Medications and Alcohol Craving

Alcohol Research & Health, Fall, 1999 by Robert M. Swift

In the second experiment, 51 heavy beer drinkers were pretreated with either a placebo or 50 mg of naltrexone daily, each for 7 consecutive days prior to the drinking sessions. Again, the subjects' latency to drinking increased during the naltrexone period compared with the placebo. The subjects who received naltrexone also consumed less alcohol, and the time they took to finish one drink was increased. In this experiment, subjects reported less of an urge to drink when they received naltrexone than when they received a placebo (Davidson et al. 1999).

In a randomized, double-blind, placebo-controlled study, Volpicelli and colleagues (1997) found no reduction in craving measured on a 10-point scale among subjects receiving naltrexone. However, these researchers have noted that many subjects dropped out of treatment prematurely and that the clinical effectiveness of naltrexone might be improved by techniques for enhancing medication compliance.

In summary, the data suggest that naltrexone's beneficial effects in reducing alcohol consumption and increasing abstinence may be associated with the ability of the drug to block craving, including both the urge to drink and associated physiological responses.

Dopamine Antagonists

Dopamine's role in reinforcement suggests the possibility of using dopamine antagonists to reduce alcohol consumption and craving. In a double-blind, placebo-controlled laboratory study, 16 subjects diagnosed with either alcohol abuse or alcohol dependence reported less craving for alcohol and consumed less of their preferred alcoholic beverage after receiving the dopamine antagonist haloperidol (Haldol(r)), a medication commonly prescribed to treat severe psychiatric illness (Modell et al. 1993).

The dopamine antagonist tiapride, marketed in Europe for the treatment of alcohol abuse and dependence, was shown to be effective in increasing abstinence in a randomized, double-blind trial with more than 100 subjects conducted in Great Britain, although craving for alcohol was not specifically assessed (Shaw et al. 1994).

A preliminary, double-blind, placebocontrolled laboratory study of the recently approved antipsychotic medication olanzepine (Zyprexa(r)) on alcohol-induced stimulation and cue-induced craving found that pretreatment with olanzepine attenuated measures of alcohol- and cue-induced craving (Hutchison et al. 1998). Unlike traditional antipsychotic dopamine antagonists, this medication is less likely to produce neurological side effects, such as movement disorders.

Serotonergic Medications

Several pharmacological agents that alter serotonergic function in the brain appear to reduce ethanol consumption in animals (Kranzler and Anton 1994; LeMarquand et al. 1994). However, in he clinical treatment of alcohol-dependent patients, the effects of most serotonergic medications seem to be only modest in reducing alcohol consumption. Such medications increase the overall activity of serotonin in synapses as well as agonists and antagonists at various serotonin-receptor subtypes.