Medication Shows Promise in Treating Alcoholism
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What makes some drinkers lose control over how much they drink? It's a question that alcoholics, their families and those who treat alcoholics have long pondered. The general consensus seems to be that the causes of alcohol abuse are a combination of psychosocial as well as biological components. Lately, researchers are learning a lot more about those biological components, and some scientists say they are closer than ever to developing a pill for alcoholism. From member station WMRA, David Molpus reports.
DAVID MOLPUS reporting:
Thomas Albrey Barnes(ph) of Stanardsville, Virginia, says he always drank heavily from age 15 to 62. Toward the end he was downing a fifth a day or more, and it was killing him. That changed last spring on the day he showed up--drunk--to take part in a clinical drug trial at the University of Virginia Medical Center in Charlottesville.
Mr. THOMAS ALBREY BARNES (Recovering Alcoholic): I wanted to stop drinking and I have.
MOLPUS: The drug UVA is testing shows promise curbing cravings for alcohol. It's known as topiramate or by its brand name Topamax. It's been on the market for years as an anti-seizure medication usually prescribed for epileptic patients. The FDA is waiting on more studies before endorsing its use as a treatment for alcoholism. But as far as Thomas Barnes is concerned, Topamax is the only explanation for his sobriety, which has lasted more than six months now.
Mr. BARNES: I was in the program for a couple or three weeks and absolutely didn't even think about alcohol. I never took a drink since the first day that I was here.
MOLPUS: So what's happened to that desire to get high?
Mr. BARNES: It's just--it's not there. It just doesn't exist anymore.
MOLPUS: Neuroscientist and psychiatrist Bankole Johnson is in charge of the UVA study. It is similar to a small clinical trial he ran at the University of Texas Health Science Center in San Antonio. Two years ago he reported from there that Topamax significantly improved abstinence rates or reduced drinking among hard-core alcoholics for a period of a month or more. The Virginia trials, along with similar research in other states, are attempts to replicate those results and track the patients over a longer period of time. Johnson says he's seen remarkable results from Topamax in his private practice.
Dr. BANKOLE JOHNSON (University of Virginia): Usually about week five or week six, they tell you that they don't have the same drive for drinking, and in fact, one individual described as a thirst, and that the thirst for alcohol had been quenched.
MOLPUS: Johnson and other pioneers in addiction medications say recent advances in understanding of neurochemistry are providing real optimism that researchers can target parts of the brain affected by alcohol with effective medication. The neurotransmitter believed to be most associated with cravings for alcohol is dopamine.
Dr. JOHNSON: One of the things that is very important for determining whether somebody takes one drink and then another followed by another is really the excess of the amount of dopamine in the brain.
MOLPUS: Breaking that down further, Johnson explains that within the dopamine system are two antagonists. One is called glutamate; its function is to release feelings of pleasure. The body knows that too much pleasure is not a good thing, and has a built-in check on glutamate called GABA. The problem is in an alcoholic's brain there is too much glutamate and not enough GABA. That's where the Topamax pill comes in.
Dr. JOHNSON: Topamax basically cuts down the glutamate level in the brain and actually enhances the activity of GABA.
MOLPUS: So it restores balance.
Dr. JOHNSON: Restores balance, almost to where the brain would have been if it had not been an alcoholic brain.
MOLPUS: If the amount of dopamine in the brain can be modulated and restraints placed on the pleasure feelings from alcohol, then, Johnson says, even if an alcoholic has a slip after taking the drug and does have a drink, it won't lead to the second, third, fourth or fifth drink.
Dr. JOHNSON: They don't get a buzz. They don't get any kind of drive from drinking. And the idea is that if somebody's going out to buy a drink and they don't get a buzz, they'll stop doing it because there's absolutely no point in doing it.
MOLPUS: Some colleagues in the field, such as Boston University psychiatrist Dominic Ciraulo, say the Topamax results are already a major scientific finding, a landmark in the treatment of alcohol dependence. Robert Malcolm of the University of South Carolina says this and other new medications could change the direction of alcoholism treatment.
At least 18 similar drugs are now under development, and the federal government's National Institute on Alcohol Abuse is sponsoring more than 50 clinical trials, eight times the number just over a decade ago.
But not everyone is so enthusiastic. Some physicians specializing in addiction, as well as alcohol treatment counselors, say Topamax and other pills have a spotty record and certainly don't work for all alcoholics who've tried them. Dorothy Tompkins is an addictionologist in Charlottesville.
Dr. DOROTHY TOMPKINS (Specialist): Some people will take that drug or some of the other drugs, such as acamprosate of naltrexone, and it may seem to help in the beginning, and later on they go back to the same pattern they've had before.
MOLPUS: Tompkins says no pill alone can keep alcoholics sober. They have to change their attitudes and their way of living. Phoebe Fliokas agrees. She's a substance abuse counselor in Charlottesville who says curbing cravings for alcohol is only part of the problem.
Ms. PHOEBE FLIOKAS (Substance Abuse Counselor): There are all sorts of other things, problems with judgment, problems with inability to soothe themselves or deal with feelings, and so the clients that we are working with need much more than just that medication.
MOLPUS: Fliokas and others involved in alcoholism treatment centers say talk therapy and 12-step recovery programs, like Alcoholics Anonymous, will remain an essential part of the mix. Research scientists are not putting up an argument about that. Medical school Professor Bankole Johnson says the new drugs for alcoholism are not a cure. The hope is, he says, that they will be able to induce a remission in the disease enabling other behavioral interventions to take hold. Johnson is confident that with more research medicines for alcoholism will become as effective at arresting that disease as antidepressants are for mental illness or insulin is for diabetes.
There are an estimated 18 million Americans who suffer from alcohol dependence, and most don't get treatment of any kind. For the few who've had access to these experimental drugs and found success, like Thomas Barnes, there's just one regret--that they didn't come along sooner.
Mr. BARNES: So many years lost. I can't change yesterday, but I can change tomorrow.
MOLPUS: For NPR News, I'm David Molpus in Charlottesville, Virginia.
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