Available online 19 March 2024

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Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.

Section snippetsA global public health burden

Harmful alcohol use is one of the leading risk factors for morbidity and mortality worldwide (WHO, 2018). In 2016, the harmful use of alcohol resulted in 5.3% of all deaths and 5.1% of all disability-adjusted life years. Globally, an estimated 237 million men and 46 million women have an alcohol use disorder (AUD), with the highest 12-months prevalence among men and women in the European Region (14.8% and 3.5%, respectively) and the Region of the Americas (11.5% and 5.1%, respectively) (WHO,

Alcohol dependence and alcohol use disorder

According to ICD-11, AD is characterized by impaired control over drinking, the sensation of the urge to use alcohol (craving), continued use of alcohol despite adverse consequences, and distortions in thinking (most notably denial of harms), a higher priority given to alcohol use than to other activities and obligations, increased tolerance, and finally AWS (WHO, 2019). AWS is a clinically significant cluster of symptoms, behaviours and/or physiological features, varying in severity and

Treatment goals

The goals of AD treatment include the achievement of sustained abstinence, reduction in frequency and severity of relapse, reduction in the total amount of drinking and improvement in health and psychosocial functioning (EMA, 2010, FDA, 2015). Therefore, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. Patients with AD who desire sustained abstinence are detoxified, if necessary, treated for AWS, and then follow a

An undertreated disorder

AUD appears to be the mental disorder with the lowest treatment penetration (Mann, Aubin, Charlet, & Witkiewitz, 2017). The treatment gap reaches 85%–90% for AUD, strikingly higher than that for affective disorders (56%) or schizophrenia (32%) (Kohn, Saxena, Levav, & Saraceno, 2004). In the USA, according to the 2012–2013 NESARC-III survey, only 7% of individuals with DSM-5 AUD sought treatment within the past 12 months, while 20% sought treatment over their lifetime. These rates were slightly

Etiology and pathophysiology

AUD has a complex and not fully from understood etiology and pathophysiology. A wide range of genetic, epigenetic, and intracellular variables are involved (Egervari et al., 2021, Kim and Shukla, 2006). Exploration of the genetic and epigenetic landscape of AUD has emerged as a critical component in illuminating its etiology and potentially inspiring creative, tailored treatment options. Almost 50% of the risk for AUD has genetic origins (Agrawal and Lynskey, 2008, Verhulst et al., 2015).

Co-occurring disorders

Addiction plus additional mental health problems are usually referred to as dual disorders or co-morbid disorders. These can arise simultaneously or sequentially during a patient’s life. This clinical high concurrency strongly shows that dual diseases are not random. It appears acceptable to investigate the causal link between these circumstances (Szerman & Peris, 2018). More specifically, community-based epidemiologic studies have found a significant prevalence of concurrent mental problems in

Further on the role of stigma

Patients with AUD often seek treatment for physical symptoms for example headaches and abdominal pain rather than for addiction, something health practitioners must be vigilant for (Gilchrist, Moskalewicz et al., 2011). However, health workers report difficulty treating such patients owing to perceived aggression, manipulation, or lack of motivation, and are even known to avoid SUD patients (Ford, 2011). Thus, health practitioners must enhance their attitudes and skills toward this patient

Personalized medicine

Personalized medicine may play an important role in treating AUD by targeting treatments to individual genetics, epigenetics, endophenotypes, and/or phenotypes that impact addiction susceptibility or response to treatments. The study of pharmacogenomics, which investigates how gene variants can influence drug response, is central to this strategy. Polymorphisms in genes such as alcohol dehydrogenase and aldehyde dehydrogenase have been shown to have a major impact on therapy response rates (

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