A Pill for Alcoholism?

NPR reported this weekend that the University of Virginia is conducting a study on a new drug to help alcoholics who are trying to quit drinking. The drug called topiramate (Topamax®) has shown some remarkable successes, but has not yet been approved by the FDA to treat alcoholics. To date, three medications--disulfiram (Antabuse®), naltrexone (Trexan®), and acamprosate (Campral®)--have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence, but barely 20% of people who need them, use them. Recently, however, there has been research supporting a more central role for medications in the treatment of alcohol-seeking behavior. This behavior appears to be related neurobiologically to dopamine and other neurotransmitters that can alter dopamine function. Topiramate was originally synthesized as a potential anti-diabetic agent and was found to be similar to anticonvulsants. It used for example in the treatment of adult migraine headache. It is a GABA-receptor agonist (GABA is the predominant inhibitory neurotransmitter) and a glutamate antagonist (glutamate is a predominant excitatory neurotransmitter). In a chronic alcoholic state, GABA is decreased while glutamate and dopamine are increased. Work done in 2003 by Dr. Bankole Johnson and his team at the University of Texas at San Antonio have shown that topiramate blocks the glutamate receptors and increases the GABA effect; this combined effect produced a decrease in heavy drinking days and alcohol craving (a person can have one drink and not crave the second third, fourth, fifth, etc.) with an increase in non-drinking days.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) claims that almost 18 million people in the USA abuse or are addicted to alcohol. According to BusinessWeek, this abuse and addiction costs the USA around $185 billion a year in medical services, lost wages, and law enforcement resources. The NIAAA also claims that alcohol affects women differently than men. “Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women's bodies have less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman's body than in a man's. In other words, it would be like dropping the same amount of alcohol into a much smaller pail of water. That is why the recommended drinking limit for women is lower than for men… In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain, heart, and liver damage, progress more rapidly in women than in men.” For information on alcoholism science go here.