Treatment of alcoholism

Medication that alters the brain's response to alcohol could change the treatment of problem drinking so that it more closely resembles the type of care now routine for diabetes, high cholesterol and depression. Researchers say the medications — some already available, others nearing FDA approval — could help lift the social stigma that prevents many problem drinkers from seeking help. The availability of a pill or a shot could bring alcoholism out of the national closet in the same way that drugs in the Prozac family have made depression a legitimate and treatable disease for millions of people in the U.S. With the revolution in antidepressants, "people are much less likely to view depression as the fault of the person like alcoholism is now," said Dr. Henry R. Kranzler, professor of psychiatry and an alcoholism researcher at the University of Connecticut Health Center in Farmington. Though several drug companies are working to develop new medications for alcoholism, at least one has been available for 10 years. Naltrexone is a pill that appears to work by blocking chemicals in the brain that make people feel good when they drink alcohol. Because it blunts the pleasure sensation in people with alcohol addictions, it may reduce their urge to drink. Naltrexone works well for at least some patients, but doctors have been slow to prescribe it. In a survey published last year in the journal Addiction, Kranzler and his colleagues asked 1,388 physicians who treat substance abusers about their prescribing habits. On average, the doctors prescribed naltrexone to only 13 percent of their patients. The doctors cited insufficient understanding about alcoholism medications but also said studies showing that naltrexone works only for certain alcoholics made them reluctant to prescribe it. Kranzler and others acknowledged that naltrexone is not for everyone. But for people in whom it works, the effect can be dramatic, reports The Settle Times. According to Daily Times, treatment with the anti-epilepsy drug Topamax (topiramate) appears to reduce alcohol craving and drinking in alcoholic adults, new research suggests. Unlike existing drugs for alcohol dependence that are only started when alcohol use stops, Topamax can be given before the patient abstains, Dr Bankole A Johnson from the University of Texas Health Science Center at San Antonio noted in a telephone interview with Reuters Health. "Typically, alcoholics must become abstinent before they are placed on medication," he said. Topamax "can be used to treat alcoholics at a point of crisis while they are still drinking, so this allows people to be treated earlier when it is needed the most. " Topamax is unique in that it targets two chemical pathways that are believed to underlie alcohol’s rewarding effects, Johnson explains in the medical journal Alcoholism: Clinical and Experimental Research. In the study, 150 alcohol-dependent adults were treated with Topamax, at various doses, or with an inactive "placebo." All patients also received brief behavioral therapy. Alcohol use and cravings were assessed by surveyeing the subjects and by performing a blood test. Throughout the 12-week study, Topamax was much more effective than placebo in curbing craving and drinking. At the end of the study, the Topamax group had 2.88 fewer drinks per day, 27.6 percent fewer heavy-drinking days, and 26.2 percent more days abstinent compared with the placebo group. Importantly, Johnson said, Topamax does not appear to have any direct interaction with alcohol. Side effects seen more often with Topamax than placebo included dizziness, weight loss, and memory problems, among others. Brain pathways containing the neurotransmitter dopamine, also referred to as the "feel-good" brain chemical, are believed to mediate alcohol's rewarding effects, including craving. Whereas alcohol consumption facilitates dopamine neurotransmission, topiramate – a sulfamate fructo-pyranose derivative – decreases dopamine release through antagonism of glutamate activity at alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)/kainite receptors and facilitation of the inhibitory neurotransmitter, gamma amino butyric acid (GABA). Johnson conducted a "proof-of-concept" clinical trial, an experiment designed to test the direct consequences of an idea. Trial participants comprised 150 individuals (107 males, 43 females), 21 to 65 years of age, all of whom were diagnosed with alcohol dependence. For a 12-week period, 75 patients received topiramate (an escalating dose of 25 mg/day to 300 mg/day), 75 received a placebo, and all received a minimal intervention called Brief Behavioral Compliance Enhancement Treatment. Patients self-reported their alcohol consumption (drinks/day, drinks/drinking day, percent heavy drinking days, percent days abstinent) and craving (using the Obsessive Compulsive Drinking Scale). In addition, serum gamma-glutamyl transferase (GGT) levels – considered a sensitive and reliable biological marker of heavy drinking – were measured at baseline and at three, six, nine, and 12 weeks, publishes About.