Pharmacological interventions for alcohol use disorder on quality of life: a meta-analysis of randomized controlled trials

Alcohol Alcohol. 2026 Sep 20;61(6):agag067. doi: 10.1093/alcalc/agag067.

ABSTRACT

AIMS: Quality of life (QoL), a critical factor for sustaining recovery from alcohol use disorder (AUD), has been examined as an AUD-related outcome in randomized controlled trials (RCTs) that evaluated pharmacotherapy for AUD. This review evaluates the efficacy of this therapy in improving mental and physical health-related QoL.

METHODS: RCTs were identified across seven databases. Study quality was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2. A systematic review with meta-analysis was conducted. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered with PROSPERO (CRD420261277890).

RESULTS: Eighteen RCTs with 4376 participants were evaluated. Naltrexone was linked to improvements in both mental QoL (d = 0.30, 95% CI: 0.08-0.52) and physical QoL (d = 0.16, 95% CI: 0.01-0.31). Nalmefene improved physical QoL (d = 0.13, 95% CI: 0.02-0.25) but not mental QoL (d = 0.18, 95% CI: -0.004 to 0.354). Topiramate showed no improvement in either domain. However, further analysis indicated that topiramate was associated with a small improvement in physical QoL, which could correlate with a reduced percentage of heavy drinking days. Interpret these findings with caution. Acamprosate, sertraline, and psilocybin were associated with improved mental or physical QoL, whereas ketamine, varenicline, levetiracetam XR, and quetiapine were not. Interpretation is limited to single trials-no eligible RCTs reporting the specified QoL outcomes for disulfiram.

CONCLUSIONS: Certain medications for AUD are linked with improved mental and physical QoL, but evidence remains limited. Future RCTs should assess QoL and establish whether improvements are clinically meaningful.

PMID:42831801 | DOI:10.1093/alcalc/agag067