Substitution therapy for alcoholism: time for a reappraisal?
- 8 July 2011
- journal article
- Published by SAGE Publications in Journal of Psychopharmacology
- Vol. 26 (2), 205-212
- https://doi.org/10.1177/0269881111408463
Abstract
A number of compounds already in use as medications for various indications substitute for ethanol at clinically relevant brain pathways, in particular, at gamma-aminobutyric acid (GABA) receptors. Nevertheless, although substitute medications have been recognized for heroin and tobacco dependence, patients with alcohol dependence are rarely offered an analogous approach. Benzodiazepines may have paradoxical effects, and abuse and dependence are known. Baclofen (GABAB agonist) has not been associated with dependence or misuse and has been effective in several trials in preventing relapse, although research is required to establish the optimal dosing regimen. GABA-ergic anticonvulsants, helpful in treating withdrawal, have yet to emerge as effective in relapse prevention. Clomethiazole and sodium oxybate, the latter having been shown to be effective in relapse prevention, have incurred a reputation for dependence and abuse. However, data have emerged showing that the risk of abuse of sodium oxybate is lower than many clinicians had foreseen. For a condition where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality, the time now seems right for reappraising the use of substitute prescribing for alcohol dependence.This publication has 62 references indexed in Scilit:
- Baclofen Effect Related to Liver DamageAlcohol: Clinical and Experimental Research, 2011
- Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem®): Differences in characteristics and misuseDrug and Alcohol Dependence, 2009
- A Double‐Blind Trial of Gabapentin Versus Lorazepam in the Treatment of Alcohol WithdrawalAlcohol: Clinical and Experimental Research, 2009
- Gamma Hydroxybutyric Acid (GHB) for the Treatment of Alcohol Dependence: A ReviewInternational Journal of Environmental Research and Public Health, 2009
- Acute Interaction of Baclofen in Combination With Alcohol in Heavy Social DrinkersAlcohol: Clinical and Experimental Research, 2008
- Baclofen and Gamma-Hydroxybutyrate WithdrawalNeurocritical Care, 2008
- Relative Abuse Liability of γ-Hydroxybutyric Acid, Flunitrazepam, and Ethanol in Club Drug UsersJournal of Clinical Psychopharmacology, 2007
- ??-Hydroxybutyric AcidToxicological Reviews, 2004
- γ-Hydroxybutyric acid in the treatment of alcoholism: dosage fractioning utility in non-responder alcoholic patientsDrug and Alcohol Dependence, 1998
- Maintaining abstinence from alcohol with γ-hydroxybutyric acidThe Lancet, 1998