Pharmacotherapy of alcohol use disorders and concurrent psychiatric disorders: a review.

Alcohol use disorders (AUDs) are among the most prevalent psychiatric disorders. Epidemiologic studies have shown a high prevalence of concurrent psychiatric disorders among people with AUDs as well as a higher prevalence of AUDs in people with psychiatric disorders than in the general population. Though psychiatric patients with concurrent AUDs are at increased risk for morbidity and mortality, they are commonly undertreated for their alcohol-related disorders. The efficacy of pharmacotherapy for AUDs is well documented. Our paper reviews the common pharmacotherapies available for AUDs and focuses on the available research regarding treatment of AUDs among psychiatric populations with mood, anxiety, and psychotic disorders. Despite the high prevalence of concurrent AUDs and psychiatric disorders, very limited information has been collected using a randomized controlled trial design targeting those concurrent conditions. Several prevalent psychiatric disorders have not been studied when co-occurring with AUDs. Further research of pharmacological treatments for concurrent AUDs and psychiatric diagnoses is urgently needed. Les troubles lies a l'utilisation d'alcool (TUA) sont parmi les troubles psychiatriques les plus prevalente. Des etudes epidemiologiques ont indique une prevalence elevee de troubles psychiatriques concomitants chez les personnes souffrant de TUA ainsi qu'une prevalence plus elevee de TUA chez les personnes souffrant de troubles psychiatriques que dans la population generale. Bien que les patients psychiatriques ayant un TUA concomitant soient a risque accru de morbidite et de mortalite, ils sont habituellement sous-traites pour leurs troubles lies a l'alcool. L'efficacite de la pharmacotherapie pour les TUA est bien documentee. Notre article passe en revue les pharmacotherapies regulieres offertes pour les TUA et porte sur la recherche disponible concernant le traitement des TUA chez les populations psychiatriques souffrant de troubles de l'humeur, anxieux, et psychotiques. Malgre la prevalence elevee des TUA et des troubles psychiatriques concomitants, une information tres limitee a ete recueillie a l'aide d'une methode d'essai controle randomise ciblant ces affections concomitantes. Plusieurs troubles psychiatriques prevalente n'ont pas ete etudies lorsqu'ils sont en concomitance avec les TUA. Il y a un besoin urgent d'autre recherche sur les traitements pharmacologiques des TUA concomitants avec des diagnostics psychiatriques. Key Words: alcohol, use disorders, concurrent disorders, psychiatric disorders, pharmacotherapy, medications Received April 2011, revised, and accepted November 2011. Abbreviations 5-HT^sub 1A^ 5-hydroxytryptamine receptor 1A AD antidepressant AUD alcohol use disorder BD bipolar disorder CAPS Clinician Administered PTSD Scale CBT cognitive-behavioural therapy CCHS 1,2 Canadian Community Health Survey: Health and Well-Being ECA Epidemiologic Catchment Area GABA gamma-aminobutyric acid GAD generalized anxiety disorder HARS Hamilton Anxiety Rating Scale MDD major depressive disorder NESARC National Epidemiology Survey of Alcohol and Related Conditions PTSD posttraumatic stress disorder RCT randomized controlled trial SSRI serotonin selective reuptake inhibitor SUD substance use disorder Alcohol use disorders are among the most prevalent psychiatric disorders.1 The relation between AUDs and concurrent psychiatric disorders has been well established, and a large number of population-based epidemiologic studies have shown both a high prevalence of concurrent psychiatric disorders in people with AUDs1 ^5 as well as a higher prevalence of AUDs among psychiatric patients than in the general population.6-8 Results from the ECA Study, the first large population-based survey focusing on rates of concurrent SUDs and additional psychiatric disorders, found that 37% of people with an AUD had a concurrent psychiatric disorder,1 and that 22% of those with any psychiatric disorder had an AUD (compared with 11% of people without any psychiatric disorders). …