Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review Ajay Manhapra, MD, Anirban Chakraborty, MBBS, and Albert J. Arias, MD, MS Topiramate is a non-benzodiazepine anticonvulsant medication with multi-faceted pharmacologic action. It has emerged as an efficacious pharmacotherapeutic option forthe treatment. Topiramate is a non-benzodiazepine anticonvulsant medication with multi-faceted pharmacologic action. It has emerged as an efficacious pharmacotherapeutic option for the treatment of addiction, especially alcohol use disorder (AUD). We present a broad narrative review of the putative mechanism of action and clinical utility of topiramate with regard to AUD and other substance use disorders Topiramate pharmacotherapy for alcohol use disorder and other addictions: A narrative review (1 CME) 4.88 (8 votes) Register. Non-Member - $29.99; Regular Member - Free! Retired - Free! Early Career Physician - Free! Please review the journal article in it's entirety . You must register to access. Quiz Topiramate is an anticonvulsant medication most commonly prescribed for epilepsy and migraine headaches. Topiramate is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol use disorder (AUD), although off-label use for the treatment of AUD has increased in recent years . C., Maisel, N. C., & Finney, J. W. (2014). A meta-analysis of topiramate's effects for individuals with alcohol use disorders. Alcoholism, Clinical and.
Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review; Consensus and Controversies Between Pain and Addiction Experts on the Prevention, Diagnosis, and Management of Prescription Opioid Use Disorder; Buprenorphine and Naloxone Versus Buprenorphine for Opioid Use Disorder in Pregnancy: A Cohort Stud Topiramate Effect on Alcohol Use Disorders . Since topiramate was first considered as a treatment for alcohol use disorders, a number of studies have been done to test its effectiveness. The studies show that topiramate is an effective treatment option in alcohol use disorders, specifically in terms of reducing the harmful drinking patterns of.
Background and aims: Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders (AUDs) is an emerging concept. Our objective was to explore the comparative effectiveness of drugs used in this indication. Design: Systematic review with direct and network meta-analysis of double-blind randomized controlled trials (RCTs) assessing the efficacy of. The main focus of this narrative review is to present and discuss the most relevant clinical data about the pharmacological therapy for alcohol use disorders
-All recommend pharmacotherapy for alcohol use disorder • 70% relapse with psychosocial treatment alone Yet • Fewer than 1 in 3 patients receive treatment for alcohol use disorder • Fewer than 1 in 10 receive medication 90% do not receive treatment New AHRQ Resources Help Primary Care Clinicians Treat Alcohol Use Disorder. Content. . Article. is a potential novel pharmacotherapy for alcohol use disorder. The aims were to compare. Disulfiram. Disulfiram (Antabuse) was the first medication available for the treatment of alcohol use disorder, and it remains the most widely prescribed medication in some countries. Disulfiram inhibits the low Km alcohol metabolism enzyme aldehyde dehydrogenase 2 (ALDH2) in the liver and the brain, increasing the downstream acetaldehyde levels (Vasiliou et al. 1986) In 2016, 6.6% of the US adult population reported heavy alcohol use and 26.2% reported at least 1 episode of binge drinking (defined as 4 or more drinks in a day for women and 5 or more drinks in a day for men) during the preceding month (). 1 Between 2006 and 2010, the annual number of alcohol-associated deaths in the United States was approximately 88 000, or 9.8% of all US deaths. 2 In 2010. Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review Journal of Addiction Medicine, Vol. 13, No. 1 Double-Blind Randomized Clinical Trial of Prazosin for Alcohol Use Disorder
