Source: Lancet, The (UK) Website: http://www.thelancet.com/ Contact: The Lancet Ltd Pubdate: Sat, 16 Jan 1999 Author: Dorothy Bonn Volume 353, Number 9148 NEW TREATMENTS FOR ALCOHOL DEPENDENCY BETTER THAN OLD Two relatively new drugs--naltrexone and acamprosate--show promise for the treatment of alcohol-dependent patients, says a US report. Both drugs seem to reduce the patient's urge to drink and drinking frequency, and may improve abstinence. But disulfiram, widely used for 50 years, has "minimal impact". The report, based on a systematic review of the best available evidence and commissioned by the US Agency for Health Care Policy and Research (Rockville, MD, USA), concludes that disulfiram, which acts as a psychological deterrent to alcohol intake by producing unpleasant symptoms, may be beneficial when given under supervision, but that this "has not been well studied". The limited evidence available does not prove that serotonergic agents benefit patients with alcohol dependence without co-existing depression or anxiety, the report continues. There is evidence that lithium is not efficacious in the treatment of core symptoms of alcohol dependence, and "minimal" evidence of lithium's efficacy for alcohol-dependent symptoms in patients with associated depression. However, both naltrexone and acamprosate reduce the number of drinking days and enhance abstinence, says the report. Naltrexone, which is thought to reduce the rewarding properties of alcohol, also reduces craving and relapse rate. "The growing evidence that drug treatments may be useful in treating alcohol dependence, particularly in patient subgroups, is very pleasing", says pyschopharmacologist David Nutt (University of Bristol, UK). "The findings that opiate blockade with naltrexone and GABA/glutamate modulation with acamprosate reduce relapse rates should provide a platform for developing new therapies based on our growing knowledge of the effects of alcohol on brain pharmacology. They also raise the question of whether combinations of these drugs might have added value." Alcoholism affects about 10% of the adult US population--100 000 of whom die each year from alcohol-related disease or injury. The leader of the report team, Suzanne West, warns that "these new medications will not eliminate the problem of alcohol dependence. Many individuals continued to drink even while taking the medications", she explains. Twin study illuminates genetic basis for alcohol dependence In a US study of male twins, genetic factors accounted for more than half of the variability in risk of developing alcohol dependence or abuse, the rest being attributed to environmental influences not shared by family members. 3516 twins, about 40% of whom met the DSMIIIR or DSMIV diagnostic criteria for alcohol dependence or alcohol abuse without dependence, took part in the study. Higher pair correlations for diagnosis in monozygotic than in dizygotic twins were not associated with greater similarity in childhood environments or closer recent social contact - ie, shared environmental factors had little effect on alcoholism development. Heredity was as important for determining the risk of broadly defined alcoholism (alcohol abuse/dependence or "problem drinking") as for alcohol dependence per se--ie, alcohol abuse and dependence may not have separate aetiologies (Am J Psychiatry 1998; 156: 34-40). - --- MAP posted-by: Don Beck