Les innovations thérapeutiques en alcoologie

Abstract

Psychosocial support remains the key element of treatment of alcohol-dependent patients in order to either decrease or cease their alcohol consumption. DrugsTwo drugs can now be used to reduce alcohol consumption: nalmefene and baclofen in the context of a “temporary use recommendation”. Currently available studies have shown weak to moderate effect sizes in this indication, but better results have been reported in populations confined to heavy drinkers. Four molecules are available to help patients maintain abstinence: acamprosate, naltrexone, disulfiram and baclofen. Effect sizes calculated by various meta-analyses are also low to moderate. Disulfiram appears to be more effective when the patient has understood its mechanism action and when it is used under supervision. However, the use of disulfiram is limited by the risk of rare, but potentially serious adverse effects. Identification of patient subgroups obtaining better responses to certain drugs constitutes a major research challenge, but only a few criteria have been defined to date. However, regardless of the drug considered, heavy drinking and difficulty to maintain abstinence significantly improve the effect size of the drug. After an initially promising period, especially concerning polymorphism of the OPMR1 gene coding for the morphine μ receptor, identification of genetic markers has not yet resulted in any clinical applications. Promising molecules currently under evaluation include sodium oxybate and topiramate. Among non-pharmacological treatmentsInteresting results have been demonstrated with acceptance and commitment therapy (mindfulness-based cognitive therapy). Studies have also been conducted on cognitive disorders that constitute risk factors for relapse and that limit the efficacy of treatment. The elaboration of cognitive remediation therapy programmes is an important objective for the future. Magnetic or continuous current transcranial brain stimulation methods also open up interesting perspectives, but further studies are necessary to define the place of these treatments in the management of addictive behaviours. PerspectivesFinally, the development of e-health opens up particularly encouraging perspectives to provide patients with information, to help them evaluate and monitor their consumption, to propose assistance and responses in high-risk settings or relapse or to use various therapeutic methods integrated in smartphone applications.