Am Fam Physician. 2023;107(5):online
Author disclosure: No relevant financial relationships.
Details for This Review
Study Population: 1,818 adults with alcohol use disorder in 17 randomized controlled trials; the mean age was 46.5 years, and 70% were men
Efficacy End Points: Relapse, frequency of alcohol use, amount of alcohol use
Harm End Points: Adverse events
| Benefits | Harms |
|---|---|
| In patients who completed baclofen treatment compared with placebo: 1 in 10 had a reduced risk of relapse (i.e., return to any drinking) Abstinent days increased by 17% No overall increase in the number of adverse events | Minor adverse events in patients with alcohol use disorder who were treated with baclofen compared with placebo: 1 in 10 had dizziness 1 in 35 had dry mouth 1 in 12 had fatigue 1 in 5 had paresthesias 1 in 9 had somnolence |
Narrative: Alcohol use disorder is characterized by the inability to control alcohol consumption and frequent drinking episodes leading to clinically significant impairment or distress.1,2 In U.S. adults, alcohol use disorder has a 12-month prevalence of 13.9% and a lifetime prevalence of 29.1%.3 Alcohol use disorder increases the risk of cancer, liver disease, cardiac disease, unintentional accidents, and neurologic conditions.4 Treatment options supported by the American Psychiatric Association include individualized plans that focus on nonpharmacologic approaches (including cognitive behavior therapy and 12-step therapies such as Alcoholics Anonymous) and pharmacotherapy. Pharmacologic options include opioid antagonists (naltrexone, nalmefene), glutamate antagonists (acamprosate), aversive agents (disulfiram), and anticonvulsants (gabapentin, topiramate).5
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