Int. J. Environ. Res. Public Health 2010, 7 1883 corticosteroids, does not improve 6-month survival in severe alcoholic hepatitis [30]. Our own studies with pirfenidone have suggested an important anti-inflammatory effect with ALD patients (Armendariz-Borunda, et al., unpublished results). The treatment of alcoholic hepatitis is largely symptomatic, emphasizing alcohol abstinence and meticulous attention to nutritional status. Specific therapies such as corticosteroids and pentoxyfiline need to be considered as they may reduce mortality in those patients who are at high risk of dying [41]. 7.1.3. About transplant Currently, the two main indications for liver transplant are: ALD and liver failure caused by HCV infection both in Europe and North America. Alcoholic hepatitis remains a controversial indication for liver transplantation; currently the procedure is not performed in this these patients owing to the fact that they continue consuming alcoholic beverages. Furthermore, it is required a period of abstinence as a rule before liver transplantation in many clinics. At the end of this period, liver functionality improves significantly in most of the cases so the process is not performed. Although it has been reported that transplant outcome in ALD and other entities, such as chronic HVC infection, is very similar, in the daily practice many transplants are interrupted for the reasons previously described [42]. 7.2. Alcohol Use Disorders Alcoholism is a multifactorial entity; hence the treatment must be addressed with different strategies related to AD. Alcohol use disorders are treatable disorders when efficacious medicines are added to enhance the effects of psychosocial treatment. Due to personal, social and health impact of alcohol use disorders, therapy must be guided towards a complete management including pharmacotherapy, behavioral interventions and medical board. For this reason, different strategies have been developed. Although abstinence remains the ultimate goal in treating alcohol-dependent individuals, reducing the frequency of heavy drinking has the major impact on decreasing alcohol-related consequences and improving quality of life [43]. 7.2.1. Pharmacotherapy The most promising compounds appear to be those that modulate the function of opioids, glutamate with or without gamma-aminobutyric acid (GABA), and serotonin (5-HT) [43]. The most used and approved pharmacotherapy by the Food and Drug Administration of the United States is naltrexone, acamprosate and disulfiram. Naltrexone is an opioid antagonist which is prescribed for alcoholism treatment [44]. Oral naltrexone and naltrexone depot formulations have generally demonstrated efficacy in treating AD, but with small effect. Treatment with naltrexone works for some individuals, but not for everyone. It has been proved a functional polymorphism of the μ-opioid receptor (OPRM1) gene that might predict naltrexone response. Anton et al. demonstrated the relationship between the functionally significant OPRM1 Asp40 allele and the response to naltrexone in alcoholic patients. Carriers of the Asp40 allele had an increased percentage of abstinent days (P = 07) and a decreased percentage of heavy drinking days (P = 0.04). The homozygous Asn40/Asn40 genotype showed no medication differences [45].