NCAD West | MAT Options Show Promise in Treatment of SUD

According to a 2019 report, 14.5 million individuals ages 12 and old had an alcohol use disorder, including 414,000 adolescents between the ages of 12 and 17, making alcohol the most misused substance in the United States.

Help can come in a variety of forms, and on Saturday morning at the National Conference on Addiction Disorders West, Valerie Carrejo, MD, FAAFP, FASAM, associate professor and addiction medicine fellowship program director for the University of New Mexico Department of Family and Community Medicine, discussed several options, including multiple medications.

Of those with alcohol use disorder, about 13% receive specialized treatment and 24% receive any kind of help at all, Carrejo said. Typically, there is a 10-year gap between the onset of AUD symptoms and individuals receiving their first treatment, she said.

Screening patients for alcohol misuse and addiction can be challenging, particularly because when asking patients about their consumption patterns, there is a lack of clarity on what defines “a drink,” Carrejo said. Alcohol content can vary widely between types of beverages, so it is important to ask patients not only the number of drinks they consume, but the types as well.

Behavioral support for patients in treatment can be divided into 3 primary categories:

• Counseling, which includes cognitive behavior therapy, motivational enhancement therapy and marital/family therapy
• Brief interventions, such as mutual help groups, Alcoholics Anonymous and 12-Step programs
• Online recovery services

In addition to behavioral treatment modalities, 3 oral medications are now approved by the FDA for the treatment of AUD:

Naltrexone. Delivered in a daily dose, naltrexone blocks opioid receptors to reduce cravings and rewards for drinking. Carrejo said providers should be sure patients are not actively using opioids and have been free of any opioid use for 7 to 10 days before starting on naltrexone.

Acamprosate. Delivered in 3 doses per day (with smaller doses for patients with renal impairment), acamprosate affects glutamate and GABA neurotransmitter systems.

Disulfiram. Patients can be given disulfiram once per day, starting at least 12 hours after consuming their last drink. Disulfiram inhibits the immediate metabolism of alcohol, and creates a buildup of acetaldehyde that causes flushing, nausea, sweating and tachycardia. As a result, patients become less inclined to use alcohol because its consumption actively makes them feel worse.

Carrejo also shared 3 other medications being used to treat AUD:

Topiramate. Preferred for patients with seizure disorder, topiramate is provided in a daily dose. In a meta-analysis of 7 clinical placebo trials, topiramate demonstrated efficacy with higher rates of abstinence and lower rates of heavy drinking than that of naltrexone and acamprosate, but further research is necessary.

Gabapentin. While shown to be more efficacious than a placebo in a meta-analysis of 2019 placebo-controlled randomized control trials, the only measure in which analysis clearly favored the use of gabapentin was in a reduction of heavy drinking days.

Baclofen. A 2012 study looked at high-risk drinkers’ rates of abstinence or low-risk consumption levels 1 year after initiating high-dose baclofen. (Of note, Carrejo said the high dose used in the study was nearly double what is otherwise considered a high dose of baclofen.) After 1 year, 132 of the 181 participants who engaged in the study completed it, and 80% of those who completed were either abstinent or had low risk levels, Carrejo said.