Bharadwaj Balaji, Selvakumar Nivedhitha, Kuppili Pooja Patnaik
Department of Psychiatry, De-addiction Clinic, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Ind Psychiatry J. 2018 Jul-Dec;27(2):163-171. doi: 10.4103/ipj.ipj_79_17.
Alcohol use disorders (AUDs) is an important public health concern as estimates of the prevalence of AUD range at 4%-6% in the Indian population. Currently, there is limited literature on the pharmacotherapeutic interventions for AUD in the Indian setting. It is imperative to identify the possible variations in their effects from Western studies, and hence the current review was attempted to perform a comprehensive evaluation and critical appraisal of the methodology of the evidence on pharmacological strategies of relapse prevention of AUD in the Indian setting. A total of 18 studies were included in the review. Disulfiram was the most common pharmacological agent to be studied. The initial literature before 2000 focused primarily on disulfiram, whereas the studies in the next decade compared it to acamprosate and naltrexone and emerging interest in anticraving agents such as baclofen and topiramate had been noted over the past few years. No studies were available on newer agents such as ondansetron, selective serotonin reuptake inhibitors or formulations such as depot and implants. Deterrent agents were found to be better when compared to anticraving agents in terms of abstinence and relapse, whereas the latter were more effective for control of craving. Among the pharmacological agents studied, the greatest evidence exists for disulfiram for relapse prevention which could be due to affordability of disulfiram and social support in the Indian context. The chief methodological limitations include the lack of randomized trials and objective measures for assessing abstinence.
酒精使用障碍（AUDs）是一个重要的公共卫生问题，据估计，印度人群中AUDs的患病率在4%-6%之间。目前，关于印度背景下AUDs药物治疗干预的文献有限。必须确定其疗效与西方研究可能存在的差异，因此本综述试图对印度背景下预防AUDs复发的药理学策略证据的方法进行全面评估和批判性评价。本综述共纳入18项研究。双硫仑是研究最多的药物。2000年之前的早期文献主要关注双硫仑，而在接下来的十年里，研究将其与阿坎酸和纳曲酮进行了比较，并且在过去几年中，人们对巴氯芬和托吡酯等抗渴望药物的兴趣日益浓厚。关于昂丹司琼、选择性5-羟色胺再摄取抑制剂等新型药物或长效注射剂和植入剂等剂型尚无研究。在戒酒和防止复发方面，威慑性药物比抗渴望药物效果更好，而后者在控制渴望方面更有效。在所研究的药物中，双硫仑预防复发的证据最为充分，这可能归因于双硫仑在印度背景下的可承受性和社会支持。主要的方法学局限性包括缺乏随机试验以及评估戒酒情况的客观指标。
