Alcohol dependence (alcoholism) is a disease characterized by a strong craving for alcohol, inability to stop drinking, a need to consume greater amounts to produce the alcohol "high" and avoid the onset of withdrawal symptoms (like restlessness, irritability, sweating, nausea, tremors, hallucinations and convulsions).

The National Council on Alcohol and Drug Dependence estimates about 18 million Americans are problem drinkers. Excessive alcohol consumption can cause problems with family relationships, ability to work or keep a job or complete school work. People who drink and drive may have frequent arrests for DUI (driving under the influence). Nearly 50 percent of all traffic deaths are alcohol-related. Alcohol is a factor in 25 percent of admissions to emergency departments, 33 percent of suicides, and more than 50 percent of homicides. Excessive consumption of alcohol is also related to an increased risk for death from heart disease, cancer and stroke.

Treating Alcohol Dependence

Alcohol dependence is a disease and there is no cure. People who decide to stop drinking need to stay away from alcohol for the rest of their lives to prevent a relapse. However, stopping isn't easy because patients have a hard time coping with withdrawal symptoms and learned alcohol-related behaviors (such as drinking and socializing with friends).

Health experts say support groups (like Alcoholics Anonymous®) can be very helpful for people trying to stop drinking and maintain abstinence. Medications can help reduce withdrawal symptoms. There are also medications that are specifically approved to reduce alcohol cravings and dependence.

New Use for a Drug

Researchers are now testing another drug for treatment of alcoholism, called topiramate (TOPOMAX®). The drug is currently approved to treat certain types of seizures in patients with epilepsy and as a preventive treatment for migraines. Bankole Johnson, D.Sc., M.D., Ph.D., Psychiatrist/Pharmacologist with the University of Virginia, says topiramate interferes with neurotransmitters, a class of brain chemicals. Investigators hope the drug will reduce the activity of a specific neurotransmitter, called dopamine, a chemical involved in processing emotional response and pleasure.

In a recent study, researchers enrolled more than 300 men and women with a diagnosis of alcohol dependency. For fourteen weeks, half of the participants received topiramate and half received a placebo. In addition, patients received weekly counseling sessions to enhance behavioral compliance.

Johnson says topiramate reduced the urge to drink and increased the length of abstinence during the treatment period. The drug led to significantly fewer obsessions and compulsions related to alcohol use, greater quality of life improvement and a reduction in sleep disturbances. Most patients saw an improvement in alcohol-related symptoms within the second or third week of the trial.

Topiramate had a positive effect on physical health as well. Compared to those taking the placebo, patients in the active drug group had a decrease in body mass index, lowered diastolic and systolic blood pressure, decreased cholesterol and improvement in liver function and reduction in liver enzymes (a marker of liver damage from heavy drinking).

Johnson says being able to take a pill to reduce alcohol dependence may reduce the stigma associated with heavy drinking and enable patients to maintain privacy during their recovery. He cautions that topiramate is currently not FDA approved for treatment of alcohol dependence. The drug must be started at low dosages and then carefully increased. It can cause mild to moderate side effects, like dizziness, slowness of movement, problems with concentration or memory and numbness and tingling. Long-term studies are needed to determine how long patients will need to take the medication to stay away from alcohol.

For information about the study, log onto http://www.clinicaltrials.gov. Then type the trial identification number in the search box: NCT00223639.

For general information on alcohol dependence and treatment:

American Psychological Association, Help Center

The National Council on Alcoholism and Drug Dependence

National Institute on Alcohol Abuse and Alcoholism

National Institute on Drug Abuse