Emerging Pharmacologic Treatments for Alcohol Dependence

Increased understanding of the neurobiology of alcohol dependence has led to studies of pharmacologic agents that modify drinking behavior. Because alcoholism is a heterogeneous disease involving multiple neurotransmitter and receptor systems, it is likely that a variety of pharmacologic agents will be required to have the greatest impact on outcomes across individuals. Several medications have been approved for the management of alcohol dependence. In addition, several drugs currently used for other indications have been studied for use in alcohol dependence, and some of these drugs show promise. For example, selective serotonin reuptake inhibitors have been shown to reduce drinking in subgroups of alcoholic patients, including those with comorbid depression and those with later-onset alcohol dependence. Ondansetron, a selective 5-hydroxytryptamine₃ receptor antagonist, may attenuate the urge to drink and thus increase abstinence. The anticonvulsant agent topiramate also has significantly reduced drinking behavior in early clinical studies. Baclofen, a γ-aminobutyric acid B agonist, has been shown to decrease drinking in animal models and in 1 small, placebo-controlled trial in humans. Rimonabant, a cannabinoid CB₁ receptor antagonist, has been shown to help nicotine dependence in humans, and in animal studies, to reduce alcohol consumption; no clinical trials in alcoholism have been published. Dopamine antagonists, including clozapine and the newer atypical antipsychotics, may have value in the treatment of alcoholism but require further study. Corticotropin-releasing factor 1 receptor antagonists and neuropeptide Y₁ receptor antagonists have been shown to reduce drinking behavior in animals but have not undergone clinical trials.