Treating Alcohol Use Disorder: Medication Considerations and Goals Beyond Abstinence

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Melissa Weimer revisit the fundamentals of alcohol use disorder (AUD), discussing medications like acamprosate, disulfiram, naltrexone, topiramate, and others and how to support various treatment goals, whether that means reducing use or achieving abstinence. 

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Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Melissa Weimer, DO, MCR, DFASAM

Dr. Melissa Weimer is board-certified in Internal Medicine and Addiction Medicine, focusing on substance use disorders in hospital settings.  She is an Associate Professor of Medicine at Yale School of Medicine and currently the Medical Director of the Yale Addiction Medicine Consult Service (YAMCS) at Yale New Haven Hospital. Dr. Weimer has worked on local, state, and national levels to enhance access to evidence-based treatments for substance use disorders.  As an educator, she teaches healthcare students and professionals about substance use disorders and serves as the Associate Program Director of the Yale Addiction Medicine Fellowship program. She is also the Medical Director/Lead Trainer for the SAMHSA-funded Providers Clinical Support System-Medications for Alcohol Use Disorder. 

📖 Show Segments

• 00:05 - Introduction 
• 00:27 - Alcohol Awareness Month and AUD Statistics 
• 01:42 - FDA-Approved Medications for AUD 
• 05:35 - Topiramate and Other Treatment Options 
• 08:21 - Choosing the Right Medication for Patients 
• 14:27 - Barriers to Medication Use and Overcoming Them 
• 17:32 - Telehealth and Network Therapy 
• 19:44 - Integrating Psychosocial Treatments with Medication 
• 26:20 - Patient-Centered Goals and Risk Mitigation 
• 35:06 - Key Takeaways  
• 36:36 - Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Medications for AUD: Medications for AUD are safe and effective and should be offered to more individuals diagnosed with the disorder.  
• Setting Goals: Abstinence is not always the required or primary goal. Reducing alcohol use is a valid and beneficial goal that can also be supported with medications. 
• Comprehensive Approach: Treating AUD requires a multifaceted approach, combining medication with psychosocial interventions. 
• MAUD and Liver Disease: Medications for alcohol use disorder (MAUD) can be used safely in hospital settings and in patients with liver disease and have been shown to reduce all-cause mortality in individuals with alcohol-related cirrhosis. 
• Choosing the Right Medication: Tailoring the medication choice to fit the patient's overall profile and preferences can significantly enhance adherence and treatment outcomes. 
• Addressing Barriers: Institutional barriers and cultural resistance within clinics and recovery spaces must be addressed to normalize and support the use of medication in treating substance use disorders. 

🔗 Resources

• PCSS-MAUD Education: Free, comprehensive training, guidance, recourses, and mentoring on the prevention, diagnosis, and treatment of AUD. 
  • Integrating Medications for Alcohol Use Disorder and Alcohol Use Services into Primary Care - Online Course 
  • Pharmacotherapy for Alcohol Use Disorder: Best Practices and Clinical Strat