酒精使用障碍的诊断与药物治疗：综述。
Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review.
机构信息
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
出版信息
JAMA. 2018 Aug 28;320(8):815-824. doi: 10.1001/jama.2018.11406.
IMPORTANCE
Alcohol consumption is associated with 88 000 US deaths annually. Although routine screening for heavy alcohol use can identify patients with alcohol use disorder (AUD) and has been recommended, only 1 in 6 US adults report ever having been asked by a health professional about their drinking behavior. Alcohol use disorder, a problematic pattern of alcohol use accompanied by clinically significant impairment or distress, is present in up to 14% of US adults during a 1-year period, although only about 8% of affected individuals are treated in an alcohol treatment facility.
OBSERVATIONS
Four medications are approved by the US Food and Drug Administration to treat AUD: disulfiram, naltrexone (oral and long-acting injectable formulations), and acamprosate. However, patients with AUD most commonly receive counseling. Medications are prescribed to less than 9% of patients who are likely to benefit from them, given evidence that they exert clinically meaningful effects and their inclusion in clinical practice guidelines as first-line treatments for moderate to severe AUD. Naltrexone, which can be given once daily, reduces the likelihood of a return to any drinking by 5% and binge-drinking risk by 10%. Randomized clinical trials also show that some medications approved for other indications, including seizure disorder (eg, topiramate), are efficacious in treating AUD. Currently, there is not sufficient evidence to support the use of pharmacogenetics to personalize AUD treatments.
CONCLUSIONS AND RELEVANCE
Alcohol consumption is associated with a high rate of morbidity and mortality, and heavy alcohol use is the major risk factor for AUD. Simple, valid screening methods can be used to identify patients with heavy alcohol use, who can then be evaluated for the presence of an AUD. Patients receiving a diagnosis of the disorder should be given brief counseling and prescribed a first-line medication (eg, naltrexone) or referred for a more intensive psychosocial intervention.
重要性
饮酒每年导致 88,000 名美国人死亡。尽管常规筛查重度饮酒可以识别出患有酒精使用障碍（AUD）的患者，并且已经得到推荐，但只有 1/6 的美国成年人报告曾被医疗保健专业人员询问过饮酒行为。在一年期间，多达 14%的美国成年人存在酒精使用障碍，这是一种与临床显著损害或痛苦相关的问题性饮酒模式，尽管只有约 8%的受影响个体在酒精治疗机构接受治疗。
观察结果
美国食品和药物管理局批准了四种药物来治疗 AUD：双硫仑、纳曲酮（口服和长效注射制剂）和安非他酮。然而，AUD 患者最常接受咨询。尽管有证据表明这些药物具有临床意义的效果，并且它们被列入临床实践指南作为中重度 AUD 的一线治疗方法，但由于考虑到它们对可能受益的患者的处方率不到 9%。纳曲酮每天可给药一次，可使任何饮酒的可能性降低 5%， binge 饮酒风险降低 10%。随机临床试验还表明，一些批准用于其他适应症的药物，包括癫痫（例如，托吡酯），在治疗 AUD 方面是有效的。目前，没有足够的证据支持使用药物遗传学来个性化 AUD 治疗。
结论和相关性
饮酒与高发病率和死亡率相关，重度饮酒是 AUD 的主要危险因素。简单有效的筛选方法可用于识别重度饮酒的患者，然后对其 AUD 进行评估。接受该疾病诊断的患者应接受简短的咨询，并开处方一线药物（例如，纳曲酮）或转介进行更密集的心理社会干预。
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