Treatment of alcohol use disorder with psychiatric co-morbidity

Kurzzusammenfassung in leicht verständlicher Sprache

In this systematic review, we aimed to summarize the current evidence for the treatment of patients who suffer from both alcohol use disorder and one or more other psychiatric disorder at the same time. We found a large number of research reports, but most of the results were still highly uncertain. Nevertheless, we were able to conclude that psychological treatment for depression, anxiety, and PTSD can be effective also in patients with active alcohol use disorder. The medication naltrexone is also effective in reducing alcohol use, for patients with alcohol use disorder and psychiatric co-morbidity.

Abstract

Hintergrund und Fragestellung
Alcohol use disorder often co-exists with other psychiatric disorders. Management of such “dual diagnosis” is often considered challenging, and many treatment trials have excluded patients with co-morbidities. This systematic review aimed to summarize the existing evidence from randomized clinical trials, investigating the effects of pharmacological or psychological interventions for adults with a substance use disorder and a co-existing psychiatric diagnosis.

Methoden
A systematic literature search was performed, using the databases CINAHL, Cochrane Library, Embase, Medline, PsycINFO and Scopus. Only randomized controlled trials using structured diagnostic procedures were included. Articles were assessed for relevance, and risk of bias was evaluated using a modified version of the Cochrane RoB2 tool. Results were extracted according to the intention-to-treat principle, and the evidence was rated using GRADE. Since the results could not be synthesized through meta-analysis due to heterogeneity, Synthesis Without Meta-analysis (SWiM) was applied.

Ergebnisse
130 reports of randomized clinical trials were included in the main project, encompassing all substance use disorders (not only alcohol). For pharmacological treatments, the certainty of evidence was very low for most analyses. The most robust evidence was found for naltrexone, which may lower alcohol use without worsening psychiatric symptoms, in patients with alcohol use disorder and psychiatric co-morbidity. For psychological interventions, the evidence was most consistent in populations with depression, anxiety, and PTSD, with reductions in both psychiatric symptoms and substance use, when compared to treatment as usual.

Diskussion und Schlussfolgerung
Despite a relatively large number of studies, the evidence base for treatment of alcohol use disorder with psychiatric co-morbidity is still limited. Psychological treatment appears to be effective for adults with comorbid depression, anxiety and PTSD, and naltrexone is a safe and effective pharmacological option in the treatment of alcohol use disorder, also in patients with psychiatric co-morbidity.

Interessenskonflikte sowie Erklärung zur Finanzierung
Ich erkläre, dass während der letzten 3 Jahre keine wirtschaftlichen Vorteile oder persönlichen Verbindungen bestanden, die die Arbeit zum eingereichten Abstract beeinflusst haben könnten.