Remarks y The term “combined treatment” refers to psychosocial interventions provided together with pharmacological treatment.

• Psychosocial interventions considered included: CBT, couples therapy, psychodynamic therapy, behavioural therapies, social network therapy, contingency management, motivational interventions, 12-step facilitation and mutual help groups.
• Pharmacological treatment considered included: acamprosate, disulfiram and naltrexone. y The term “alcohol dependence” refers to diagnosis according to the ICD-10 or DSM-IV criteria or equivalent ICD-11 and DSM-5 diagnosis.

Implementation considerations y Both naltrexone and acamprosate are relatively expensive medicines compared with disulfiram, which is considerably less expensive and may be more readily accessible in low-income settings. However, medicines may not be registered and available in all countries. The decision to use acamprosate, disulfiram or naltrexone should be made taking into consideration harms and benefits, availability and individual preference. y Decision on the choice and implementation of psychosocial and/or pharmacological treatment should be based on individual characteristics of the person it is prescribed for. Service providers should help the person make decisions about available treatments, based on providing relevant information (e.g. possible side-effects, counterindications, costs). Even if it is not possible to provide combined interventions, individuals should be provided with either psychosocial or pharmacological treatment. y Even though differences for adverse events were not identified, medicines for alcohol dependence treatment can have side-effects and service providers should monitor them carefully. The sideeffect profile is generally acceptable for most people receiving acamprosate or naltrexone. Education of the individual and their carer (e.g. family member) regarding potential adverse events with disulfiram is important. The balance of benefits versus harms in non-specialized settings is unclear. y Discontinuities in drug availability and access to psychosocial interventions (common in LMICs) may interfere with continuation of treatment and should be considered in planning treatment.