Alcohol Carlat Reports | Carlat Publishing

Expert Q&A

From The Carlat Child Psychiatry Report, Substance Use in Children and Adolescents

CCPR: Welcome, Dr. Yule. How prevalent is teen drinking? Dr. Yule: While there has been a decline in alcohol use since the 1980s, alcohol remains the substance most widely used by adolescents. When we look at past-month use by 12th graders in 2019, 5.7% had smoked cigarettes, 22.3% had used cannabis, and 29.3% had used alcohol (www.niaaa.nih.gov/public

Research Update

Exposure Therapy Efficacious for PTSD Co-Occurring With Alcohol Use Disorder

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Review of: Norman SB et al, Efficacy 2019;76(8):791–799 Patients with co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) have worse outcomes compared to patients with either diagnosis alone. Integrated approaches, in which both diagnoses are simultaneously addressed, are viewed as best practice. Providers, however, are

Research Update

The COMBINE Study: A Core Paper in the Treatment of AUD

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Research Update 2

Does Low to Moderate Alcohol Drinking Help or Hurt Cognition?

From The Carlat Addiction Treatment Report, Alternative Treatment in Addiction

Review of: Zhang R et al, JAMA Netw Open 2020;3(6):e207922 Is alcohol good or bad for cognition? The evidence is mixed. A new study brings additional clarity to this question by including a diverse patient population and by using longitudinal cognitive measurements of the subjects as opposed to cross-sectional evaluations at one time point. In an

Clinical Update

Despair, Loneliness, and Substance Use Disorders

From The Carlat Addiction Treatment Report, Social Aspects of Addiction

Despair and loneliness are underappreciated contributors to substance use disorders (SUD). Their impact can be seen particularly in rural areas hit hard by industrial restructuring and poverty. This article will explore the interplay between despair, loneliness, and SUD and will review some strategies to use in your patients. Hardship From 1999 to 2

Clinical Update

Faith and Addiction

From The Carlat Addiction Treatment Report, Social Aspects of Addiction

Discussing a patient’s spiritual life might not be something you do routinely. Conversations can be time-consuming, uncomfortable, or seemingly irrelevant to treating a substance use disorder (SUD). But studies have shown that faith can be an asset in addiction treatment. Patients may want to discuss their spiritual lives with you or have questions ab

Research Update

Is AA the Toast of the Town?

From The Carlat Addiction Treatment Report, Social Aspects of Addiction

Topics: Alcohol | Alcohol use disorder | Behavioral treatment | Meta-analysis | Systematic review

Review of: Kelly JF et al, Cochrane Database Syst Rev 2020;(3):CD010216 Alcoholics Anonymous (AA) is the most widely used psychosocial treatment for alcohol use disorder (AUD). Historically, low quality of scientific evidence has limited our ability to speak confidently of AA’s effectiveness. Previous Cochrane reviews (which tend to occupy the high

Research Update

A Timely Look at Community Reinforcement for Seniors With Unhealthy Alcohol Use

From The Carlat Addiction Treatment Report, Social Aspects of Addiction

Topics: Alcohol | Alcohol use disorder | Geriatric Psychiatry | Motivational Interviewing | Psychotherapy

Review of: Andersen K et al, Addiction 2020;115(1):69–81 During the COVID-19 pandemic, when every personal contact requires risk-reward deliberations, understanding the impact of relationships on health is crucial. This timely study, conducted from 2014 through 2016, investigated whether social networks reduce drinking among older adults with alcoh

Research Update

Efficacy and Acceptability of Varenicline for Alcohol Use Disorder

From The Carlat Addiction Treatment Report, Opioid Use Disorder Treatment

Topics: Alcohol | Alcohol use disorder | Pharmacology | Tobacco use disorder | Varenicline

REVIEW OF: Oon-Arom A et al, Drug Alcohol Depend 2019;205:1–9 Varenicline, a partial agonist of one of the nicotinic receptors, is approved for the treatment of tobacco use disorder and has also been found to decrease alcohol use in some individuals who smoke. Naltrexone, acamprosate, and disulfiram are FDA approved and effective for alcohol use di

Research Update

Does Baclofen Titrated to High Doses Reduce Alcohol Use?

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Review of: Rigal L et al, Addiction 2019 Dec 13 [Epub ahead of print] Baclofen is a muscle relaxant and anti-spasmodic that has been used off-label for treating alcohol use disorder for many years. The research base is mixed, with studies showing inconsistent efficacy and tolerability at different doses. In this latest randomized, placebo-controlled

Research Update

Gabapentin for Alcohol Use Disorder, Redux

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Review of: Anton RF et al, JAMA Intern Med 2020;180(5):1–9 Gabapentin has had mixed results in the treatment of alcohol use disorder (AUD), but it is clearly effective in the treatment of alcohol withdrawal syndrome (AWS). In this study, researchers tested whether gabapentin might be effective specifically in treating adults with AUD who also had a

Expert Q&A

Treating Alcohol Use Disorder

From The Carlat Addiction Treatment Report, Alcohol Addiction

CATR: Can you tell us about the role of medications for alcohol use disorder (AUD)? Dr. Arias: Medications are a very important part of AUD treatment. They can and should be used as a first-line treatment in any reasonable medical setting—primary care or psychiatry, or a specialty addiction setting. Unfortunately, very few patients ever receive them.

Clinical Update

Biomarkers of Alcohol Use

From The Carlat Addiction Treatment Report, Alcohol Addiction

We all want to know how much alcohol our patients are drinking. Asking patients directly about their drinking often generates useful information and helps build rapport, but this tactic is not always reliable. Denial and shame as well as issues related to secondary gain can sometimes contaminate self-report. Thankfully, there are many measures that can

Research Update

Gabapentin Enacarbil XR Efficacy Less Than Expected for AUD

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Review of: Falk DE et al, Alcohol Clin Exp Res 2019;43(1):158–169 Gabapentin enacarbil extended-release (GE-XR) (Horizant) is an extended-release version of gabapentin. GE-XR is a prodrug, meaning that once ingested it is metabolized into gabapentin. It is currently approved for treatment of postherpetic neuralgia and restless legs syndrome. It di

Clinical Update

Disulfiram: An Underused Strategy for Alcohol Use Disorders

From The Carlat Psychiatry Report, Depression

Alcohol ranks third among preventable causes of death in the US, but it is by far the most undertreated. Fewer than 8% of people with alcohol use disorders (AUDs) receive treatment for their disease, and only a minority of them receive FDA-approved medications. Those medications are acamprosate (Campral), naltrexone (Vivitrol, ReVia), and disulfiram (An