Topiramate has been approved by the US Food and Drug Administration for the treatment of epilepsy since the 1990s, and it has also been used off-label in the treatment of many types of addictive disorders. To date, no systematic review has embraced the entire field of addiction, both substance use and behavioral addictions, including eating disorders, to compare topiramate-based protocols and. The present study sought to replicate prospectively the effect of topiramate and rs2832407 in patients with DSM-5 alcohol use disorder (AUD) who sought to reduce or stop their drinking Topiramate pharmacotherapy for alcohol use disorder and other addictions: a narrative review. Manhapra A, Chakraborty A, Arias AJ. J Addict Med. 2019; 13 :7-22 Topiramate pharmacotherapy for alcohol use disorder and other addictions: A narrative review. J Addict Med . 2019;13(1):7-22. Pytell JD, Buresh ME, Graddy R. Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice Topiramate, as well as other antiepileptic medicines, may affect your mental health. You may have suicidal feelings, think about killing yourself or try to do so. This can happen within a week of starting topiramate or may take as long as 24 weeks after starting the medication
Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, Bulik CM: Binge-eating disorder in adults. A systematic review and meta-analysis. Ann Intern Med. 2016, 20:409-420. 10.7326/M15-2455; Manhapra A, Chakraborty A, Arias AJ: Topiramate pharmacotherapy for alcohol use disorder and other addictions: a narrative review. J Addict Med. 2019. Topiramate can be initiated while the patient is still drinking, and hypothetically may help alcohol-dependent patients withdraw slowly from chronic alcohol use. Although these medications are not recommended by guidelines as first-line therapy, they may be considered useful in patients who have other co-morbidities or psychiatric disorders Calculating receipt of topiramate across four years. For each fiscal year (FY) (from October 1 through September 30, 2009-2012), we used the VHA National Patient Care Database (NPCD) to identify all veteran patients that had an AUD diagnosis (alcohol abuse or alcohol dependence, ICD-9-CM codes 303.9x or 305.0x) recorded in any outpatient or inpatient encounter during those years alcohol use disorder, only acamprosate is considered safe for use in patients with severe ALD Topiramate. A recent meta-analysis found that topiramate use may result in fewer drink - ing days, heavy drinking days, and number of drinks per drinking day.7 Additionally, topiramate has demonstrated a statisticall
Topiramate. Topiramate is thought to work by increasing inhibitory (GABA) neurotransmission and reducing stimulatory (glutamate) neurotransmission, although its precise mechanism of action is not known. Although topiramate has not yet received FDA approval for treating alcohol addiction, it is sometimes used off-label for this purpose Alcohol dependence is a major health problem worldwide. Various pharmacological agents have been used in the management of alcohol dependence. This review looks at the role of topiramate and other anticonvulsants in the management of alcohol dependence. Topiramate is the most widely used anticonvulsant in the treatment of alcohol dependence This is a summary of a systematic review evaluating the evidence regarding the efficacy comparative effectiveness, and adverse effects of medications in adults with alcohol use disorder (AUD). The systematic review included 167 articles reporting on 135 eligible studies published from January 1, 1970, to October 11, 2013. The full report, listing all studies, is available at www. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 311(18), 1889-1900. Kranzler, H. R., & Van Kirk, J. (2001). Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res, 25(9), 1335-1341 * TOPIRAMATE (TOPAMAX) GABA enhancer, thought to reduce the rewarding effects of alcohol; 25 mg/d then increase by 25 to 50 mg/d each week to 200 mg/d max Systematic review including 6 RCTs and total of 979 participants: Fewer drinks/drinking day (-1.6) Higher % days abstinent (mean difference 15.5%) Less heavy drinking (standardized mean -0.44.
