Department of Psychiatry, University of Pittsburgh Medical Center, PA, USA.
CNS Drugs. 2012 Jul 1;26(7):559-69. doi: 10.2165/11634330-000000000-00000.
Alcohol use disorder (AUD) occurs in few young adolescents, but is as common as in adults by the late teens. To address problems with the current American Psychiatric Association DSM-IV criteria, the anticipated DSM-V will eliminate the distinction between substance abuse and dependence in favour of a single category. For adolescents, pharmacotherapy for AUD may target alcohol withdrawal symptoms, alcohol consumption reinforcement properties, craving or co-morbid mental disorders. While uncommon among adolescents, severe alcohol withdrawal may require the closely monitored application of benzodiazepines. Disulfiram alters alcohol metabolism and has been shown to increase abstinence in adolescents with AUD, but sufficient motivation to maintain abstinence is needed for this approach to be appropriate. Medications to reduce alcohol craving, including naltrexone and acamprosate, may also assist some adolescents in maintaining abstinence. Adolescents with AUD typically also have co-morbid mental disorders and problems with other substances. Co-morbid mental disorders, such as major depressive disorder and attention-deficit hyperactivity disorder, may be addressed by pharmacotherapy. The potential for interactions between prescribed medications and alcohol or illicit substances necessitates patient education and monitoring. While there is a paucity of empirical information on the applicability of these pharmacotherapy approaches in adolescents, cautious application of these medications in selected cases in the context of systematic psychosocial interventions is warranted to promote abstinence and address associated problems.
酒精使用障碍（AUD）在青少年中很少见，但到青少年后期，其发病率与成年人相当。为了解决当前美国精神病学协会 DSM-IV 标准存在的问题，预计 DSM-V 将消除物质滥用和依赖之间的区别，转而采用单一类别。对于青少年，酒精使用障碍的药物治疗可能针对酒精戒断症状、酒精消费强化特性、渴望或共病精神障碍。虽然在青少年中不常见，但严重的酒精戒断可能需要密切监测苯二氮䓬类药物的应用。双硫仑改变酒精代谢，已被证明可增加 AUD 青少年的戒酒率，但需要有足够的戒酒动机，这种方法才合适。减少酒精渴望的药物，包括纳曲酮和阿坎酸，也可能有助于一些青少年戒酒。患有 AUD 的青少年通常也伴有共病精神障碍和其他物质问题。共病精神障碍，如重度抑郁症和注意缺陷多动障碍，可以通过药物治疗来解决。由于处方药与酒精或非法物质之间可能存在相互作用，因此需要对患者进行教育和监测。虽然关于这些药物治疗方法在青少年中的适用性的实证信息很少，但在系统心理社会干预的背景下，谨慎地将这些药物应用于选定病例中，以促进戒酒并解决相关问题是必要的。
