Paille François, Martini Hervé
Department of Addiction Treatment, University Hospital, Vandoeuvre-lès-Nancy, France.
Subst Abuse Rehabil. 2014 Aug 8;5:87-94. doi: 10.2147/SAR.S45666. eCollection 2014.
Reduction of alcohol consumption is not yet a widely accepted treatment objective for alcohol-dependent patients, as abstinence is often considered to be the only possible objective in this situation. However, various studies have demonstrated the value of proposing these two options to such patients. Firstly, reduction of alcohol consumption very significantly reduces the risk of alcohol-related damage, and also modifies the patient's and the doctor's perception of the disease, resulting in improved access to care and better patient adherence with the proposed treatment objective and consequently better clinical results. Recent studies have shown that some medicinal products can help patients reduce their alcohol consumption. One such product, nalmefene, has been granted European marketing authorization and is now being released onto the market in various countries. The ESENSE 1 and 2 studies in alcohol-dependent patients showed that, in combination with BRENDA, a psychosocial intervention focusing on reinforcement of motivation and treatment adherence, nalmefene significantly reduced the number of heavy drinking days and mean daily total alcohol consumption versus placebo. This reduction was more marked in the marketing authorization target population, ie, patients with a high or very high drinking risk level according to World Health Organization criteria. Another original feature of this molecule is that it can be used as needed if the patient perceives a risk of drinking, which is a more flexible approach and more likely to ensure the patient's active involvement in the treatment of his/her disease. This molecule opens up interesting and original therapeutic prospects in the treatment of alcohol dependence.
减少酒精摄入量尚未成为酒精依赖患者广泛接受的治疗目标,因为在这种情况下,戒酒往往被认为是唯一可能的目标。然而,多项研究已证明向此类患者提出这两种选择的价值。首先,减少酒精摄入量能显著降低与酒精相关损害的风险,还能改变患者和医生对该疾病的认知,从而改善获得治疗的机会,提高患者对建议治疗目标的依从性,进而取得更好的临床效果。最近的研究表明,一些药物产品可帮助患者减少酒精摄入量。一种此类产品,纳美芬,已获得欧洲市场授权,目前正在各国上市。针对酒精依赖患者的ESENSE 1和2研究表明,与专注于强化动机和治疗依从性的心理社会干预措施布伦达相结合时,纳美芬与安慰剂相比,能显著减少重度饮酒天数和平均每日酒精总摄入量。在市场授权目标人群中,即根据世界卫生组织标准饮酒风险水平高或非常高的患者中,这种减少更为明显。该分子的另一个独特之处在于,如果患者察觉到饮酒风险,可按需使用,这是一种更灵活的方法,更有可能确保患者积极参与自身疾病的治疗。该分子为酒精依赖的治疗开辟了有趣且独特的治疗前景。