Pharmacotherapy for alcohol use disorder. 2015 3 Monterosso J, Flannery B, Pettinati H, et al. Predicting treatment response to naltrexone: the influence of craving and family history. Am J Addict. 2001: 10:258. 4 Verheul R, et al. 2005 as cited in Uptodate. Pharmacotherapy in alcohol use disorder. 201 1. Introduction. In the United States, alcohol use disorders (AUDs) (alcohol abuse and dependence) have a lifetime prevalence of 30% (Hasin et al., 2007) and a 12-month prevalence of 8.5% (Grant et al., 2004).Globally, alcohol is involved in 3.3 million deaths in a given year (), and it is the third leading cause of preventable death in the U.S. (Prevention, 2014)
specific facilities and overall are receiving pharmacotherapy for AUD. Keywords: Alcohol use disorders, Addiction, Pharmacotherapy, Topiramate, Pharmacotherapy utilization, Veterans Background Four medications have been approved by the US Food and Drug Administration (FDA) for the treatment of alcohol dependence, including naltrexone (both oral an Note: Alcohol abuse** and alcohol dependence †† were once considered separate disorders. They have now been combined into one disorder - alcohol use disorder - that can range from mild to severe. ** Alcohol use that interferes with your daily life, affects your relationships with others, or puts you in danger Current treatments for alcohol use disorders have limited efficacy and there is a high degree of variability in treatment response. In a randomised, placebo-controlled clinical trial, there was a large effect size for topiramate in people homozygous for the GRIK1 rs2832407*C allele. The primary aim of the TOP study is to examine prospectively the therapeutic and cost-effectiveness of. Jonas DE. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014 May;311(18):1889-900. Jorgensen CH, Pederson B, Tonnesen H. The efficacy of disulfiram for the treatment of alcohol use disorder. Alcoh Clin Exp Res. 2011;35(10): 1749-58
A randomized pilot trial of topiramate for alcohol use disorder in veterans with traumatic brain injury: Effects on alcohol use, cognition, and post-concussive symptoms. Drug and alcohol dependence Pennington DL, Bielenberg J, Lasher B, Herbst E, Abrams G, Novakovic-Agopian T, Batki S Substance use disorders are chronic, relapsing, and harmful conditions characterized by executive dysfunction. While there are currently no approved pharmacotherapy options for stimulant and cannabis use disorders, there are several evidence-based options available to help reduce symptoms during detoxification and aid long-term cessation for those with tobacco, alcohol and opioid use disorders
Alcohol is a major contributor to global disease and a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. Alcohol use disorder is one of the most common psychiatric disorders, with nearly one-third of U.S. adults experiencing alcohol use disorder at some point during their lives. Alcohol use disorder also has economic consequences. Recommended Outcomes (preview - will review in detail at the conclusion) The approved medications warrant at least as much 3rdrd-party payer support as medications for other medical disorders. Approved medications have a place in the management of alcohol use disorders at several different stages, and in a variety of settings Tidsskrift for Den Norske Legeforening. (Use of drugs for alcohol use disorders in Norway 2004-16. Journal of the Norwegian Medical Association) doi: 10.4045/tidsskr.18.0383; Kalpakci, A., Sofuoglu, M., Petrakis, I., & Rosenheck, R. A. (2018). Gender differences among Veterans with alcohol use disorder nationally in the Veterans Health. 16. Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889-1900. 17. Del Re AC, Gordon AJ, Lembke A, Harris AH. Prescription of topiramate to treat alcohol use disorders in the Veterans Health Administration
Topiramate is an oral antiepileptic that has off-label indications for the treatment of certain substance use disorders, including cocaine use disorder. 9 Topiramate is usually initiated at 25-50 mg/day orally, and the daily dose is increased weekly by 25-50 mg to a range of 200-300 mg/day in divided doses for this off-label use Meta-Analysis of Topiramate's Effects for Individuals with Alcohol Use Disorders Topiramate is a medication used to treat alcohol use disorders (AUD) in adults. It is thought to work by reducing cravings for alcohol through inhibiting the glutamate receptors and keeping dopamine from being released in the brain Integrated psychosocial interventions are helpful in decreasing substance abuse. Valproate and naltrexone may decrease alcohol use and citicoline may decrease cocaine use and enhance cognition. Conclusions: There is a very limited number of pharmacotherapy and an even smaller number of psychosocial interventions. Our review highlights the need.
