Disorders related to the abuse of alcohol should be considered as a social and health emergency. The alcohol dependent patient runs the risk of developing physical, psychological, social, economic and legal problems. Thus, there is a need to find new therapeutic strategies for the treatment of alcohol dependence. Abstinence has always represented the elective therapeutic approach in alcohol dependence; nevertheless, considering abstinence as the only successful result in clinical treatment does not allow capturing significant aspects in consumption patterns of patients. From the literature, significant results have emerged regarding reduction of alcohol consumption in terms of frequency and quantity, which can become a marker of clinical progression towards abstinence.
The present is an in-depth analysis of the existing literature (from 1962 to 2012) on possible therapeutic interventions in the treatment of alcohol dependence. The literature focuses on the relationship between “reduction of consumption versus abstinence”, with both representing possible treatments in alcohol dependence.
The results of a large body of research seem to agree in emphasizing a linear correlation between systemic exposure to alcohol and morbidity and mortality. On the other hand, the scientific evidence does not indicate precise and identifiable thresholds for the damage incurred from ethanol. In the light of the available data, the concept of reduction of alcohol consumption versus abstinence has become useful from clinical, social and economic aspects. The opportunity to reduce risk and organ damage, to involve the patient in a therapeutic program towards abstinence, to prevent the development of alcoholism into more severe forms and to reduce the social and economic impact are important indicators that can be achieved considering the therapeutic strategies examined.
From analysis of the literature, it is possible to understand that reduction of alcohol consumption can be an intermediate valid goal both therapeutically and socially, and acceptable for those patients unable or unmotivated to achieve abstinence, in order to reduce the clinical risks associated with heavy drinking. During treatment there is an important and active dual role of both the doctor and patient who should share common goals resulting from accurate analysis of the motivation and personological characteristics of the patient. New pharmacological strategies can be useful to reach this therapeutic goal. Nalmefene, a modulator of the opioid system with antagonist activity on opioid mu and delta receptors and partial agonist activity on kappa opioid receptors, appears to be especially effective in reducing ethanol consumption.