Jared Chicoine, a stockbroker in his 30s, knew rock bottom
wasn't far when he blacked out at a work-related social
function. An attempt to quit cold turkey left him as jumpy
as a cat, something he tried to counteract with weed.
Bad idea � now he's stuck with two addictions. Self-medicating
didn't work for Jared but maybe he didn't pick the right
drug. A medication used to treat epilepsy may be able
to curb the craving for booze in alcoholics.
A report in the August issue of
Alcoholism: Clinical & Experimental Research
reveals that topiramate works even when an alcoholic
who wants to quit is still hitting the bottle. Other
drug treatments for alcohol dependence are only given
to those who've already started to abstain. "Topiramate
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's needed the most," said
Dr Bankole Johnson of the University of Texas Health
Science Center in San Antonio.
The thinking behind the study was
that alcohol targets biochemical pathways in the brain
that initially reward the drinker and keep them filling
the glass. By disrupting the target gamma aminobutyric
acid and glutamate pathways, topiramate could remove
the pleasurable aspect of drinking and even make the
difficult early days of alcohol withdrawal easier to
endure.
To test this hypothesis, 150 alcohol-dependent
adults (107 males and 43 females) aged 21 to 65 were
randomly selected to get either a placebo or topiramate.
The daily doses of both were systematically ratcheted
up from 25 to 300mg.
At the end of the 12-week trial,
those taking topiramate had cut down their quota by
three drinks per day, reported almost 28% fewer days
when drinking was heavy, and over 26% more booze-free
days than the placebo crowd. As well, those taking the
drug had lower levels of serum gamma-glutamyl transferase
� an enzyme linked to heavy drinking.
The self-reported craving for alcohol
was virtually nil in the alcoholics on topiramate, as
assessed by an obsessive-compulsive drinking scale.
These benefits were tempered somewhat by the development
of side effects, like dizziness, difficulty in movement,
mental confusion and weight loss. However, Dr Johnson
wasn't concerned with this downside. "Efficacious drugs
usually have side effects. Indeed, more patients dropped
out from the placebo group compared with the topiramate
group on account of side effects," he said.
"This work is an important
step in exploring new types of agents that may have
a more potent effect in preventing or reducing drinking,"
said Raye Litten, PhD and co-leader of the Medications
Development Team at the US National Institute on Alcohol
Abuse and Alcoholism. However, the use of a single drug
alone may not be enough to keep alcoholics from falling
off the wagon. "Because alcoholism is a heterogeneous
disease, we most likely need medications that act on
multiple sites," said Dr Litten. "A combination of medications
and behavioural therapies will most likely produce the
best outcome."
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