Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, 22908-0623, USA.
Am J Psychiatry. 2010 Jun;167(6):630-9. doi: 10.1176/appi.ajp.2010.08101500.
Alcoholism remains a serious cause of morbidity and mortality despite progress through neurobiological research in identifying new pharmacological strategies for its treatment. Drugs that affect neural pathways that modulate the activity of the cortico-mesolimbic dopamine system have been shown to alter drinking behavior, presumably because this dopaminergic system is closely associated with rewarding behavior. Ondansetron, naltrexone, topiramate, and baclofen are examples. Subtyping alcoholism in adults into an early-onset type, with chronic symptoms and a strong biological predisposition to the disease, and a late-onset type, typically brought on by psychosocial triggers and associated with mood symptoms, may help in the selection of optimal therapy. Emerging adults with binge drinking patterns also might be aided by selective treatments. Although preliminary work on the pharmacogenetics of alcoholism and its treatment has been promising, the assignment to treatment still depends on clinical assessment. Brief behavioral interventions that encourage the patient to set goals for a reduction in heavy drinking or abstinence also are part of optimal therapy.
尽管神经生物学研究在确定治疗酒精中毒的新药理学策略方面取得了进展，但酒精中毒仍然是一个严重的发病和死亡原因。已经证明，影响调节皮质-中脑边缘多巴胺系统活动的神经通路的药物可以改变饮酒行为，这可能是因为这种多巴胺能系统与奖赏行为密切相关。昂丹司琼、纳曲酮、托吡酯和巴氯芬就是例子。将成人酗酒分为早发性，具有慢性症状和强烈的疾病生物学倾向，以及晚发性，通常由心理社会诱因引起，并与情绪症状相关，可能有助于选择最佳治疗方法。有 binge drinking 模式的青少年可能也会受益于选择性治疗。尽管酒精中毒及其治疗的药物遗传学的初步工作很有希望，但治疗的分配仍然取决于临床评估。鼓励患者为减少重度饮酒或戒酒设定目标的简短行为干预也是最佳治疗的一部分。
