As reported by The Hartford Courant, October 9, 2007.

Headache Pill Helps Curb Drinking

By William Hathaway

Heavy drinkers can significantly reduce their consumption of alcohol by taking the headache drug Topamax, a study published online today says.

The results, which will appear in Wednesday's print issue of the Journal of the American Medical Association, do not signal a cure for alcoholism, but rather a new tool that can help the alcoholic quit -- or more controversially -- cut back on their drinking, the study's authors say.

"This is definitely not a home run, but compared to existing treatments this is a double, when all we have had before is singles,'' said Dr. Henry Kranzler, professor of psychiatry at the University of Connecticut and contributing author to the study.

However, addiction experts warn against sending a message to alcoholics that a drug might allow them to drink safely.

"You won't find me telling a patient here to take a pill and go drink moderately,'' said Janina J. Kean, president and chief executive of High Watch Farm, a substance abuse treatment center in Kent. "You might as well give them a gun and tell them to go shoot themselves.''

UConn was one of 17 sites to test topiramate, the generic name for Topamax, on 371 people who drank 11 drinks a day on average. The drug is made by Ortho-McNeil, which funded the study,

The study was unusual in that it measured a reduction in consumption among active drinkers, rather than the relapse rates of abstinent alcoholics.

According to several measures, individuals in the study who were taking the drug were more likely than subjects receiving a placebo to reduce drinking or even abstain from drinking during the 14-week trial. The drug works on several areas of the brain to reduce the craving for alcohol.

The study group participants on average had at least five drinks on 82 percent of the days prior to entering the study.

Those "heavy drinking'' days were reduced to 44 percent by people who took topiramate, compared to 52 percent among those taking the placebo.

The beneficial effects of topiramate seemed to get stronger the longer people took the drug, the study showed. However, 10 percent of subjects taking the drug experienced adverse side effects such as fatigue and short-term memory loss.

For a variety of reasons, including a lingering belief among physicians that alcoholism is a moral disorder rather than a disease, many doctors have been loathe to prescribe drugs to treat alcoholism, said lead author of the study Dr. Bankole Johnson, chairman of the department of psychiatry at the University of Virginia.

However, Johnson and Kranzler argue that topiramate appears to be more effective than two drugs currently used to treat cravings associated with alcohol dependence, naltroxene and acamprosate. Also, the drug can used without extended and expensive rehabilitation stays.

But Kranzler and Johnson tread on much more controversial ground when they also suggest that with drugs like Topamax, it is possible that some of the heavy drinkers might be able to moderate their drinking to safer levels.

"If it can be shown, that chronic treatment lead to chronic remission as with blood pressure medication, why not?" Johnson said. Kranzler says he is not advocating that alcoholics who have stopped drinking try to drink safely again.

But he also notes the majority of the people in the JAMA study wanted to reduce drinking, not to stop. And in theory, some of the study participants might be successful at permanently reducing drinking with the help of drugs such as topiramate.

At this point, he said, science can't figure out which people might be successful at just cutting back and which need to stay away from alcohol altogether.

"There here are a subset of people who can never drink in a limited way and those people ought to be abstinent,'' Kranzler said. "But I can't pick them out." Kean at High Watch says that such drugs will be of great value in reducing severe cravings associated with alcohol withdrawal but that abstinence should be the only goal for addicts who will do anything for a drink or a drug.

She said many alcoholics often have to deal with severe psychological problems and need a social support network like Alcoholics Anonymous to remain sober.

"The best outcomes occur in people who don't drink at all and attend AA meetings,'' agreed Dr. Mark L. Willenbring, director of treatment and recovery research for the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health.

However, Willenbring also says that while abstinence should be the goal for problem drinkers, a reduction in alcohol abuse, which that carries an annual cost of $185 billion in the United States alone, could have great benefits to society.

"But we shouldn't confuse goals with real outcomes,'' he said.