Anticonvulsant May Have Role In Treating Alcohol Abuse

Combining the anticonvulsant topiramate with a brief behavioral compliance enhancement treatment produced significant improvements in psychosocial functioning in patients with moderate alcohol dependence in a study reported last month in the Archives of General Psychiatry.

Significantly, the study also found that improvement in quality of life occurred in patients who achieved abstinence from alcohol, as well as those who significantly reduced, but did not cease, alcohol consumption.

A team led by Bankole Johnson, M.D., Ph.D., who was the Wurzbach distinguished professor of psychiatry and pharmacology at the University of Texas Health Center at San Antonio at the time the research was conducted, compared 75 patients with moderate alcohol dependence who received the brief behavioral compliance enhancement treatment (BBCET) plus topi-ramate with 75 patients who received BBCET plus placebo.

Johnson is now a professor and chair of psychiatry at the University of Virginia School of Medicine. The work was funded in part by Ortho-McNeil (maker of the Topamax brand of topiramate) and by grants from the division of alcohol and drug addiction of the department of psychiatry at the University of Texas and the National Institute on Alcohol Abuse and Alcoholism.

During the 12-week, double-blind randomized controlled trial, all patients received the same BBCET—a brief “psychosocial adherence enhancement program emphasizing that medication compliance is critical to changing the alcoholic's drinking behavior.”

BBCET was conducted weekly for all 12 weeks using a standardized manual. Escalating doses of either topiramate or matching placebo were used (up to a maximum of 300 mg a day for topiramate) such that the maximum dose for each patient was administered daily between week eight and week 12.

A series of outcome measures was used, including the Clinician's Global Impression–Severity Scale to rate patients' severity of alcohol dependence weekly; the Clinician's Global Impression–Change Scale to rate patients' improvement in psychosocial functioning from baseline; the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and the Drinker Inventory of Consequences.

At the end of the 12-week study, participants who had received topiramate showed significantly greater improvement in all drinking outcomes, including a 27 percent reduction in heavy drinking days, compared with those taking placebo. Participants on topiramate were 2.63 times more likely than those on placebo to report they were “abstinent and not seeking alcohol,” and 2.17 times more likely to say they were “significantly improved.” Those taking topiramate were 2.81 times more likely than those on placebo to have a high score (in at least the 90th percentile) on the Q-LES-Q for overall life satisfaction and contentment.

Adverse events noted in those on topi-ramate mirrored those known to be associated with other uses of the drug, including dizziness, paresthesias, psychomotor slowing, impairment in memory or concentration, and weight loss.

“Topiramate's effect at improving psychosocial functioning was robust, with an increasing trend toward better outcomes as treatment progressed,” Johnson and his coauthors wrote. “As heavy drinking was reduced, more individuals experienced an improvement in psychosocial functioning.”

Johnson and his colleagues addressed whether a central issue in pharmacotherapy with alcoholism should be complete abstinence or effective reduction in heavy drinking. “The important implication here is that even though abstinence is the `gold standard' of alcoholism treatment and was the goal of this study,” they wrote, “a harm-reduction strategy based on reducing heavy drinking may be a worthwhile treatment goal, especially if the patient will not or cannot become abstinent.”

An abstract of “Oral Topiramate Reduces the Consequences of Drinking and Improves the Quality of Life of Alcohol Dependent Individuals” is posted online at<http://archpsyc.ama-assn.org/cgi/content/abstract/61/9/905>.▪