Pharmacopsychiatry 2024; 57(01): 21-29
DOI: 10.1055/a-2190-4842
Original Paper

Patient Perspectives on Pharmacotherapy of Alcohol Dependence

Julian Wellensiek
1   LVR Hospital Bonn, Department of Addiction Disorders and Psychotherapy, Bonn, Germany
Michael Specka
2   LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
Johannes Just
3   Witten/Herdecke University, Faculty of Health, Department of Medicine, Witten, Germany
Markus Banger
1   LVR Hospital Bonn, Department of Addiction Disorders and Psychotherapy, Bonn, Germany
Udo Bonnet
2   LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
4   Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany
Norbert Scherbaum
2   LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
› Author Affiliations
Clinical Trials Registration: German Clinical Trials Register DRKS00013881


Introduction Pharmacotherapy with drugs like naltrexone or acamprosate is a well-evaluated element in the treatment of alcohol dependence (AD). However, in many countries, these medications are rarely administered. The objective of the present study was to identify from patients’ perspective factors that prevent the initiation and compliance with pharmacological treatment of AD.

Methods Patients from inpatient alcohol withdrawal treatment underwent a standardized interview. Questions included socio-demographic data, history of AD, treatment history, knowledge and personal experience regarding pharmacotherapy of AD, and personal views about the causes of AD.

Results Three hundred patients (mean age 47.3 years, 27.7% female, mean duration of AD 8.9 years, 67% with a history of previous inpatient withdrawal treatment) were included. The majority of patients (58.7%) already knew drugs for the pharmacotherapy of AD. Thirty percent had ever used such medications, most often acamprosate. Except for disulfiram, pharmacotherapy of AD had lasted only a few weeks, on average. Medication usually had been applied without additional psychotherapy. No severe side effects were reported. Patients had often stopped pharmacotherapy on their own, when assuming they had reached stable abstinence. Openness to start pharmacotherapy for AD was currently stated by 67% of the total sample. In multiple logistic regression, openness was predicted by having a concept of AD as a medical disease and by a shorter duration of AD.

Discussion To improve the administration of pharmacotherapy for AD implementation strategies should be systematically developed and evaluated with a focus on the concept of AD as a medical disease.

