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ROBERT SWIFT, M.D., PH.D., is Professor of Psychiatry and Human Behavior, Brown University Medical School, Center for Alcohol and Addiction Studies, and Associate Chief of Staff for Research, Providence VA Medical Center, Providence, RI. Address correspondence to Dr. Swift at the Center for Alcohol and Addiction Studies, Box G-BH, Brown University, Providence, RI 02912 (robert_swift_MD{at}brown.edu).

Purpose. To review pharmacotherapies and psychosocial interventions for the treatment of alcohol dependence, including recent developments that may minimize nonadherence. Summary. Alcohol dependence is a widespread, chronic disorder with enormous health consequences. Psychological and behavioral therapies have been the mainstay of treatment and are demonstrated to be effective, but they do not lead to reduced drinking or abstinence in all patients. Advances in neurobiology have led to the identification of drug targets and the development of novel drugs to treat alcohol dependence, and many patients will benefit from the addition of pharmacotherapy to their treatment regimen. Pharmacologic treatment options for use in conjunction with psychotherapy include the aversion-based therapy disulfiram, the opioid receptor antagonist naltrexone, and acamprosate, which is thought to act by normalizing the glutamate and -aminobutyric acid neurotransmitter systems. The effectiveness of pharmacotherapies depends on adherence, which is often poor in alcohol-dependent patients. Recently, a monthly, extended-release formulation of naltrexone has been approved for alcohol dependence, which promises to minimize nonadherence, a problematic factor in the management of alcohol dependence. Conclusion. Pharmacotherapy added to psychosocial therapy can improve treatment effectiveness. Advances in drug delivery mechanisms, such as injectable and extended-release formulations, may improve medication adherence rates in patients with alcohol dependence, thereby enhancing patient outcomes. Index terms: Acamprosate; Alcohol deterrents; Alcoholism; Alcohols, ethyl; Behavior therapy; Compliance; Dependence; Disulfiram; Injections; Mechanism of action; Naltrexone; Patients; Sustained-action medication