INSERM-ERi 24 (GRAP), Centre Universitaire de Recherche en Santé, Université de Picardie Jules Verne, 80025, Amiens, France.
CNS Drugs. 2017 Mar;31(3):181-186. doi: 10.1007/s40263-017-0413-4.
The concept of binge drinking (BD) refers to patterns of heavy episodic alcohol consumption, with BD primarily occurring among adolescents and young adults. Several official definitions of BD have been proposed, in particular by the World Health Organization, the National Institute on Alcoholism and Alcohol Abuse, and the Substance Abuse and Mental Health Services Administration. Nevertheless, none of these definitions address the psychosocial and medical consequences of the type of alcohol use seen in BD. In practice, BD can thus correspond to either hazardous or harmful use of alcohol (HUA), while the episodic nature of heavy drinking in BD means that it does not meet the criteria for 'alcohol dependence'. This diagnostic differentiation is important because it determines which type of intervention is recommended. Psychosocial, rather than pharmacological, interventions are recommended as first-line treatment for adults with HUA, while pharmacological treatment is recommended for alcohol dependence; however, HUA appears to be associated with much poorer outcomes in adolescents, which could thus warrant early use of pharmacotherapy in this patient group. For HUA, and especially in adolescents, there is currently a severe lack of data regarding the efficacy and safety of the different drugs that have been approved for adults with alcohol dependence. Various guidelines propose the use of drugs for some types of BD but that use remains off-label and empirical, which raises important safety and ethical concerns. Future research on BD should systematically assess the criteria for HUA to better differentiate its subtypes with actual consequences and better address the heterogeneity of BD in terms of both clinical profiles and outcomes. Regarding pharmacotherapy, some national guidelines have recommended nalmefene for 'mild' dependence or second-line treatment for HUA, but such recommendations are not supported by evidence. Only naltrexone has been investigated in HUA but not in adolescents. More clinical trials should be conducted among adolescents with BD and HUA criteria to determine the most appropriate use of drugs in this particularly vulnerable population of subjects.
binge drinking (BD) 是指大量、频繁饮酒的行为模式，主要发生在青少年和年轻人中。世界卫生组织、美国国立酒精滥用和酗酒研究所以及物质滥用和精神健康服务管理局等机构提出了几种 BD 的官方定义。然而，这些定义都没有涉及到 BD 中所观察到的酒精使用类型的心理社会和医学后果。实际上，BD 既可以对应于危险或有害的饮酒行为 (HUA)，也可以对应于暴饮。BD 中的大量饮酒具有间歇性特征，因此不符合“酒精依赖”的标准。这种诊断区分很重要，因为它决定了推荐哪种干预类型。对于 HUA 患者，建议采用心理社会而非药物干预作为一线治疗，而对于酒精依赖患者，则建议采用药物治疗；然而，HUA 在青少年中似乎与更差的结果相关，因此可能需要在该患者群体中早期使用药物治疗。对于 HUA，特别是在青少年中，目前缺乏关于已批准用于治疗成人酒精依赖的不同药物的疗效和安全性的数据。各种指南都建议使用药物治疗某些类型的 BD，但这种用法仍属超适应证和经验性的，这引发了重要的安全性和伦理学问题。未来关于 BD 的研究应系统评估 HUA 的标准，以更好地区分具有实际后果的不同亚型，并更好地解决 BD 在临床特征和结局方面的异质性问题。关于药物治疗，一些国家的指南建议使用纳美芬治疗“轻度”依赖或作为 HUA 的二线治疗，但这些建议缺乏证据支持。仅对 HUA 进行了纳曲酮的研究，而未对青少年进行研究。应在具有 BD 和 HUA 标准的青少年中进行更多的临床试验，以确定在这一特别脆弱的人群中最适当的药物使用方法。
