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Next Issue - 12.19.06  
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A PUBLICATION OF CME OUTFITTERS VOLUME 1, ISSUE 28 - December 5, 2006
FROM THE CLINICAL KNOWLEDGE CENTER
 December Is National Drunk and Drugged Driving Prevention Month

Quick Facts About Alcohol Use and Drunk Driving

 Nearly 14 million Americans - 1 in every 13 adults - abuse alcohol or meet the criteria for alcohol dependence. Several million more adults engage in risky drinking that could lead to alcohol problems. These patterns include binge drinking and heavy drinking on a regular basis. In addition, 53 percent of men and women in the United States report that one or more of their close relatives have a drinking problem. The consequences of alcohol misuse are serious, and in many cases, life threatening. Alcohol abuse and alcoholism can worsen existing conditions such as depression, or induce new problems such as memory loss, depression, or anxiety.(1) Heavy drinking can increase the risk for cancer of the liver, esophagus, throat, and larynx, as well as liver cirrhosis, immune system problems, brain damage, and fetal alcohol syndrome.(2) Alcohol is causally related to more than 60 medical conditions, including heart disease, liver disease, infectious disease, and cancer,(3,4) and contributes to more than 100,000 deaths in the United States each year.(5) In purely economic terms, alcohol-related problems cost society approximately $185 billion per year.(6) In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries; homicides and suicides are also more likely to be committed by persons who have been drinking.

Some facts about alcohol-related motor vehicle accidents from the National Center on Injury Prevention Control:
• In 2005, 16,885 people died in alcohol-related motor vehicle crashes, accounting for 39% of all traffic-related deaths in the United States.
• An alcohol-related motor vehicle crash kills someone every 31 minutes and nonfatally injures someone every two minutes.
• Drugs other than alcohol (e.g., marijuana and cocaine) are involved in about 18% of motor vehicle driver deaths. These other drugs are generally used in combination with alcohol.
• Each year, alcohol-related crashes in the United States cost about $51 billion.
• Most drinking and driving episodes go undetected. In 2005, nearly 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics. That's less than 1 percent of the 159 million self-reported episodes of alcohol-impaired driving among U.S. adults each year.

Over the last 20 years, adjuvant pharmacotherapy has become a more prominent option in optimizing outcome in rehabilitation programs for alcohol-dependent patients. Disulfiram, acamprosate, and naltrexone are currently the only FDA-approved agents for the management of alcohol dependence.(7) Disulfiram disrupts alcohol metabolism, leading to a buildup of acetaldehyde that causes flushing, nausea and vomiting, weakness, and lowered blood pressure, among many other effects. Acamprosate is a centrally acting synthetic compound that appears to restore the normal activity of glutaminergic neurons, which become hyperexcited as a result of chronic alcohol exposure.(8) A review of data shows that overall, patients treated with acamprosate exhibited a significantly greater rate of treatment completion, time to first drink, abstinence rate, and/or cumulative abstinence duration than patients treated with placebo.(9,10) Naltrexone is a potent opioid-receptor antagonist that blocks the effects of endogenous opioids, which increase after alcohol consumption.(11) A meta-analysis of published studies suggests that naltrexone administration does not significantly diminish short-term discontinuation of treatment or help patients to avoid alcohol, but does appear to reduce the risk of relapse to heavy drinking and the frequency of drinking compared with placebo.(12)

While oral naltrexone appears to be effective in treating alcohol dependence, poor patient adherence and widely fluctuating plasma levels limit its efficacy. Compared with placebo over 6 months, 380 mg of long-acting, injectable naltrexone in conjunction with psychotherapy resulted in a 25% decrease rate in the event rate of heavy drinking days. There was no significant difference noted in risky drinking or nonabstention days. The effect was greater in men, and in those who had practiced some abstinence prior to beginning the study.(13) In other studies of safety and efficacy of long-acting naltrexone versus placebo, naltrexone was generally safe and well-tolerated, and resulted in fewer drinking days during treatment and a significantly greater abstinence rate.(14,15) To maximize the efficacy of the alcohol treatment program, psychosocial therapy should be concomitantly given to all alcohol-dependent patients receiving naltrexone administration.(16)

For more information about alcohol dependence and other addictions, and to see newly added clinical abstracts in this area, visit our Alcohol Use Disorders Clinical Knowledge Center at www.neuroscienceCME.com/resources_knowledge_alcohol.asp.

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 References
  1. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA 1990;264:2511-2518.
  2. Grant BF, Dawson DA, Stinson FS, et al. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug Alcohol Depend 2004;74:223-234.
  3. National Institutes of Health. Drinking in the United States: Main Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). U.S. Alcohol Epidemiologic Data Reference Manual, Volume 6, First Edition. November 1998. NIH Publication No. 99-3519.
  4. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Substance Dependence, Abuse and Treatment Tables;2004. http://oas.samhsa.gov/nsduh/2k4tabs/Sect5peTabs1to99.htm#tab5.49a. Accessed 08/28/06.
  5. Bagnardi V, Blangiardo M, Vecchia C, et al. Alcohol consumption and the risk of cancer. Alcohol Research and Health 2001;25(4);263-270.
  6. Room R, Babor T, Rehm J. Alcohol and public health. Lancet 2005;365:519-530.
  7. Litten RZ, et al. Development of medications for alcohol use disorders: recent advances and ongoing challenges. Expert Opin Emerg Drugs 2005;10:323-343.
  8. Wilde MI, Wagstaff AJ. Acamprosate. A review of its pharmacology and clinical potential in the management of alcohol dependence after detoxification. Drugs 1997;53:1038-1053.
  9. Mason BJ. Acamprosate and naltrexone treatment for alcohol dependence: an evidence-based risk-benefits assessment. Eur Neuropsychopharmacol 2003;13:469-475.
  10. Koob GF, et al. Potential neuroprotective effects of acamprosate. Alcohol Clin Exp Res 2002;26:586-592.
  11. Srisurapanont M, Jarusurasisn N. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 2005; Jan 25:CD001867.
  12. Thomas CP, et al. Research to practice: adoption of naltrexone in alcoholism treatment. J Subst Abuse Treat 2003;24:1-11.
  13. Kranzler HR, et al. Naltrexone depot for treatment of alcohol dependence: a multicenter, randomized, placebo-controlled clinical trial. Alcohol Clin Exp Res 2004;28:1051-1059.
  14. Johnson BA, et al. A pilot evaluation of the safety and tolerability of repeat dose administration of long-acting injectable naltrexone (Vivitrex) in patients with alcohol dependence. Alcohol Clin Exp Res 2004;28:1356-1361.
  15. Mark T, et al. Barriers to the use of medications to treat alcoholism. Am J Addict 2003;12:281-294.
  16. Garbutt JC, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized control trial. JAMA 2005;293:1617-1625.



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