Overall Comments on Pharmacological Treatment

Pharmacological treatments have proved effective in treating anxiety, depression and psychosis in co-occurring mental and alcohol use disorders. The overall approach recommended by Kranzler and Soyka (2018) is “When psychiatric symptoms persist despite a substantial reduction or cessation in drinking, the optimal approach is to continue alcohol pharmacotherapy and add a specific psychiatric medication.” (p 817). 

As earlier, the following guidance should be read in conjunction with clinical practice guides for specific comorbid mental disorders.  What follows focuses on whether the medication 1) is superior to placebo in terms of its primary target 2) does not lead to worse alcohol outcomes, and 3) leads to improved overall outcomes such as quality of life.   

Given the complexities of co- and multi-morbid presentations, guidance on polypharmacy (National Institute for Health and Care Excellence, 2017) and on “off label” prescribing (Royal Australian and New Zealand College of Psychiatrists, 2018) are important to consider.  The potential for drug-drug interactions should be taken into account.  The side effect profile of any medications prescribed should be considered for potentially exacerbating any comorbid conditions.  Clinicians should also be alert to the possibility of poorer adherence to prescriptions and increased risk of overdose while intoxicated. As above the co-ordination of care between different health professionals is crucial.