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How can personalized care, addressing comorbidities, and focusing on gradual improvement help increase treatment success for alcohol use disorder?
Joseph R. Volpicelli, MD, PhD, sat with Psychiatric Times to discuss his research on alcohol use disorder (AUD) and addiction.
Volpicelli said when he first started his research, the prevailing notion was that addiction was related to a moral failing or a defect in a person’s personality. Now, he said, it is known that it is related to the biochemistry of a person. The challenge is that many evidence based treatments have not been used clinically.
“Less than 2% are taking medication that has been proven to be helpful to people with addiction,” Volpicelli said.
Not only is the amount a patient drinks important to treating them, according to Volpicelli, but also how much it impacts the patient’s life. It can increase anxiety and depression and interferes with social relationships, as well as personal health. Having a good relationship with the patient is important because patients will be more likely to adhere to treatment.
“Don’t expect 100% improvement,” Volpicelli says, “Expect incremental improvement over time.” Making sure clinicians know all of the effective treatments will help keep patients engaged in treatment. Staying patient and meeting patients where they are can positively impact treatment.
Disentangling comorbidities, such as depression and AUD, is difficult to do when it comes to treatment. Volpicelli said he does not focus on labels or say a patient can not be treated until addressing other issues.
Naltrexone is the gold standard for treating AUD, and that patients who have a hard time controlling how much they drink would be a good candidate for the treatment. Patients who feel euphoric and have more energy after drinking see positive effects with naltrexone. Patients using alcohol for its sedative effects would see a positive impact from naltrexone.
The more psychiatrists learn about addiction, the better and more effective patients can experience treatment. Volpicelli suggests naltrexone has different use modalities, including taking it every day to abstain from drinking entirely or taking it in anticipation of a high-risk event like attending a wedding. Motivation in patients is important to understand in order to help them understand the way their life can improve.
Dr Volpicelli is the executive director of the Institute of Addiction Medicine.