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Study presents limited assessment of pharmacotherapy for alcohol use disorders
  1. Duncan Raistrick
  1. Correspondence to Dr Duncan Raistrick, Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, UK; d.raistrick{at}nhs.net

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What is already known on this topic

In relapse prevention pharmacotherapies for the treatment of addiction problems, the effects on outcome are modest compared with other influences (such as patient characteristics, active follow-up and social stability)1 and complicated by the effects of psychosocial interventions that are always recommended alongside any prescribing.2

What this paper adds

  • The analysis provides an update on disulfiram, naltrexone and acamprosate trials reporting on predominantly drinking categories by effect size and number needed to treat but without indicators of clinical meaningfulness. The analysis was for trials with an abstinence goal: the evidence supported, but could not differentiate between, naltrexone and acamprosate—it did not support disulfiram.

  • The paper identifies some small studies of new drugs, but typically these lacked adequate data for analysis; moreover, only 8 of 123 studies were rated as low risk of bias, and the mix of psychosocial interventions added to uncertainties of effectiveness.

  • Unusually, numbers needed to harm are reported. The harms are generally mild: anxiety, diarrhoea and vomiting with acamprosate; …

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