Publication History

Received: 31 May 2023
Received: 20 September 2023

Accepted: 29 September 2023

Article published online:
05 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Carvalho AF, Heilig M, Perez A. et al. Alcohol use disorders. Lancet 2019; 394: 781-792
  • 2 Soyka M, Kranzler HR, Hesselbrock V. et al. Guidelines for biological treatment of substance use and related disorders, part 1: Alcoholism, first revision. World J Biol Psychiatry 2017; 18: 86-119
  • 3 Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: A review. JAMA 2018; 320: 815-824
  • 4 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: 1889-1900
  • 5 Castrén S, Mäkelä N, Alho H. Selecting an appropriate alcohol pharmacotherapy: Review of recent findings. Curr Opin Psychiatry 2019; 32: 266-274
  • 6 Heikkinen M, Taipale H, Tanskanen A. et al. Real-world effectiveness of pharmacological treatments of alcohol use disorders in a Swedish nation-wide cohort of 125 556 patients. Addiction 2021; 116: 1990-1998
  • 7 Krampe H, Stawicki S, Wagner T. et al. Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome. Alcohol Clin Exp Res 2006; 30: 86-95
  • 8 Han B, Jones C, Einstein EB. et al. Use of medications for alcohol use disorder in the US: Results from the 2019 National Survey on Drug Use and Health (Letter). JAMA Psychiatry 2021; 78: 922-924
  • 9 Fairbanks J, Umbreit A, Kolla BP. et al. Evidence-based pharmacotherapies for alcohol use disorder: Clinical pearls. Mayo Clin Proc 2020; 95: 1964-1977
  • 10 Scherbaum N, Holzbach R, Stammen G. et al. Very low frequency of drug therapy of alcohol dependence in Germany - Analysis of data of a statutory health insurance. Pharmacopsychiatry 2020; 53: 37-39
  • 11 Wallhed Finn S, Lundin A, Sjöqvist H. et al. Pharmacotherapy for alcohol use disorders - Unequal provision across sociodemographic factors and co-morbid conditions. A cohort study of the total population in Sweden. Drug Alcohol Depend 2021; 227: 108964
  • 12 Kim Y, Hack LM, Ahn ES. et al. Practical outpatient pharmacotherapy for alcohol use disorder. Drugs Context 2018; 7: 1-14
  • 13 Knox J, Hasin DS, Larson FRR. et al. Prevention, screening and treatment for heavy drinking and alcohol use disorder. Lancet Psychiatry 2019; 6: 1054-1067
  • 14 Gregory C, Chorny Y, McLeod SL. et al. First-line medications for the outpatient treatment of alcohol use disorder: A systematic review of perceived barriers. J Addict Med 2022; 16: e210-e218
  • 15 Mark TL, Kranzler HR, Song X. et al. Physicians’ opinions about medications to treat alcoholism. Addiction 2003; 98: 617-626
  • 16 Mark TL, Kranzler HR, Poole VH. et al. Barriers to the use of medications to treat alcoholism. Am J Addict 2003; 12: 281-294
  • 17 Scheurich A, Müller MJ, Wetzel H. et al. Reliability and validity of the German version of the European Addiction Severity Index (EuropASI). J Stud Alcohol 2000; 61: 916-918
  • 18 Crawford J, Heather N. Public attitudes to the disease concept of alcoholism. Int J Addict 1987; 22: 1129-1138
  • 19 Arbeitsgemeinschaft medizinischer Fachgesellschaften (AWMF). S3-Leitlinie – Screening, diagnose und behandlung alkoholbezogener störungen [Highest quality level guideline: Screening, diagnosis and treatment of alcohol–related disorders]. Online:, accessed May 10, 2023
  • 20 Peduzzi P, Concato J, Kemper E. et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49: 1373-1379 DOI: 10.1016/s0895-4356(96)00236-3.. PMID: 8970487
  • 21 Bauer U, Hasenöhrl A. Therapieerfolg Alkoholabhängiger nach qualifizierter entzugsbehandlung und konventioneller Entgiftung [Success of alcohol dependents after comprehensive withdrawal treatment or conventional detoxification treatment]. SUCHT 2000; 46: 250-259
  • 22 Rittenberg A, Hines AL, Alvanzo AAH. et al. Correlates of alcohol use disorder pharmacotherapy receipt in medically insured patients. Drug Alcohol Depend 2020; 214: 10817410
  • 23 Zimmermann M, Papa A. Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory. Psychol Psychother 2020; 93: 537-554
  • 24 Probst C, Manthey J, Martinez A, Rehm J. Alcohol use disorder severity and reported reasons not to seek treatment: A cross-sectional study in European primary care practices. Subst Abuse Treat Prev Policy 2015; 10: 32
  • 25 Rehm J, Allamani A, Elekes Z. et al. Alcohol dependence and treatment utilization in Europe - A representative cross-sectional study in primary care. BMC Fam Pract 2015; 16: 90
  • 26 Australian National Survey of Mental H, Wellbeing. Proudfoot H, Teesson M. Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of mental health and wellbeing. Soc Psychiatry Psychiatr Epidemiol 2002; 37: 451-456
  • 27 Rombouts SA, Conigrave JH, Saitz R. et al. Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: A systematic review. BMC Fam Pract 2020; 21: 260
  • 28 Oliva EM, Maisel NC, Gordon AJ. et al. Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Curr Psychiatry Rep 2011; 13: 374-381
  • 29 Mark TL, Kranzler HR, Poole VH. et al. Barriers to the use of medications to treat alcoholism. Am J Addict 2003; 12: 281-294
  • 30 Haley SJ, Pinsker EA, Gerould H. et al. Patient perspectives on alcohol use disorder pharmacotherapy and integration of treatment into primary care settings. Subst Abus 2019; 40: 501-509
  • 31 Verthein U, Kuhn S, Gabriel K. et al. Die behandlung des alkoholentzugs mit oxazepam oder clomethiazol – eine naturalistische beobachtungsstudie [Treatment of alcohol withdrawal syndrome with oxazepam or clomethiazole - A naturalistic observational study]. Psychiatr Prax 2018; 45: 95-102
  • 32 Reichl D, Enewoldsen N, Weisel KK. et al. Association of impulsivity with quality of life and well-being after alcohol withdrawal treatment. J Clin Psychol 2022; 78: 1451-1462