Pharmacologic Approaches to the Management of Alcoholism

Our understanding of alcohol craving, both as a cause for chronic abuse and relapse and as a targetfor intervention, has been refined significantly in recent years. For example, craving experienced duringalcohol withdrawal may be mediated by γ-aminobutyric acid (GABA) and glutamate receptormechanisms, whereas the memory of the rewarding aspects of alcohol may be mediated by dopamine,opiate, and glutamate systems. Therefore, pharmacologic treatments for alcohol dependence may betargeted to numerous pathways. This article will discuss animal and clinical studies of the opioid antagonists(primarily naltrexone), acamprosate, and disulfiram. The side effects and treatment recommendationsfor each drug will also be reviewed.