Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, and Mental Illness Research, Education, and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia.
Am J Psychiatry. 2023 Aug 1;180(8):565-572. doi: 10.1176/appi.ajp.20230488.
Alcohol is regularly consumed throughout most of the world, including by nearly half the U.S. population age 12 or older. Heavy drinking, which is also common, contributes to multiple adverse medical, psychiatric, and social outcomes and more than 140,000 deaths annually in the United States. It is the major risk factor for alcohol use disorder (AUD), whose current U.S. prevalence is 11%. However, AUD is undertreated, with less than 15% of individuals with a lifetime diagnosis receiving any treatment. Risk of AUD is nearly equally genetic and environmental. AUD is responsive to psychosocial treatments, including cognitive-behavioral therapy and motivational enhancement therapy. Alcohol affects multiple neurotransmitter systems, and thus pharmacotherapy for AUD is also effective. The three medications approved in the United States to treat AUD-disulfiram, naltrexone (oral and long-acting injectable formulations), and acamprosate-are underprescribed, despite being considered first-line treatments in clinical practice guidelines. Two medications not approved for treating AUD, topiramate and gabapentin, have shown efficacy in treating the disorder and are used off-label. Recent studies of novel drug candidates, including psychedelics and phosphodiesterase-4 inhibitors, are promising additions for the treatment of AUD, although they require further evaluation before being used clinically. Despite the growing availability of efficacious psychosocial and pharmacological treatments for AUD, it remains a highly stigmatized condition. Research aimed at enhancing the identification and treatment of AUD, including precision therapeutics, could broaden the acceptability of AUD treatment, benefiting affected individuals and their families and reducing the stigma associated with the disorder.
酒精在世界上的大部分地区都有被定期消费，包括近一半的美国 12 岁或以上的人口。大量饮酒也很常见，会导致多种不良的医疗、精神和社会后果，在美国每年导致超过 14 万人死亡。它是酒精使用障碍（AUD）的主要风险因素，其目前在美国的流行率为 11%。然而，AUD 的治疗不足，只有不到 15%的终身诊断患者接受任何治疗。AUD 的风险几乎同样受到遗传和环境的影响。AUD 对心理社会治疗有反应，包括认知行为疗法和动机增强疗法。酒精会影响多种神经递质系统，因此药物治疗 AUD 也很有效。在美国被批准用于治疗 AUD 的三种药物——双硫仑、纳曲酮（口服和长效注射制剂）和安非他酮——尽管被认为是临床实践指南中的一线治疗方法，但处方不足。两种未被批准用于治疗 AUD 的药物——托吡酯和加巴喷丁——已被证明对治疗该疾病有效，并被用于标签外。最近对新型药物候选物的研究，包括迷幻药和磷酸二酯酶-4 抑制剂，为 AUD 的治疗提供了有希望的补充，尽管在临床应用之前还需要进一步评估。尽管针对 AUD 的有效心理社会和药物治疗方法越来越多，但它仍然是一种高度污名化的疾病。旨在增强 AUD 识别和治疗的研究，包括精准治疗，可能会提高 AUD 治疗的可接受性，使受影响的个人及其家人受益，并减少与该疾病相关的耻辱感。
