Substitution therapy for alcoholism: time for a reappraisal?

Abstract

A number of compounds already in use as medications for various indications substitute for ethanol at clinically relevant brain pathways, in particular, at gamma-aminobutyric acid (GABA) receptors. Nevertheless, although substitute medications have been recognized for heroin and tobacco dependence, patients with alcohol dependence are rarely offered an analogous approach. Benzodiazepines may have paradoxical effects, and abuse and dependence are known. Baclofen (GABA(B) agonist) has not been associated with dependence or misuse and has been effective in several trials in preventing relapse, although research is required to establish the optimal dosing regimen. GABA-ergic anticonvulsants, helpful in treating withdrawal, have yet to emerge as effective in relapse prevention. Clomethiazole and sodium oxybate, the latter having been shown to be effective in relapse prevention, have incurred a reputation for dependence and abuse. However, data have emerged showing that the risk of abuse of sodium oxybate is lower than many clinicians had foreseen. For a condition where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality, the time now seems right for reappraising the use of substitute prescribing for alcohol dependence.

• Authors: Jonathan Chick, David J Nutt
• Journal: Journal of psychopharmacology (Oxford, England) (J Psychopharmacol) Vol. 26 Issue 2 Pg. 205-12 (Feb 2012) ISSN: 1461-7285 [Electronic] United States
• PMID: 21742726 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticonvulsants
• GABA-B Receptor Agonists
• Chlormethiazole
• Benzodiazepines
• Sodium Oxybate

Topics

• Alcoholism (drug therapy)
• Anticonvulsants (adverse effects, therapeutic use)
• Benzodiazepines (adverse effects, therapeutic use)
• Brain (drug effects, metabolism)
• Chlormethiazole (adverse effects, therapeutic use)
• Drug-Related Side Effects and Adverse Reactions
• GABA-B Receptor Agonists (adverse effects, therapeutic use)
• Harm Reduction
• Humans
• Sodium Oxybate (adverse effects, therapeutic use)