Anxiety and Alcohol Use Disorders: Comorbidity and Treatment Considerations. Joshua P. Smith, Ph.D., and Carrie L. Randall, Ph.D. Joshua P. Smith, Ph.D., is an assistant professor at the Charleston Alcohol Research Center and outpatient director at the Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South. Identify patients who are candidates for pharmacotherapy for alcohol use disorder 2. Discuss the benefits, risks, and use of medications for alcohol use E. A. Topiramate in Alcohol Use Disorders: Review and Update. - PubMed - NCBI. 2015. E. A. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in. Rubinsky AD, Chen C, Batki SL, Williams EC, Harris AH. Comparative utilization of pharmacotherapy for alcohol use disorder and other psychiatric disorders among US Veterans Health Administration patients with dual diagnoses. J Psychiatr Res. 2015;69:150-157. 45. Lee MR, Weerts EM. Oxytocin for the treatment of drug and alcohol use disorders
Over the past decade, 12-month alcohol use, high-risk drinking, and alcohol use disorder (AUD) have increased by 11.2%, 29.9%, and 49.4%, respectively, in the United States. (1) In addition to increasingly high prevalence rates of AUD and the severe health and economic consequences associated with the disorder, (2) AUD is also highly comorbid. Cocaine use disorder remains a serious problem in the USA and worldwide. In the USA, 900,000 adults met criteria for cocaine use disorder in 2014 and 40% of visits to emergency departments for drug misuse or abuse involved cocaine. 1 Cocaine use is associated with cardiovascular and neurologic effects, and chronic repeated exposure leads to tolerance, adverse psychological and behavioral. A meta-analysis of topiramate's effects for individuals with alcohol use disorders. Alcohol Clin Exp Res 2014; 38:1481. Pennington DL, Bielenberg J, Lasher B, et al. A randomized pilot trial of topiramate for alcohol use disorder in veterans with traumatic brain injury: Effects on alcohol use, cognition, and post-concussive symptoms Alcohol use disorders (AUDs) are among the most prevalent psychiatric disorders. Epidemiologic studies have shown a high prevalence of concurrent psychiatric disorders among people with AUDs as wel..
All four placebo-controlled studies reported a significant decrease in alcohol use with topiramate compared to placebo. In one 14-week study, for example, the percent of heavy drinking days was 44% in topiramate patients compared to 52% in placebo patients (Johnson BA et al, JAMA 2007;298(14):1641-1651) Aim To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care. Design Open cohort study. Setting General practices contributing data to the UK Clinical Practice Research Database. Participants 39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013
Comparative utilization of pharmacotherapy for alcohol use disorder and other psychiatric disorders among U.S. Veterans Health Administration patients with dual diagnoses. Journal of Psychiatric Research, 69, 150 - 157 . doi: 10.1016/j.jpsychires.2015.07.01 . focusing on pharmacotherapy for methamphetamine or amphetamine use disorder found predominantly negative results for the use of antidepressants. No difference was identified for the outcome of abstinence, (4 RCTs, n = 590) or retention in treatment (6 RCTs, n = 831)
. Recently, the novel anti-epileptic topiramate has shown great promise as a new treatment for this disorder. The objective of this review is to discuss the limitations of the. Pharmacotherapy for Alcohol Use Disorders in Outpatient Settings. The review and meta-analysis by Jonas and colleagues examines the benefits and potential harms of approved medication for adults with alcohol use disorders.. The medications that were examined are often combined with other behavioral outpatient treatment 3. Alcohol abuse. Prescriber's Letter 2013;29. 4. RosnerS, Hackl-HerrwerthA, et al. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews 2010 (12). 5. Jonas D, AmickH, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA2014;311(18):1889. 6
