Pharmacotherapy of alcohol dependence

Alcohol is a commonly used psychoactive substance all over the world and responsible for a significant proportion of mortality and morbidity. The treatment of alcohol dependence consists of two phases, detoxification and rehabilitation. Pharmacotherapy is being investigated to enhance abstinence and prevent relapse and complement interventions at a psychosocial level. Alcohol activates dopamine in the nucleus accumbens and mediates positive reinforcement and reward. The US Food and Drug Administration (FDA) have approved three medications, disulfiram, naltrexone and acamprosate for the treatment of alcohol dependence. The selective serotonin reuptake inhibitors (SSRIs) particularly fluoxetine and citalopram have been evaluated. Buspirone and Ondansetron have also been tried for alcohol dependence. Combination of naltrexone and acamprosate has shown promising results. It is essential to develop clinically useful pharmacological treatments, which can be evaluated using large-scale clinical trials. Clinical trial methodologies to evaluate combination treatments and using medications along with psychosocial treatments are required.