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).