Drug may lessen withdrawal

By Neil D. Rosenberg of the Journal Sentinel staff

October 24, 1997 An experimental drug that could double the success rate in
treating alcoholics by blocking withdrawal symptoms is undergoing testing
at a Milwaukee hospital.

The drug, called acamprosate, is taken daily for months rather than
briefly during initial detoxification and can block symptoms such as
tremors, anxiousness and irritability. The result is a drastic reduction in
cravings for alcohol, increased abstinence and sharply reduced relapse rates.

Earlier studies in Europe show relapse rates were reduced to about 25% in
the first three months of treatment, compared with relapse rates of 50% in
people undergoing traditional alcohol treatment programs, said Lance Longo,
medical director of addiction psychiatry at Sinai Samaritan Medical Center,
where the drug is being tested.

Sinai Samaritan is one of 20 sites nationwide to participate in the
testing, which is the last step before the drug's developer seeks
permission from the Food and Drug Administration to market it in the United
States. The Center for Addiction and Behavioral Health Research here also
is cooperating.

Acamprosate is unlike any other available psychotropic drug. It appears to
work by dampening nerve transmission activity in the brain by blocking
receptors called glutamate NMDA on the surface of nerve cells in the brain.

A new view of alcohol addiction theorizes that longterm alcohol
consumption increases these receptor sites, which then increase the nerve
activity of the brain during drinking.

But when drinking stops, the brain and nervous system are left in a
hyperexcitable state represented by symptoms such as restlessness,
shaking and difficulty sleeping.

"Drinkers then tend to drink again to temper that effect," Longo said.

Acamprosate is believed to work, at least in part, by binding to those
receptor sites. That has the effect of dampening nervetransmission
activity or reducing the excitatory state, and with it the symptoms and the
craving to drink, he said.

While the medication is no magic bullet for alcoholism, it could be of huge
benefit in what is a major public health problem that is difficult to treat.

According to the the National Council on Alcoholism and Drug Dependence,
there are about 14 million Americans who abuse alcohol with more than 8
million classified as alcoholics. Nearly 2 million people are in treatment
for alcohol abuse.

Studies show that 50% or more of people treated for alcoholism relapse in
three months and 75% relapse in one year, according to Bruce Berg, an
alcoholism specialist and clinical assistant professor of medicine at the
University of Pennsylvania Medical School. And the relapse rate is 90%
after four years, according to the federal National Institute of Alcoholism
and Alcohol Abuse.

Two years ago, naltrexone the first drug since Antabuse in 1951 to be
approved to treat alcohol abuse came on the market. Naltrexone works by
blocking painkilling and pleasureproducing receptors in the brain, which
has the effect of dampening the euphoria the "buzz" that alcohol
produces.

But naltrexone can be toxic to the liver, which is of special concern in
drinkers who may already have liver damage. For that reason, the drug has
not been widely used, Longo said.

Acamprosate has no effect on the liver and its side effects are limited to
possible nausea, diarrhea, itching, dampened sex drive and/or insomnia.

Longo is still seeking volunteers for the drug study. Participants must be
age 18 or older, dependent on alcohol and without any other major medical
or psychiatric problems. The study will last eight months; during the first
six months, participants will get either acamprosate or a placebo. There
then will be two months of followup.