Current treatments of alcohol use disorder.

International review of neurobiology Pub Date : 2024-01-01 Epub Date: 2024-03-19 DOI:10.1016/bs.irn.2024.02.005
Tommaso Dionisi, Giovanna Di Sario, Lorenzo De Mori, Giorgia Spagnolo, Mariangela Antonelli, Claudia Tarli, Luisa Sestito, Francesco Antonio Mancarella, Daniele Ferrarese, Antonio Mirijello, Gabriele Angelo Vassallo, Antonio Gasbarrini, Giovanni Addolorato
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Abstract

Emerging treatments for alcohol dependence reveal an intricate interplay of neurobiological, psychological, and circumstantial factors that contribute to Alcohol Use Disorder (AUD). The approved strategies balancing these factors involve extensive manipulations of neurotransmitter systems such as GABA, Glutamate, Dopamine, Serotonin, and Acetylcholine. Innovative developments are engaging mechanisms such as GABA reuptake inhibition and allosteric modulation. Closer scrutiny is placed on the role of Glutamate in chronic alcohol consumption, with treatments like NMDA receptor antagonists and antiglutamatergic medications showing significant promise. Complementing these neurobiological approaches is the progressive shift towards Personalized Medicine. This strategy emphasizes unique genetic, epigenetic and physiological factors, employing pharmacogenomic principles to optimize treatment response. Concurrently, psychological therapies have become an integral part of the treatment landscape, tackling the cognitive-behavioral dimension of addiction. In instances of AUD comorbidity with other psychiatric disorders, Personalized Medicine becomes pivotal, ensuring treatment and prognosis are closely defined by individual characteristics, as exemplified by Lesch Typology models. Given the high global prevalence and wide distribution of AUD, a persistent necessity exists for development and improvement of treatments. Current research efforts are steadily paving paths towards more sophisticated, effective typology-based treatments: a testament to the recognized imperative for enhanced treatment strategies. The potential encapsulated within the ongoing research suggests a promising future where the clinical relevance of current strategies is not just maintained but significantly improved to effectively counter alcohol dependence.

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目前治疗酒精使用障碍的方法。
新出现的酒精依赖治疗方法揭示了导致酒精使用障碍(AUD)的神经生物学、心理学和环境因素之间错综复杂的相互作用。已获批准的平衡这些因素的策略涉及对 GABA、谷氨酸、多巴胺、羟色胺和乙酰胆碱等神经递质系统的广泛操纵。创新性的发展涉及 GABA 再摄取抑制和异位调节等机制。谷氨酸在慢性酒精中毒中的作用受到更密切的关注,NMDA 受体拮抗剂和抗谷氨酸能药物等治疗方法显示出巨大的前景。与这些神经生物学方法相辅相成的是向个性化医学的逐步转变。这种策略强调独特的遗传、表观遗传和生理因素,采用药物基因组学原理来优化治疗反应。与此同时,心理疗法也已成为治疗领域不可或缺的一部分,以解决成瘾的认知行为问题。在 AUD 与其他精神疾病并发的情况下,个性化医疗就变得至关重要,它可以确保治疗和预后与个体特征密切相关,莱施类型学模型就是很好的例子。鉴于 AUD 在全球的高发病率和广泛分布,开发和改进治疗方法的必要性始终存在。目前的研究工作正在稳步铺设通往更复杂、更有效的基于类型学的治疗方法的道路:这证明了加强治疗策略的必要性已得到认可。当前研究中蕴含的潜力预示着一个充满希望的未来,在这个未来中,当前策略的临床相关性不仅会得到保持,而且会得到显著改善,从而有效对抗酒精依赖。
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