Winslow Bradford T, Onysko Mary, Hebert Melanie
Swedish Family Medicine Residency Program, Littleton, CO, USA.
Kaiser Permanente, Highlands Ranch, CA, USA.
Am Fam Physician. 2016 Mar 15;93(6):457-65.
The U.S. Preventive Services Task Force recommends that clinicians screen adults for alcohol misuse and provide persons engaged in risky or hazardous drinking behaviors with brief behavioral counseling to reduce alcohol misuse. However, only a minority of American adults with high-risk alcohol use receive treatment. Three medications are approved by the U.S. Food and Drug Administration to treat alcohol use disorder: acamprosate, disulfiram, and naltrexone. Acamprosate and naltrexone reduce alcohol consumption and increase abstinence rates, although the effects appear to be modest. Disulfiram has been used for years, but evidence supporting its effectiveness is inconsistent. Other medications may be beneficial to reduce heavy alcohol use. The anticonvulsants topiramate and gabapentin may reduce alcohol ingestion, although long-term studies are lacking. Antidepressants do not decrease alcohol use in patients without mood disorders, but sertraline and fluoxetine may help depressed patients decrease alcohol ingestion. Ondansetron may reduce alcohol use, particularly in selected subpopulations. Further study is needed for genetically targeted or as-needed medications to reduce alcohol use.
美国预防服务工作组建议临床医生对成年人进行酒精滥用筛查，并为有危险或有害饮酒行为的人提供简短的行为咨询，以减少酒精滥用。然而，只有少数有高风险饮酒行为的美国成年人接受治疗。美国食品药品监督管理局批准了三种药物用于治疗酒精使用障碍：阿坎酸、双硫仑和纳曲酮。阿坎酸和纳曲酮可减少酒精摄入量并提高戒酒率，不过效果似乎并不显著。双硫仑已使用多年，但支持其有效性的证据并不一致。其他药物可能有助于减少大量饮酒。抗惊厥药托吡酯和加巴喷丁可能会减少酒精摄入，尽管缺乏长期研究。抗抑郁药对没有情绪障碍的患者不会减少酒精使用，但舍曲林和氟西汀可能有助于抑郁症患者减少酒精摄入。昂丹司琼可能会减少酒精使用，特别是在特定亚人群中。对于基因靶向或按需使用的减少酒精使用的药物，还需要进一步研究。
