Health

How Sobering

New drug shows promise in treating alcoholism

Nearly 1 in 10 Americans has a drinking problem — a number that may be trending higher.

Indeed, alcohol is among the factors driving a recent reversal in longevity gains among white middle-aged Americans.

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Once the cycle of addiction begins, kicking the habit can seem impossible. Alcoholics Anonymous is the default treatment sought by the million or more Americans who regularly attend meetings. Yet even AA’s success rate, though hotly contested, is only between 5 and 10 percent.

Given these desperate figures, many have long wished for a scientific advance in the treatment of alcoholism. Now, there may be one.

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Scientists in Sweden are on the cusp of changing the way we treat alcoholism. In two separate studies, researchers found that a drug called OSU6162, which normalizes dopamine levels in the brain, can reduce an alcoholic’s craving for booze and enjoyment of alcohol.

Could this be a new “sober pill” to treat alcoholism?

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“OSU6162 has several desirable characteristics of a medication for alcohol dependence,” Pia Steensland, co-author of both studies and an associate professor in the Department of Clinical Neuroscience at the Karolinska Institute, told LifeZette. “We have for the first time shown that OSU6162 can attenuate alcohol craving in the alcohol-dependent patients.”

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The first study, published in the journal European Neuropsychopharmacology, showed promising results in humans. The second study, published in Addiction Biology, showed how the drug works by balancing dopamine levels in alcohol-dependent rats.

“The present studies are based on the knowledge that dopamine and the brain reward system is one potential treatment target due to its involvement in the development and maintenance of alcohol dependence,” Steensland said in an interview with LifeZette.

“If there was a pill on the market that would change my brain chemistry and my dopamine levels, where I could have one glass of wine and stop, I would want to try it,” said one alcoholic.

Drinking alcohol causes the brain to release dopamine, a hormone that creates a feeling of euphoria and well-being. With continued drinking, however, the brain’s reward system adapts and becomes desensitized, releasing less dopamine.

Over time, the brain requires more alcohol to feel intoxicated and feel good. Eventually, a heavy drinker needs to drink more for the brain to release enough dopamine to feel “normal.” That’s when addiction sets in. The same dopamine reward system cycle is present in other addictions, like heroin and sugar, as well.

For Sally Smith (not her real name), the idea of taking a pill to manage her alcoholism and possibly help her one day drink socially sounds great.

“If there was a pill on the market that would change my brain chemistry and my dopamine levels, where I could have one glass of wine or a cocktail and stop, and not have any negative effects, I would definitely want to try it,” she told LifeZette.

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Smith has struggled with alcoholism and addiction since college. In her mid-20s, she went to rehab and got sober. By going to AA meetings and doing the Twelve Steps, she said, she stayed sober for more than a decade. But last fall, after a rough breakup with her longtime boyfriend, Smith, now age 37, relapsed.

“I was super lonely,” she said. “I was socially drinking at first, and I was fine.”

Soon, however, she began drinking too much, too often, and even started blacking out.

“Most of the time, especially when I was alone, I didn’t stop after one drink — I kept drinking,” she said.

This past month, Smith entered an intensive outpatient-treatment program. She’s trying to get sober again and stay sober, but admits it isn’t easy.

“I have to acknowledge that alcohol can be very deadly, and it could have taken me down a really deadly path,” she said.

Still, she said she wishes she could find a way to drink in moderation.

“Social drinking is pleasurable and relaxing,” she said.

A pill like OSU6162 may one day make Smith’s dream possible. For now, however, she’ll need to stick with more traditional treatments — AA meetings and counseling. An OSU6162 medication won’t hit the market any time soon.

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Though this is “a first important ‘proof of concept’ study,” said Steensland, “larger clinical efficacy trials with larger patient groups and longer treatment period (three to six months) are needed to determine if the OSU6162 also can help alcohol-dependent people drink less alcohol and reduce the risk of relapse.”

Steensland said more funding is needed before trials can begin.

More than 16 million adults in the U.S. have an alcohol-use disorder, and nearly 88,000 people die each year from alcohol-related causes, making it the third largest cause of preventable death in the United States, according to the National Institutes of Health. In 2006, alcohol abuse cost the U.S. $223.5 billion.

Still, there are few medications on the market that specifically treat alcoholism, and they are prescribed in very small numbers because of negative side effects and questionable efficacy.

The most commonly prescribed medication is disulfiram, sold under the brand name Antabuse. The drug works by blocking an enzyme that’s crucial to the metabolizing of alcohol.

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When a person drinks with Antabuse in his system, he will get very ill – nausea, extreme vomiting, headaches, blurred vision, sweating, and heart palpitations, among other side effects. The medication is supposed to work as an aversion therapy – once an alcoholic on Antabuse tries drinking once, he will experience the horrible side effects and never drink again.

But more often, the alcoholic chooses to stop taking the Antabuse, and then starts drinking again. As a result, it’s not an effective long-term treatment, and prescription rates have remained low.

OSU6162, by contrast, has “a beneficial side effect profile.” It’s also unique in that it targets the dopamine system directly.

Joy Demos, a licensed social worker and former clinical supervisor of inpatient detox at Beth Israel Medical Center in New York City, welcomes any new treatment in the fight against alcoholism and addiction.

“Anything that prevents people from committing lifelong physical damage or dying because of an addiction is, for me, a major plus,” she told LifeZette. “I think it’s good to have more treatment options available, especially for young people, who are sometimes deterred by Twelve Step programs because they don’t feel it’s for them.”

But she also cautioned that “everyone is looking for a magic pill,” and that addiction usually isn’t that simple.

Steensland agreed.

“We do not believe that one pill is a quick fix out of a complex disorder such as addiction. However, if we, through medication, can help these individuals control their craving for alcohol, we can give them an increased ability to assimilate other … psychological treatments necessary to recover or control their drinking,” she said.

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