Axelrath Sarah
Colorado Coalition for the Homeless, Denver, CO.
J Addict Med. 2024;18(6):617-618. doi: 10.1097/ADM.0000000000001360. Epub 2024 Aug 16.
Alcohol use disorder (AUD) is responsible for a significant burden of medical, economic, and social harm globally and across the United States. Currently, only three FDA-approved medications for AUD are available, and most patients with AUD never receive pharmacotherapy. Disulfiram, the first medication that FDA approved for treatment of AUD, is recommended as a second-line treatment option by several national treatment guidelines citing safety concerns and lack of high-quality comparative studies. In this issue, Holt argues that disulfiram should be reclassified as a first-line treatment for AUD based on promising open-label randomized controlled trials (RCTs) for disulfiram as a behavioral intervention. Review of the literature suggests that disulfiram can be a useful treatment for a highly selected group of patients with no medical or psychiatric contraindications, high motivation for abstinence, and adequate family support. Unfortunately, many patients with AUD, a disorder characterized by high rates of medical and psychiatric multimorbidity and social vulnerability, fall outside of this narrow selection criteria. Prescribers should consider other FDA-approved medications as first-line treatment options for most patients with AUD, reserving disulfiram for the rare patients in whom the potential for benefit clearly outweighs risk of harm.
酒精使用障碍（AUD）在全球和美国范围内都造成了巨大的医学、经济和社会危害负担。目前，美国食品药品监督管理局（FDA）仅批准了三种用于治疗AUD的药物，而且大多数AUD患者从未接受过药物治疗。双硫仑是FDA批准的第一种用于治疗AUD的药物，由于安全问题以及缺乏高质量的对比研究，几种国家治疗指南将其推荐为二线治疗选择。在本期杂志中，霍尔特认为，基于双硫仑作为行为干预措施的有前景的开放标签随机对照试验（RCT），双硫仑应重新归类为AUD的一线治疗药物。文献综述表明，双硫仑对于一小部分经过严格挑选的患者可能是一种有效的治疗方法，这些患者没有医学或精神方面的禁忌证，戒酒动机强烈，且有足够的家庭支持。不幸的是，许多AUD患者并不符合这一狭窄的选择标准，AUD这种疾病的特点是医学和精神共病率高且社会脆弱性高。对于大多数AUD患者，开处方者应将其他FDA批准的药物作为一线治疗选择，仅将双硫仑留给那些明显受益大于潜在危害风险的罕见患者。
