Updating Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings
1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?
What medications are effective in reducing alcohol consumption and/or cravings in individuals with alcohol use disorder? We are interested in this topic because the current EPC review was completed in 2014.
2. Why are you struggling with this issue?
While there are 3 FDA approved medications for alcohol use disorder, only 1 of the 3 is widely used because the other 2 are impractical to use (i.e. acamprosate is dosed 3 times a day with a total of 6 different tabs and disulfiram has been shown to have poor compliance). As such, only naltrexone (which is FDA-approved for alcohol use disorder) is widely used of the three but many patients may have contraindications to this medication. Many medications (such as gabapentin and topiramate) are being used "off-label" by clinicians in an attempt to treat the growing number of individuals with alcohol use disorder but the evidence around these medications has not been examined systematically. The recent COVID-19 pandemic has exacerbated the proportion of individuals struggling with unhealthy alcohol use and alcohol use disorder.
Clinically, I struggle with how to best treat alcohol use disorder when naltrexone is contraindicated or poorly tolerated by patients. Frequently, I am left with using a medication with uncertain evidence in an attempt to offer the patient some treatment for alcohol use disorder. From an AHRQ perspective, an updated evidence synthesis would be very helpful for the ongoing EvidenceNow: Managing Unhealthy Alcohol Use Initiative
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
I would like to see an updated evidence synthesis examining the effectiveness of the various medications being used to treat alcohol use disorder. An updated evidence synthesis could also draw more awareness of the usefulness of medications for alcohol use disorder (current uptake by clinicians is quite low). I will know the issue has been addressed and/or is improving when higher proportions of patients with alcohol use disorder are being treated with medications and alcohol use disorder rates are decreasing.
4. When do you need the evidence report?
Fri, 09/30/2022
5. What will you do with the evidence report?
The evidence report will inform clinical practice and could inform the ongoing EvidenceNow: Managing Unhealthy Alcohol Use Initiative. They will also be used by addiction medicine organizations to inform practice guidelines.
(Optional) About You
What is your role or perspective? Primary care physician, addiction medicine specialist, AHRQ program official for EvidenceNow: Managing Unhealthy Alcohol Use Initiative
If you are you making a suggestion on behalf of an organization, please state the name of the organization: N/A
May we contact you if we have questions about your nomination? Yes
