Pharmacologic approaches to the management of alcoholism.

Our understanding of alcohol craving, both as a cause for chronic abuse and relapse and as a target for intervention, has been refined significantly in recent years. For example, craving experienced during alcohol withdrawal may be mediated by gamma-aminobutyric acid (GABA) and glutamate receptor mechanisms, whereas the memory of the rewarding aspects of alcohol may be mediated by dopamine, opiate, and glutamate systems. Therefore, pharmacologic treatments for alcohol dependence may be targeted to numerous pathways. This article will discuss animal and clinical studies of the opioid antagonists (primarily naltrexone), acamprosate, and disulfiram. The side effects and treatment recommendations for each drug will also be reviewed.