1. Out of 43 interventions, acamprosate was the only intervention associated with greater likelihood of alcohol abstinence compared to placebo.
2. Acomprosate, naltrexone, and acomprosate-naltrexone were associated with lower dropout rates compared to placebo.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Excessive alcohol consumption has long been associated with a number of medical conditions, in particular liver disease. However, support and treatment for individuals with alcohol dependence are not always accessible: In the United Kingdom for example, only 1 in 4 with alcohol dependence seek treatment, and 82% of those don’t receive the specialist treatment they need. Therefore, supporting and treating alcohol dependence in a primary care setting is a potential consideration. The current study is a systematic review and meta-analysis, aiming to determine which interventions suitable for a primary care setting are most effective for alcohol abstinence. The findings showed that out of 43 pharmacological, psychosocial, and combined interventions, acamprosate was the sole intervention with sufficient evidence correlating it to a greater likelihood of alcohol abstinence for up to 12 months. As well, the only interventions with lower dropout rates were acamprosate, naltrexone, and acamprosate-naltrexone. The central strength of this study was the analysis of randomized controlled trials only, which compared interventions to a placebo or other control. The main weaknesses of this study were that most of the trials were small, single trials, with little high-quality data supporting interventions that would be suitable for primary care. Furthermore, few studies were conducted on combined pharmacological and/or psychosocial interventions.
In-Depth [systematic review and meta-analysis]: This study analyzed 64 randomized controlled trials on interventions for adults with alcohol dependency who had undergone detoxification during the study or within 4 weeks prior. Outcomes measured include continuation of abstinence over the study period, to assess the intervention’s effectiveness, and the drop-out rate, to gauge the tolerability of the intervention. The results showed with moderate confidence that acamprosate was associated with increased odds of abstinence for up to 12 months, compared to placebo (odds ratio 1.86, 95% CI 1.49-2.33). A few interventions were also associated with increased odds, but with weak confidence, such as topiramate, sodium oxybate, and quietapine. No psychosocial interventions correlated to greater abstinence. In terms of drop-out rates, the interventions with reduced dropout rates compared to placebo (with moderate confidence) were acamprosate (OR 0.73, 95% CI 0.62-0.86), naltrexone (OR 0.70, 95% CI 0.50-0.98), and acamprosate-naltrexone combined (OR 0.30, 95% CI 0.13-0.67). Therefore, acamprosate was the only intervention in this systematic review and meta-analysis found to be effective and tolerable for abstinence in adult alcohol-dependence patients, with the potential for usage in primary care settings.
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