Overview of Alcohol Use Disorder.

Alcohol is consumed by nearly half the U.S. population aged 12 or older, and heavy drinking contributes to over 140,000 deaths annually. Alcohol use disorder (AUD) has a current U.S. prevalence of 11%, yet less than 15% of individuals with a lifetime diagnosis receive treatment. Risk is nearly equally genetic and environmental. AUD responds to psychosocial treatments like cognitive-behavioral therapy and to pharmacotherapy. Three FDA-approved medications—disulfiram, naltrexone, and acamprosate—are underprescribed despite being first-line treatments. Off-label topiramate and gabapentin show efficacy, and novel candidates like psychedelics and phosphodiesterase-4 inhibitors are promising but need further evaluation. AUD remains highly stigmatized.

Study at a glance

Abstract

Alcohol is regularly consumed throughout most of the world, including by nearly half the U.S. population age 12 or older. Heavy drinking, which is also common, contributes to multiple adverse medical, psychiatric, and social outcomes and more than 140,000 deaths annually in the United States. It is the major risk factor for alcohol use disorder (AUD), whose current U.S. prevalence is 11%. However, AUD is undertreated, with less than 15% of individuals with a lifetime diagnosis receiving any treatment. Risk of AUD is nearly equally genetic and environmental. AUD is responsive to psychosocial treatments, including cognitive-behavioral therapy and motivational enhancement therapy. Alcohol affects multiple neurotransmitter systems, and thus pharmacotherapy for AUD is also effective. The three medications approved in the United States to treat AUD-disulfiram, naltrexone (oral and long-acting injectable formulations), and acamprosate-are underprescribed, despite being considered first-line treatments in clinical practice guidelines. Two medications not approved for treating AUD, topiramate and gabapentin, have shown efficacy in treating the disorder and are used off-label. Recent studies of novel drug candidates, including psychedelics and phosphodiesterase-4 inhibitors, are promising additions for the treatment of AUD, although they require further evaluation before being used clinically. Despite the growing availability of efficacious psychosocial and pharmacological treatments for AUD, it remains a highly stigmatized condition. Research aimed at enhancing the identification and treatment of AUD, including precision therapeutics, could broaden the acceptability of AUD treatment, benefiting affected individuals and their families and reducing the stigma associated with the disorder.