A Pill to Cure Alcoholism?

People struggling with alcohol addiction got some promising news this week: A team led by researchers at the University of Virginia Health System reported that the drug topiramate can lead to a reduction in heavy drinking. Topiramate is currently approved by the Food and Drug Administration to treat seizures and migraine headaches. But doctors can prescribe it "off label" for alcohol dependence.

"Alcoholism is a treatable disease," says lead author Bankole Johnson, chairman of psychiatry and neurobehavioral sciences at Virginia. "Topiramate not only reduces the symptom of the desire for heavy drinking, but also improves the physical and psychological health of the people who take it."

The study, published in the June 9 issue of the Archives of Internal Medicine, is based on a 14-week nationwide clinical trial involving 371 male and female diagnosed alcoholics. The drug proved to be better than a placebo at reducing the craving for alcohol and did a better job of lowering liver enzymes, cholesterol, body mass index, and blood pressure-which reduces the risk of serious health conditions.A reduction in both cholesterol levels and blood pressure, for example, decreases the risk of developing heart disease. Topiramate may also lower the risk for the onset of cirrhosis, the scarring of the liver that is a leading cause of death in heavy drinkers.

One advantage of treatment with topiramate, Johnson says, is that it can begin even when patients are still heavily drinking. It also is already familiar to general practitioners. "This is not true of many other medications used to treat alcohol dependence, so they may be more willing to prescribe it," says Mark Willenbring, director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, who was not affiliated with this study. "Most people with alcohol dependence never seek treatment," says Willenbring, "so it is important to find ways to make it available such that it is attractive, accessible, and affordable." He thinks topiramate has the potential to bring about a shift in the treatment of alcohol addiction similar to the sea change that occurred in treating depression after the introduction of Prozac in 1987 put help within easy reach.

Topiramate treatment was also associated with an improved quality of life: fewer sleep disturbances and a decline in obsessive thoughts about alcohol. On average, patients in the topiramate group experienced a 54 percent decline in their craving and obsessive thoughts about alcohol. This was compared with a 33 percent reduction in the placebo group. "That is what I think is very interesting about this study—that even without specific psychotherapy, individuals were able to reduce their heavy drinking," says Johnson.

Patients reported some side effects, including a numbness or tingling sensation, altered taste, weight loss leading to anorexia, and difficulty with concentration. Willenbring cites cognitive difficulty—most commonly manifested as having trouble finding words—as the most common reason patients decide to stop taking topiramate.

A range of behavioral based approaches offer another way for patients to overcome alcohol dependence, notes Jeffery Wilkins, vice chair of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center and David Fiellin, an associate professor of medicine at Yale University School of Medicine. In addition to the traditional 12-step program of Alcoholics Anonymous, they include motivational enhancement therapy, and cognitive-behavioral therapy, which help people understand and change the destructive thought and behavior patterns that lead to relapse. Often, treatment combines various behavioral based approaches.

According to a 2006 report from the National Survey on Drug Use and Health, published by the U.S. Department of Health and Human Services, 18.2 million Americans ages 12 or older met the criteria for alcohol dependence or abuse between 2002 and 2004. Ortho-McNeil Neurologics, the manufacturer of topiramate, provided funding for this study.