Improving Alcohol Use Disorder Care With Pharmacologic Treatment
Although often underused in clinical practice, medication-assisted therapy (MAT) for alcohol use disorder (AUD) can play a pivotal role in improving patient outcomes. In this conversation with Psych Congress Network, Arwen Podesta, MD, DFAPA, DFASAM, Steering Committee, Psych Congress, reviews the 3 US Food and Drug Administration (FDA)-approved medications for the treatment of AUD. Podesta also highlights the impact AUD may have on other psychiatric outcomes and underscores the unique considerations clinicians must keep in mind when assessing for suicide risk in patients with substance use disorder (SUDs).
Key Takeaways for Clinical Practice:
- Acamprosate, naltrexone (monthly injectable or daily oral), and disulfiram (Antabuse) are FDA-approved treatment options, with medication selection guided by shared decision-making, patient factors, and understanding each medication's mechanism of action.
- Clinicians should assess whether intoxication or withdrawal is associated with self-harm, violence, suicide attempts, or worsening depression, as these factors can inform treatment discussions.
- Reducing drinking and intoxication through MAT may help improve psychiatric outcomes, including suicide risk.
Read the Transcript:
Psych Congress Network: What are some of the pharmacological therapies available for the treatment of AUD? How do you determine which medication would be most effective for a particular patient?
Arwen Podesta, MD, DFAPA, DFASAM: For decades, we've had 3 FDA-approved medications for alcohol use disorder: acamprosate, naltrexone in its monthly injection form or its daily oral form, and disulfiram (Antabuse).
Very few people use any medications for AUD, though those 3 are available and FDA-approved—so thinking about using them at all is an advancement.
How to choose between those really is patient decision-making, your decision-making, understanding the mechanism of action of the medications and why the medications might be best fit for certain patients.
But don't forget, there's a whole slew of non-FDA approved pharmacology and non-pharmacological treatments as well.
PCN: What are the most important considerations for assessing suicide risk, specifically in patients with substance use disorders (SUDs)? What role does medication-assisted therapy play?
Podesta: Suicide risk is rampant in SUDs. Oftentimes with AUD, we find that people under intoxication have a higher self-harm risk, a higher violence risk, a higher suicide risk, and the list goes on.
So understanding that with your patients—if they've had that sort of outcome during an intoxicating event, if they've been intoxicated and hurt themselves, hurt someone else, attempted suicide, or their depression gets pretty stark when they're under the influence or in withdrawal—it can be so helpful for you to have a conversation with the patient about why and how to cut back or why and how to seek treatment with MAT, because it may help them decrease their drinking, decrease their intoxicating states, and therefore decrease their psychiatric [risks].
So, using MAT for AUD actually helps with all of the other associated [risks], including suicide.
Arwen Podesta, MD, DFAPA, DFASAM, is boarded in Psychiatry, Addiction Medicine, Forensic Psychiatry and Holistic & Integrative Medicine. She works in Louisiana, with an office in New Orleans, and authored a book on addiction, HOOKED (available on Amazon, see her website: www.podestawellness.com). She was recently awarded the honor of distinguished fellow of the American Psychiatry Association as well as the American Society of Addiction Medicine and is the immediate past President of the Louisiana Psychiatric Medical Association. She consults to the Louisiana governor’s HOPE committee and is a member of the Attorney General’s Opioid Abatement Taskforce. She is a national speaker, she teaches, consults and is an advocate for integrative best practices for those with addiction and psychiatric needs.
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