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 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.

Keywords: AUD treatment; Alcohol use disorder; evidence-based treatment; psychopharmacology; psychosocial treatment.

Figure 1.

Summary of available psychological treatments for AUD with the y-axis indicating the strength of the evidence in favor of a particular treatment (as perceived in this qualitative review) and the x-axis indicating the recommended placement of that treatment across the continium of AUD severity. This figure summarizes the authors’ subjective evaluation of the scientific literature, which has not been subjected to quantitative analyses (e.g., effect size estimations).

Figure 2.

Summary of available pharmacological treatments for AUD with the y-axis indicating the strength of the evidence in favor of a particular treatment (as perceived in this qualitative review) and the x-axis indicating the recommended placement of that treatment across the continium of AUD severity. Pharmacotherapies are divided into FDA-approved and off-label treatments. This figure summarizes the authors’ subjective evaluation of the scientific literature, which has not been subjected to quantitative analyses (e.g., effect size estimations).