Bouza C, Magro A, Munoz A, et al. Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction. 99:811-828. Kranzler HR. Pharmacotherapy of alcoholism: gaps in knowledge and opportunities for research. Alcohol Alcohol. 2000;35:537-547 Recently, topiramate, indicated for the treatment of seizure disorders, has shown some promise as a pharmacotherapy for problem gambling. The most persuasive evidence for the efficacy of topiramate has been reported for alcohol (in a placebo-controlled study) and for problem gambling (in which fluvoxamine served as an active control) distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each. DSM-5 integrates the two DSM-IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe subclassifications. Under DSM-5, anyone meeting any two of the 11 criteria during th Alcohol Use Disorder Pearls. Risky drinking is defined as more than 4 drinks per occasion or more than 14 drinks a week for men. For women the criteria are defined as more than 3 drinks an occasion, or more than 7 drinks a week. Screen all adults in the primary care setting for risky drinking with one of the following 3 validated tools: AUDIT, AUDIT-C and the single question screen (How many. Laura J. Fochtmann, MD, MBI. The American Psychiatric Association (APA), at its annual meeting in New York City, announced new practice guidelines for the pharmacological treatment of alcohol use disorder (AUD) with the goal of improving outcomes and quality of care for the condition
. This reduces cravings for alcohol and withdrawal symptoms.18 Topiramate has mood stabilising properties and may be efficacious in bipolar disorder, borderline personality disorder and post-traumatic stress disorder beneﬁcial for treating alcohol use disorders. It has been hypothesized that topiramate reduces alcohol intake by attenuating alcohol craving and motivation to drink (Johnson et al., 2003, 2004). This hypothesis is based largely From the Center for Alcohol and Addiction Studies, Brown Univer
Pharmacotherapy VA providers may use medications to treat alcohol dependence. Effective medications can help manage withdrawal symptoms, reduce cravings, and promote abstinence. Medications may include: Acamprosate, Disulfiram, Naltrexone and Topiramate. Additional resources: Alcohol and Liver Disease (video Pharmacotherapy • Alcohol use disorder naltrexone, acamprosate, disulfiram, topiramate* • Opioid use disorder methadone, buprenorphine, naltrexone • Tobacco use disorder varenicline, bupropion, NRT the treatment of other health conditions. Addiction Medicine: Closing the Gap between Science and Practice www.casacolumbia.org. As alcohol use is often comorbid with psychiatric disorders, topiramate may be viewed as a way to address multiple disorders with one drug. 19 The therapeutic effects of topiramate appear to be robust and there is evidence of better outcomes than with acamprosate, naltrexone or disulfiram. 18 However, it is not approved in Australia for alcohol. Pharmacotherapy for Stimulant Use Disorders: A Systematic Review. Stimulant use disorders, specifically cocaine and methamphetamine use disorders, present ongoing public health problems in the United States, with major medical, psychiatric, cognitive, socioeconomic, and legal consequences
Alcohol use is common in the American population. According to the 2008 National Survey on Drug Use and Health, more than 50% of Americans aged 12 and older reported drinking, 23% reported binge drinking, and 6.9% were heavy alcohol drinkers. 1 The prevalence rate of alcohol abuse or dependence in the United States is estimated at 5% to 14%. 1- Nationally, 3.4% of VHA patients with an alcohol use disorder received medications in FY 2009 (11,165 of 331,635 patients), up from 3.0% in FY 2007. Use of medications by patients at the facilities ranged from 0% to 12% T he narrative review of clinical benefits and potential risks of medications for maintenance treatment of opioid use disorder (MOUD) among adolescents by Camenga and colleagues (2019—this issue) is timely given the rising epidemiological trends of opioids (including opioid analgesics and heroin) among adolescents in the United States (Substance Abuse and Mental Health Services. Importance: Alcohol consumption is associated with 88 000 US deaths annually. Although routine screening for heavy alcohol use can identify patients with alcohol use disorder (AUD) and has been recommended, only 1 in 6 US adults report ever having been asked by a health professional about their drinking behavior. Alcohol use disorder, a problematic pattern of alcohol use accompanied by.
