Results from studies of
pharmacotherapies for primary
alcoholism are reviewed, including selective
serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (e.g.
fluoxetine),
opiate antagonists (e.g.
naltrexone) and
dopamine agonists (e.g.
bromocriptine). Because there is considerable co-morbidity between
alcohol dependence, anxiety, and
affective disorders, results from studies of medications used to treat these
psychiatric disorders are also reviewed, including the
5-HT agonist buspirone and the noradrenergic agent
desipramine. The neurobehavioural model of
alcohol dependence implies that combinations of medications may lead to more effective treatment; thus, identifying subtypes of alcoholic patients will be important in determining which
therapies or combinations of
therapy will be most effective in treating
alcohol dependence. For example, in an ongoing study, we are attempting to subtype an alcoholic population for treatment selection by measuring endogenous
opioid activity. Because endogenous
opioids are involved in
analgesia, we exposed male and female subjects with
alcoholism [some of whom had
post-traumatic stress disorder (
PTSD)] to cold-induced
pain and measured their response before and after administration of
naloxone or placebo. The
naloxone injection reduced
pain response. In addition, women who have
PTSD are much more sensitive to stress, which may be related to levels of brain
opioid activity.