Pharmacologic approaches to the management of alcoholism

Our understanding of alcohol craving, both as a cause for chronic abuse and relapse and as a target for intervention, has been refined significantly i n recent years. For example, craving experienced during alcohol withdrawal may be mediated by gamma -aminobutyric acid (GABA) and glutamate receptor m echanisms, whereas the memory of the rewarding aspects of alcohol may be me diated by dopamine, opiate, and glutamate systems. Therefore, pharmacologic treatments for alcohol dependence may be targeted to numerous pathways. Th is article will discuss animal and clinical studies of the opioid antagonis ts (primarily naltrexone), acamprosate, and disulfiram. The side effects an d treatment recommendations for each drug will also be reviewed.