THESIS. Two currently available medications used to treat depression and nicotine dependence have good potential for treating alcohol dependence. This is the conclusion of a doctoral thesis from Sahlgrenska Academy, which also shows that a newly developed test to measure alcohol consumption through a blood test is significantly better than currently used tests.
As of today, there are four approved pharmacotherapies for alcohol dependence; Antabuse, which in combination with alcohol causes nausea but does not affect craving for alcohol, and three medications acting on craving and control. However, not everyone benefit from the treatments.
“We need more options, to be able to find the best possible treatment for every patient, much as we do for e.g. high blood pressure. Combining different drugs and target multiple systems in the brain, is also interesting ” says Andrea de Bejczy, who wrote the thesis.
In three clinical trials, de Bejczy has compared potential pharmacotherapes to placebo. Two of them proved able to reduce alcohol intake in alcohol dependent subjects; the anti-depressant drug mirtazapine, and the smoking cessation drug varenicline.
The third drug, which influences glycine levels in the brain, failed to show treatment effect over placebo.
“However, all subjects in the study stayed abstinent longer than expected, and the results from animal studies are so promising that we would like to continue researching substances that affect the same systems in the brain. We also feel that it is important to improve the method for measuring alcohol consumption in research studies,” says de Bejczy.
A better way to measure alcohol consumption
One of the studies used a new blood alcohol marker, phosphatidylethanol, also known as PEth, developed by researchers at Lund University. The thesis concludes that this alcohol marker isbetter correlated to alcohol consumtion than the markers most commonly used today, GGT and CDT.
“PEth is more accurate, because the marker can only be formed in the presence of alcohol and therefore does not produce any false positives values. Also, this marker measure more recently comsumed alcohol.”
Alcohol studies relies heavily on collecting alcohol consumption data by subjects retrospectively recalling their alcohol consumption, which has proven to be difficult. The thesis shows that an objective markers with high accuracy, in this case PEth, provides a more accurate estimate of alcohol consumption, and should be the preferred alcohol outcome in research studies.
As well as in research studies, PEth could also be a valueable tool in health care settings and in criminal justice” says de Bejczy.
More research needed
It is not possible to say when or if the medications tested in these studies will become available for the treatment of alcohol dependence. Several studies showing efficacy of a medication are required for approval.
“Clinical trials are expensive, and it is difficult for academic research groups to find funding. Once patents have expired, pharmaceutical companies seldom continue funding research” says de Bejczy.
FACTS ABOUT ALCOHOL DEPENDENCE In Sweden, approximately one million persons consume alcohol at risk levels (equivalent to one in five adults) and approximately 450,000 persons suffer from alcohol dependence or alcohol abuse. Between 5000 and 7000 people die every year due to alcohol consumption (source: CAN (http://www.can.se/fakta)).
The Swedish names of the four available medications for alcohol dependence are Antabus®, Campral®, Naltrexone Vitaflo® and Silencro®.
The thesis is available here: Studies on new pharmacological treatments for alcohol dependence – and the importance of objective markers of alcohol consumption: https://gupea.ub.gu.se/handle/2077/42349
The thesis has already been successfully defended.
