June 2, 2000
Volume XXXIII, No. 22

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New combination drug treatment shows promise for treating alcoholics with neurochemical abnormalities

Health Science Center researchers have uncovered exciting preliminary evidence that a specific combination drug therapy is highly effective in treating alcoholics with neurochemical abnormalities, according to trial results published May 16 in Alcoholism: Clinical and Experimental Research.


Dr. Bankole Johnson (gesturing) and his team plan follow-up studies of combination drug therapy.

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 in their 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.
"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.
Director of the National Institute
on Alcohol Abuse and Alcoholism

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 also may 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 Americans1 in every 13 adults who abuse alcohol or are alcoholics.