Alcohol use disorder (AUD) is a complex medical disease with dramatic consequences to our society in terms of mortality and morbidity. Research efforts have focused on differed strategies to treat AUD, including the development of medications. Pharmacological interventions to treat AUD may act by reversing the acute effects of ethanol, managing cravings, and reducing stress and/or withdrawal. Disulfiram was the first drug approved in the USA for the treatment of AUD, and today it is the only medication used clinically whose mechanism of action is based on altering ethanol pharmacokinetics.
[Photo: Dr. Carolina Haass-Koffler]
The purpose of this review, led by Dr. Carolina Haass-Koffler, assistant professor of behavioral and social sciences and faculty member in the Center for Alcohol and Addiction Studies, was to explore the complexity of drug–ethanol interactions and discuss medications used to treat AUD that share pharmacokinetics pathways with ethanol.
Historically, AUD treatments have targeted complete abstinence from ethanol. Although disulfiram was developed as a pharmacological intervention that would facilitate abstinence, it is an approach that uses a therapeutically intended ethanol-drug interaction to deter individuals from consuming alcohol. Disulfiram produces significant adverse reactions to even small amounts of consumed alcohol, including headache and nausea. More recently, it has been suggested that while alcohol abstinence remains the ideas therapeutic outcome to achieve, a reduction in alcohol drinking below harmful levels may be a beneficial goal for AUD individuals. The development of medications that target reduction of alcohol consumption, rather than complete abstinence, represents a novel pharmacological approach to facilitate reduction of alcohol drinking to below harmful levels. Altering ethanol pharmacokinetics parameters of established medications to support low levels of alcohol consumption may represent a novel target to treat AUD.
However, challenges remain in developing pharmacological interventions that alter pharmacokinetics, without producing the intense adverse reaction to alcohol seen in disulfiram. For example, pharmacokinetics pathways are very difficult to assess accurately in a heterogeneous AUD population. Nonetheless, this review represents a preliminary exploration of a novel approach to treat AUD.
This study was published in Journal of Psychopharmacology (ahead of print).
For more information: https://www.ncbi.nlm.nih.gov/pubmed/28093021