O'Brien C P
University of Pennsylvania/VA Medical Center, Philadelphia 19104-6178.
EXS. 1994;71:349-59.
Alcoholism is a common disorder that tends to be chronic and relapsing. Although there is clear evidence that treatment can be expected to induce a period of remission or at least decreased symptoms, treatment of alcoholism is generally regarded as unsuccessful. Alcoholism should be approached as a chronic medical disorder such as diabetes or arthritis. Complete abstinence is the preferred goal, but "cures" or permanent abstinence from alcohol are rare. In this model, treatment benefits may be measured by length of remission, reduction in alcohol use, improvement in health and enhancement of social functioning. Treatment continues over a period of years, mainly on an outpatient basis with increasing intensity if symptoms recur. Medications that reduce craving for alcohol or diminish the euphoric effects of alcohol would be very helpful in the management of this chronic disorder. Pre-clinical studies have produced evidence for involvement of the endogenous opioid system in the reinforcing effects of alcohol. Recent controlled clinical trials of the opiate receptor antagonist naltrexone suggest that medications of this type may improve the results of treatment for alcoholism.
酒精成瘾是一种常见的疾病，往往具有慢性和复发性。尽管有明确证据表明治疗有望诱导一段缓解期或至少减轻症状，但酒精成瘾的治疗通常被认为是不成功的。酒精成瘾应被视为一种慢性疾病，如糖尿病或关节炎。完全戒酒是首选目标，但“治愈”或永久性戒酒很少见。在这种模式下，治疗效果可以通过缓解期的长短、酒精使用量的减少、健康状况的改善和社会功能的增强来衡量。治疗持续数年，主要在门诊进行，如果症状复发则增加治疗强度。减少对酒精的渴望或减轻酒精欣快感的药物对这种慢性疾病的管理非常有帮助。临床前研究已经提供证据表明内源性阿片系统参与了酒精的强化作用。最近对阿片受体拮抗剂纳曲酮进行的对照临床试验表明，这类药物可能会改善酒精成瘾的治疗效果。
