New Combination Drug Treatment Shows Promise for Treating Alcoholics with Neurochemical Abnormalities (5-15-00)
Researchers at The University of Texas Health Science Center at San Antonio have uncovered exciting preliminary evidence that a specific combination drug therapy is highly effective in treating alcoholics with neurochemical abnormalities, according to trial results to be published Tuesday (May 16) in Alcoholism: Clinical and Experimental Research.
For decades it has been known that, for some, alcoholism runs in the family, and that certain brain abnormalities may be transmitted. Typically, these alcoholics start drinking as youth, develop anti-social problems and are the hardest to treat. Based on the hypothesis that these alcoholics have abnormalities of the serotonergic and opioid systems, Professor Bankole Johnson’s team showed that the combination of specific serotonergic (ondansetron) and opioid (naltrexone) medications resulted in improved drinking outcomes for 85 percent of alcoholics who received the medications vs. 34 percent who received placebo. Although preliminary, this drug combination is highly promising for treating those with a biological predisposition for alcoholism, said Johnson, M.D., Ph.D., who is the William and Marguerite S. Wurzbach Distinguished Professor in the departments of Psychiatry and Pharmacology, deputy chairman for research in the Department of Psychiatry and chief of the department’s Alcohol and Drug Addiction Division.
Study participants were assigned to two groups of 10 each, one receiving medication combination therapy and the other receiving a placebo (inactive agent). Results confirmed that participants using the medication intervention consumed four times fewer drinks per day than the placebo group. Participants were enrolled in weekly psychotherapy and measures designed to evaluate physical, social and mental well-being, and drinking.
Says Dr. Johnson: "The combination of ondansetron and naltrexone significantly reduced the alcohol consumption of these biological alcoholics, presumably by correcting underlying disequilibrium in the serotonergic and opioid brain systems." Sponsored by the National Institute on Alcohol Abuse and Alcoholism, Dr. Johnson’s team is planning follow-up studies to establish these findings, and to determine if other types of alcoholics may also benefit from this treatment regimen. Using this combination of medications as the standard of treatment for severe alcoholics could be as few as four years away. "Ondansetron plus naltrexone appears to synergistically improve the drinking outcomes of these biologically predisposed alcoholics. Medications targeted toward the serotonin and opioid abnormalities of alcoholics produce a very large treatment response," explains Dr. Johnson. He notes that in the future, "we expect to be able to use molecular genetics to identify those at greatest risk for this the most severe form of alcoholism even before they get it. And if they get it, we should be able to provide them with a highly effective therapy." These findings may provide powerful treatment options for an important subgroup of the 14 million Americans—1 in every 13 adults—who abuse alcohol or are alcoholics.
QUOTES ABOUT THE STUDY CONDUCTED BY PROFESSOR BANKOLE JOHNSON AND HIS RESEARCH TEAM:
"Without question, Dr. Bankole A. Johnson’s clinical research team at The University of Texas Health Science Center at San Antonio has offered new hope for many alcoholics with his new and novel treatment of combining ondanseron (a serotoninergic agent) and naltrexone (an opioid). The combination of these two pharmacological agents has proven to be quite effective in treating alcoholics with neurochemical imbalances. Congratulations to Dr. Johnson for this new breakthrough in the field of addiction, as it was reported this month in Alcoholism: Clinical and Experimental Research."
—Pedro Ruiz, M.D.
"I sense that we are on the verge of major advances in the pharmacotherapy of alcoholism. Of all the major diseases that afflict us, it has the fewest treatment options, particularly in the development of successful medications. Successful medication for alcoholism would revolutionize the treatment of this devastating disease. Such treatment is suggested by the study of Johnson and co-workers. Although the number of subjects is limited, the results are quite promising. The complexity of alcoholism is now appreciated from recent genetic and biological studies and the use of a combination of drugs, as done by the Johnson team, represents an effective way to normalize the multiple brain systems that are disrupted in alcoholism. In addition, the drug treatment was used in conjunction with psychotherapy: it is likely that this multiple approach is what is necessary for success. This is similar to accepted treatments for heart problems or high blood pressure, where drug therapy is combined with changes in lifestyle. We can hope that alcoholism treatment will soon have the visibility and success that has been achieved for these other health problems."—R. Adron Harris, Ph.D.
M. June and J. Virgil Waggoner Professor
Director, Waggoner Center for Alcohol and Addiction Research
The University of Texas at Austin
"The study reports interesting preliminary evidence about the use of multiple pharmacologic agents in alcoholism treatment. We join Dr. Johnson in looking forward to its expansion to validate these important preliminary conclusions."
—Enoch Gordis, M.D.