC, Finney JW. A meta-analysis of topiramate's effects for individuals with alcohol use disorders. Alcohol Clin Exp Res. 2014 Jun;38(6):1481-8. https://doi.org/10.1111/acer.12411. Epub 2014 May 5. PMID: 24796492; PMCID: PMC4047180.
  
  
• Fuller RK, Branchey L, Brightwell DR, Derman RM, Emrick CD, Iber FL, James KE, Lacoursiere RB, Lee KK, Lowenstam I, et al. Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. JAMA. 1986 Sep 19;256(11):1449-55. PMID: 3528541.
  
  
• Garbutt JC, Kranzler HR, O'Malley SS, Gastfriend DR, Pettinati HM, Silverman BL, Loewy JW, Ehrich EW; Vivitrex Study Group. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005 Apr 6;293(13):1617-25. https://doi.org/10.1001/jama.293.13.1617. Erratum in: JAMA. 2005 Apr 27;293(16):1978. Erratum in: JAMA. 2005 Jun 15:293(23):2864. PMID: 15811981.
  
  
• Kranzler HR, Covault J, Feinn R, Armeli S, Tennen H, Arias AJ, Gelernter J, Pond T, Oncken C, Kampman KM. Topiramate treatment for heavy drinkers: moderation by a GRIK1 polymorphism. Am J Psychiatry. 2014 Apr;171(4):445-52. https://doi.org/10.1176/appi.ajp.2013.13081014. Erratum in: Am J Psychiatry. 2014 May 1;171(5):585. PMID: 24525690; PMCID: PMC3997125.
  
  
• Kranzler HR, Feinn R, Morris P, Hartwell EE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019 Sep;114(9):1547-1555. https://doi.org/10.1111/add.14655. Epub 2019 Jun 5. PMID: 31077485; PMCID: PMC6682454.
  
  
• Kranzler, H.R., Morris, P.E., Pond, T. et al. Prospective randomized pharmacogenetic study of topiramate for treating alcohol use disorder. Neuropsychopharmacol. 46, 1407–1413 (2021). https://doi.org/10.1038/s41386-020-00945-9
  
  
• McPheeters M, O'Connor EA, Riley S, Kennedy SM, Voisin C, Kuznacic K, Coffey CP, Edlund MD, Bobashev G, Jonas DE. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023 Nov 7;330(17):1653-1665. https://doi.org/10.1001/jama.2023.19761. PMID: 37934220; PMCID: PMC10630900.
  
  
• Sachdeva A, Choudhary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015 Sep;9(9):VE01-VE07. https://doi.org/10.7860/JCDR/2015/13407.6538. Epub 2015 Sep 1. PMID: 26500991; PMCID: PMC4606320.
  
  
• Sass H, Soyka M, Mann K, Zieglgänsberger W. Relapse prevention by acamprosate. Results from a placebo-controlled study on alcohol dependence. Arch Gen Psychiatry. 1996 Aug;53(8):673-80. https://doi.org/10.1001/archpsyc.1996.01830080023006. Erratum in: Arch Gen Psychiatry 1996 Dec;53(12):1097. PMID: 8694680.
  
  
• Volpicelli JR, Alterman AI, Hayashida M, O'Brien CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. 1992 Nov;49(11):876-80. https://doi.org/10.1001/archpsyc.1992.01820110040006. PMID: 1345133.
  
  
• US Department of Veteran’s Affairs Center for Innovation to Implementation (Ci2i), Clinical Institute Withdrawal Assessment – Alcohol
  https://www.ci2i.research.va.gov/paws/pdfs/ciwa-ar.pdf
  
  

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