Alcohol Use Disorder (Alcoholism) 303.90 gabapentin and topiramate are also options for treatment of Alcohol Use Disorder but should typically be considered after trying naltrexone and acamprosate, The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud) Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or. Pharmacotherapy of personality disorders should be considered a symptom-focused treatment, Recent approaches to pharmacotherapy of personality disorders review future science group www.futuremedicine.com 261 anxiety disorders, alcohol and substance abuse . Recent approaches to pharmacotherapy of personality disorders. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction, Wiley, 2018, 113 (2), pp.220-237. 10.1111/add.13974 . hal-0169695 Perhaps in an addiction program, availability of prescribers is less important than access to prescribers who are supportive of pharmacotherapy for alcohol use disorders, even if they are not directly linked to the addiction program. In other words, access to providers may be necessary but not sufficient to ensure prescription of these medications
When alcohol use is a problem in adolescents , illegal drug use is 11 times more likely also to be a problem. The CRAFFT test was developed specifically for screening adolescents.5 Assessing older adults: Substance use disorders in older adults are under-diagnosed. One in three older adults who abuse alcohol develops the problem after age 60 Review article: pharmacotherapy for alcohol dependence - the why, the what and the wherefore. Alimentary Pharmacology & Therapeutics, 45(7), 865-882. doi: 10.1111/apt.1396 Alcohol and Alcoholism, 38 (5), 421-426. Management of common alcohol-related depression, anxiety, insomnia, mood and anxiety disorders May be primary or alcohol-induced. Alcohol-induced disorders tend to resolve within weeks of abstinence/reduced drinking, whereas primary disorders remain the same or improve only marginally. Managemen Overall, alcohol use disorder tends to be more common in individuals with less education and low income. Globally, alcohol use disorder affects 240 million people, mostly in Europe and the Americas. Pathophysiology. Multiple theories have been suggested as to why some people develop alcohol use disorders Objectives To conduct a systematic review and meta-analysis investigating effects of exercise for people with alcohol use disorders (AUDs) across multiple health outcomes. We also investigated the prevalence and predictors of dropout from exercise studies in AUDs. Design Systematic review and random effects meta-analysis with meta-regression analyses. Data sources 3 major electronic databases.
USA was 3.8%, while the prevalence of alcohol abuse was 4.7% . Alcoholism represents a signiﬁcant public health concern associated with an estimated annual cost of $185 billion . Alcohol use disorders are major contributing factors to injuries, medical and psychiatric illnesses and alcoholism is estimated to cause more than 100 000. This review discusses the diagnosis and pharmacotherapeutic strategies in alcohol use disorder, which is highly prevalent in the US population and yet is undertreated. Through a systematic literature review, the authors have defined various patterns of alcohol use, etiology, clinical presentation, screening, diagnosis, and treatments for.
Patients who use or abuse alcohol and other substance are at high risk for insomnia and present unique challenges for treating this debilitating disease. The three avenues of treatment--behavioral, OTC medications and prescription medications--are reviewed and future trends are outlined alcohol use disorder (e.g. abstinence from alcohol use, reduction or moderation of alcohol use, other elements of harm reduction) be agreed on between the patient and clinician and that this agreement be documented in the medical record. 6. APA suggests (2C) that the initial goals of treatment of alcohol use disorder include discussion of the. In addition to use for opioid overdose reversal, naloxone appears in combination with other MAT medications in longer-term pharmacotherapy for opioid use disorder—these formulations allow the different medication combined to offset each other's negative effects leading to greater recovery support potential (Portelli, Munjal, & Leggio, 2020)
Background. Topiramate is a sulfamate-substituted monosaccharide used in the treatment of epilepsy and migraines. 1 It also has an off-label use in the treatment of bipolar disorder, depression and as a weight reduction agent, among other uses. 2 With the growing off-label use of this oral medication, it is important to raise awareness within the medical community of the potentially blinding. Baclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit To the Editor: Dr Andrade's analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers and that baclofen may be. Addiction Pharmacotherapy 1. Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director, AllCEUs 2. Identify the primary medications used to manage substance withdrawal and describe when they should be used Identify the drugs currently FDA-approved for the treatment of substance use disorders Identify a patient's stage of disease and whether and when to use pharmacotherapy including. About 1 in 3 Canadian adults meet the criteria for substance use disorder (SUD) during their lifetime as per the Statistics Canada Community Health Survey .Substance use disorder is a term defined in the DSM V which combines criteria for substance abuse and dependence .Among several diagnosable SUDs, alcohol use disorder (AUD) is the most common in Canada, 18.2% of adults meet criteria.