Academic journal article Alcohol Health & Research World

Medications for Treating Alcoholism

Academic journal article Alcohol Health & Research World

Medications for Treating Alcoholism

Article excerpt

Researchers are evaluating medications to assist in treating alcoholism. Such medications may be used to treat withdrawal or co-occurring psychiatric disorders or as an adjunct to psychosocial treatment.

The prospect of using medications to help treat certain aspects of alcoholism(1) appears increasingly attractive. Two developments have contributed to stimulating research in this area. First, there is an improved understanding of how brain cells use chemical messengers (neurotransmitters) to communicate, thereby producing mental states and, ultimately, behavior (see sidebar, p. 266). Second, it has been postulated that abnormalities in certain neurotransmitter systems may be common to both alcoholism and depressive disorders (see the article by Miller, pp. 261-264). This suggests that medications effective in treating psychiatric disorders may be useful for treating alcoholism as well. Researchers therefore have a theoretical basis for developing new medications as well as further evaluating a large number of existing medications for use in alcoholism treatment. Medications that prove useful in treating aspects of alcoholism can serve as adjuncts to standard psychosocial methods of treatment.

After various preliminary studies, the ultimate test of an experimental medication is the controlled clinical trial, in which the effects of the medication may be compared with the effects of a medically inactive substance (placebo). An additional strategy is the double-blind trial, in which both subjects and therapists remain ignorant of the treatment administered so that results can be interpreted with minimal bias.

In addition to clinical effectiveness, new medications for treating alcoholism should ideally meet special safety and compliance criteria. Such medications should not

* interact harmfully with alcohol

* have a significant abuse potential

* be toxic to organs such as the liver, which already may have been damaged by long-term alcohol consumption

* have unpleasant side effects that might limit their acceptability with patients whose motivation already may be minimal.

This article briefly discusses medications intended to reduce craving, treat psychiatric disorders, discourage consumption, antagonize alcohol's effects, and ameliorate withdrawal symptoms. (For more detail, see Meyer 1989; Kranzler and Orrok 1989; Litten and Allen 1991; Naranjo and Sellers 1992; Kranzler and Anton in press).

ANTICRAVING MEDICATIONS

Scientists believe that the positively reinforcing effects of alcohol (see sidebar, p. 267) are related to the release of dopamine into a brain area called the nucleus accumbens (Koob 1992). Dopamine release is controlled by several other neurotransmitters, including serotonin and the naturally occurring opiates. Although the specific roles of these neurotransmitters are unclear, medications that modify their actions may alter the craving for alcohol (table 1). (Table 1 omitted)

Opiate Antagonists

The most promising medication for treating alcoholism to date is naltrexone (ReViaTM), an opiate antagonist. In two studies, naltrexone reduced the relapse rate to heavy alcohol consumption by about 50 percent in alcoholics over a 12-week period (Volpicelli et al. 1992; O'Malley et al. 1992); all subjects received additional psychosocial treatment (see the article by Volpicelli et al., pp. 272-278).

Other opiate antagonists also are being examined for effectiveness. For example, a small placebo-controlled study found that nalmefene decreased the rate of relapse to abusive drinking in alcoholics (Mason et al. 1994).

Medications That Affect Serotonin

In addition to its role in brain reward pathways such as the nucleus accumbens (McBride et al. 1991), serotonin may affect the urge to drink indirectly through its role in impulse control and mood stabilization. Serotonin also may alleviate the stress intolerance caused by mood disturbances, thereby reducing the influence of environmental experiences on drinking behavior. …

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