1 / 23

Prevalence of Alcohol Use Disorders

Prevalence of Alcohol Use Disorders. NIAAA – National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Any Alcohol Use Disorder 17.6 million (8.5%). Alcohol Abuse 9.7 million (4.7%). Alcohol Dependence 7.9 million (3.8%).

nasim-farley
Télécharger la présentation

Prevalence of Alcohol Use Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prevalence of Alcohol Use Disorders NIAAA – National Epidemiologic Survey onAlcohol and Related Conditions (NESARC) Any Alcohol Use Disorder 17.6 million (8.5%) Alcohol Abuse 9.7 million (4.7%) Alcohol Dependence 7.9 million (3.8%) NIAAA= National Institute on Alcohol Abuse and Alcoholism Grant BF, et al. Arch Gen Psychiatry. 2004;61:807-816.

  2. Epidemiology of Use and Abstention Percent

  3. Epidemiology of Heavy Use Heavy Use Women: > 1 drink / day Men: > 2 drinks / day Percent

  4. 12-mo. Prevalence of DSM-IV AUD Diagnoses Men Women

  5. Medications Approved in the US for Treatment of Alcohol Dependence • Disulfiram (Antabuse): 1949 • Naltrexone (ReVia): 1994 • Acamprosate (Campral): 2004 • Long-Acting Naltrexone (Vivitrol): 2006

  6. Naltrexone • Non-specific opioid receptor antagonist • Dose dependent binding to m, d and k opioid receptors • FDA approved as adjunctive pharmacotherapy for the treatment of alcoholism

  7. Opioids • Acute alcohol increases plasma b-Endorphin levels

  8. Opioids • Opioid antagonists reduce alcohol drinking

  9. Clinical trials • Naltrexone has been shown to • Increase percentage of days abstinent from alcohol • Reduce number of drinks/drinking day • Increase time to relapse • Decrease craving for alcohol

  10. Naltrexone (Revia) in the Treatment of Alcohol Dependence 1.0 0.9 0.8 0.7 0.6 Cumulative Proportion with No Relapse 0.5 0.4 0.3 Naltrexone (N=35) Placebo (N=35) 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 Number of Weeks Receiving Medication Volpicelli et al., Arch Gen Psychiatry, 1992

  11. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Vivitrex (n = 28) Effect of Long-Acting Naltrexone on Maintenance of Abstinence Subjects with 4-day lead-in abstinence 100 90 80 70 60 Percent without Relapse 50 40 p < 0.025 30 20 10 0 Weeks Placebo (n = 28)

  12. COMBINE (Anton et al., 2006) ASAM, 2007

  13. VA cooperative study From Krystal et al 2001

  14. Cochrane review (Srisurapanont and Jarusuraisin 2002) • NTX treatment can decrease the chance of alcohol relapse for 36% as compared to placebo treatment. In addition, the treatment is likely to reduce the chance of returning to drinking for 13%. • Short-term treatment of NTX for alcoholism gives a meaningful benefit in preventing a relapse. • Small to Modest efficacy!

  15. Identifying predictors of robust treatment response to naltrexone could improve clinical practice

  16. Potential predictors of naltrexone response • Family history of alcoholism • Monterosso et al., 2001; Rubio et al., 2005 • OPRM1 m opioid receptor gene polymorphisms • Oslin et al., 2003 • Age of onset of alcohol abuse • Rubio et al., 2005 • Antisocial traits and heavier drinkers • Rohsenow et al., 2007 • Higher level of alcohol craving • Volpicelli et al., 1995 • Consistent drinking patterns • Gueorguieva et al 2007

  17. Laboratory models • Human clinical laboratory paradigms can be used to model a variety of behaviors in controlled conditions. • Careful experimental manipulations to understand the mechanisms underlying a behavior. • Can be used to evaluate medication signals following a shorter treatment period

  18. Laboratory models-Alcohol • In the field of alcohol research, controlled human laboratory studies have been used to study • different populations of drinkers • (e.g., social drinkers, dependent drinkers, women, high-risk individuals), • different types of cues • (e.g., stress, social drinking, solitary drinking, peer influences), • different types and schedules of alcohol • (e.g., beer, wine, hard liquor, IV alcohol; fixed doses, scheduled administration, ad-lib drinking).

  19. Laboratory models to study alcohol-naltrexone interactions • Human laboratory-based paradigms have been used to evaluate naltrexone’s effects in • Social drinkers • e.g. Swift et al 1994, King et al 1997 • Non-treatment seeking alcohol dependent drinkers • e.g. Anton et al 2004; Drobes et al 2004, Krishnan-Sarin et al 2007, O’Malley et al 2002 • Importantly, effects observed in laboratory studies similar to those seen in clinical trials

  20. Alcohol Self-Administration Model(O’Malley, Krishnan-Sarin et al., 2002) Day 0 Day 6 Day 7 Choice Block #1 5:00 pm Choice Block #2 6:00 pm 7 pm 4 pm Outpatient Treatment • Alcohol Reactivity • craving • Ad-Lib Period • 4 drinks per choice period (.015 g/dl) • $12 tab per choice period Naltrexone pretreatment MET Intervention Discharge Priming Drink (.03 g/dl)

  21. Naltrexone and FH of alcoholism From Krishnan-Sarin et al., 2007

More Related