Predicting the effect of different anti-craving drugs on relapse


Citation: European Neuropsychopharmacology The Journal of the European College of Neuropsychopharmacology, Volume 17 Supplement 4, Page S214

Alcohol addiction is a chronic disorder that develops on a genetic, psychosocial and environmental background. Whereas alcohol withdrawal treatment is widely accepted as a pharmacotherapeutic domain, anti-craving and relapse prevention treatment in clinical practice up to now is mainly based on psychosocial and psychotherapeutic interventions. However, there is growing interest in the interaction of psychotherapy with drug therapy since it has been shown repeatedly that pharmacological treatment is efficacious in the reduction of craving and risk of relapse in abstinent alcohol dependent patients.

Considerable efforts have been achieved in the development and the clinical implementation of relapse preventing medications. Especially acamprosate and naltrexone have demonstrated consistent efficacy in reducing the probability or severity of relapse in subjects treated for alcohol. Nonetheless, not all patients treated with such drugs respond adequately to treatment.

Understanding this suboptimal response, and being able to predict likely outcomes to treatment with individual drugs, represents a major challenge fo alcohol research. The hypothesis that there exist different modes of alcohol craving providing multiple pathways to relapse provides a stimulating theorethical framework for understanding this heterogeneity in response.

Data from psychometric studies, imaging studies and neurophysiological observations suggest that mainly endophenotypic and pharmacogenomic predictors may support both a more efficacious treatment and a closer understanding of the pathophysiology of craving and relapse.

The definition of subgroups of patients that respond preferably to a specific anticraving compound would represent a major progress in the treatment of alcohol addiction.



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