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American Psychiatric Association Releases New Treatment Guidelines for Alcohol Use Disorder


In January, the American Psychiatric Association (APA) released their new guidelines for addiction treatment of alcohol use disorders. The guidelines set a series of evidence-based treatment modalities for addiction treatment that will help guide clinicians in a variety of settings. 

This article examines these guidelines. Why is this good news? How will this help addiction treatment specialists better serve their patients? How will this supplement existing treatment options?

Addiction Treatment for AUD in 2018

The Psychiatric Annals points out the facts driving these new evidenced-based treatment guidelines:

  • AUD remains chronically undertreated, with less than one in 10 U.S. citizens receiving the treatment they need.
  • The lifetime prevalence of AUD in the U.S. stands at 29 percent.

According to ProjectKnow, close to 14 million adults abuse alcohol, and the rates are on the rise. Given these statistics, the new APA guidelines could not come at a better time.

The new APA guidelines recommend a series of steps that providers must take to treat AUD in an addiction treatment setting. The guidelines also offer rules related to the assessment and treatment of AUD. 

They cover four basic areas:

  • Assessment and treatment planning
  • MAT
  • Recommendations for when not to use MAT
  • Treatment of AUD and an opioid comorbidity

The guidelines emphasize using medication-assisted therapy (MAT) to treat AUD. A Medscape article describes the new treatment planning guidelines this way:

"Patients with AUD should have a documented comprehensive and person-centered treatment plan that includes evidence-based nonpharmacologic and pharmacologic interventions."

Addiction treatment

The new APA guidelines signify a broader approach that allows addiction treatment providers additional tools to help treat their patients. Up until now, prescriptions for these medications has been limited and underutilized, despite the fact that numerous studies report the efficacy and long-term treatment success tied to these drugs.

The guidelines include:

  • Using naltrexone and acamprosate to treat AUD. Naltrexone is an opioid agonist used to block pain and cravings for alcohol or other substances. Acamprosate reduces the urge to drink alcohol and reduces post-acute withdrawal symptoms. The APA guidelines suggest that naltrexone and acamprosate should be prescribed in patients with moderate-to-severe AUD but only when non-pharmacological treatments are not working.
  • Using topiramate and gabapentin for moderate-to-severe AUD patients, but only after trying naltrexone or acamprosate first. Both drugs are typically used to prevent seizure disorder. Medscape suggests, “…The exact mechanism of action of topiramate in the treatment of alcohol use disorders is unknown.” However, it is suggested that topiramate and gabapentin block dopamine patterns that release chemicals that reward drinking behavior. 
  • Using Disulfiram but not as a first-line treatment. Disulfiram blocks the body from metabolizing alcohol. Disulfiram causes unpleasant side effects if alcohol is ingested after the drug has been taken.

These new evidence-based guidelines represent a strong step forward for addiction treatment. The benefits of using MAT for AUD are their efficacy for combating the long-term effects of the disease. These medications target the neurotransmitters to decrease alcohol cravings. When MAT is coupled with psychotherapy, cognitive-behavioral therapy, 12-step, and motivational support, it increases the number of tools available to addiction treatment specialists.

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