Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review.
Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review.
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DOI：
10.1001/jama.2018.11406
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发表时间：
2018-08-28
期刊：
影响因子：
--
通讯作者：
Soyka M
中科院分区：
文献类型：
--
作者：
Kranzler HR;Soyka M
美国每年有8.8万人死于饮酒。尽管大量饮酒的常规筛查可以确定AUD患者的身份，并已被推荐，但只有六分之一的美国成年人报告曾被健康专业人员询问过他们的饮酒行为。酒精使用障碍(AUD)是一种有问题的酒精使用模式，伴随着临床上严重的损伤或痛苦，在14%的美国成年人中存在，尽管只有7%的受影响个人在酒精治疗机构中出现。美国食品和药物管理局(FDA)批准了四种治疗AUD的药物：双硫兰、纳曲酮(口服和长效注射制剂)和氨基己酸酯。然而，AUD患者最常见的是接受咨询。只有不到9%的患者可能从药物治疗中受益，因为有证据表明这些药物具有临床意义，并将其纳入临床实践指南，作为中到重度AUD的一线治疗。纳曲酮可以每天服用一次，可以将再次饮酒的可能性降低5%，将酗酒风险降低10%。随机临床试验也表明，一些被批准用于其他适应症的药物，包括癫痫障碍(例如托吡酯)，在治疗AUD方面是有效的。目前，没有足够的证据支持使用药物遗传学来个人化AUD治疗。饮酒与高发病率和死亡率有关，大量饮酒是AUD的主要危险因素。简单、有效的筛查方法可以用来识别大量饮酒的患者，然后可以评估他们是否存在AUD。被诊断为精神障碍的患者应该得到简短的咨询和一线药物(例如纳曲酮)，或者被转介到更密集的心理社会干预。
Alcohol consumption is associated with 88,000 U.S. deaths annually. Although routine screening for heavy alcohol use can identify patients with AUD and has been recommended, only 1 in 6 U.S. adults report ever having been asked by a health professional about their drinking behavior. Alcohol use disorder (AUD), a problematic pattern of alcohol use accompanied by clinically significant impairment or distress, is present in 14% of U.S. adults, though only 7% of affected individuals are seen in an alcohol treatment facility. Four medications are approved by the Food and Drug Administration (FDA) to treat AUD: disulfiram, naltrexone–oral and long-acting injectable formulations–and acamprosate. However, patients with AUD most commonly receive counselling. Medications are prescribed to less than 9% of patients who are likely to benefit from them given evidence that they exert clinically meaningful effects and their inclusion in clinical practice guidelines as first-line treatments for moderate-to-severe AUD. Naltrexone, which can be given once daily, reduces the likelihood of a return to any drinking by 5% and binge drinking risk by 10%. Randomized clinical trials also show that some medications approved for other indications, including seizure disorder (e.g., topiramate), are efficacious in treating AUD. Currently there is not sufficient evidence to support the use of pharmacogenetics to personalize AUD treatments. Alcohol consumption is associated with a high rate of morbidity and mortality and heavy alcohol use is the major risk factor for AUD. Simple, valid screening methods can be used to identify patients with heavy alcohol use, who can then be evaluated for the presence of an AUD. Patients diagnosed with the disorder should be prescribed brief counselling and a first-line medication (e.g., naltrexone) or referred for a more intensive psychosocial intervention.
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DOI：
10.1111/acer.13410
发表时间：
2017-07
期刊：
Alcoholism, clinical and experimental research
影响因子：
--
作者：
Busch AC;Denduluri M;Glass J;Hetzel S;Gugnani SP;Gassman M;Krahn D;Deyo B;Brown R
通讯作者：
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3.8
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通讯作者：
Trafton, Jodie A.
影响因子：
3.7
作者：
Del Re AC;Gordon AJ;Lembke A;Harris AH
通讯作者：
Harris AH
影响因子：
25.8
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Grant BF;Goldstein RB;Saha TD;Chou SP;Jung J;Zhang H;Pickering RP;Ruan WJ;Smith SM;Huang B;Hasin DS
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