According to a recent Science Daily release, study findings exploring the relationship between hospital stays and alcohol-related illnesses show that focusing on these illnesses may actually make hospital interventions more effective.

Emily C. Williams, research project director at the VA Puget Sounds Health Care System and corresponding author of the study noted that the qualities of “teachable moments” are complicated.

"On one hand, it may be the first time that a patient realizes that their drinking is responsible for a very serious illness or event requiring acute hospital care," she said.

"On the other hand, there are people who continue to drink heavily despite knowing the consequences associated with it. For the former group, hospitalization may serve as a strong impetus of change whereas, for the latter group, hospitalization may be met with a neutral attitude (or worse) toward change."

In recruiting 341 adult medical inpatients from a university medical center who self-reported risky drinking during the previous month, researchers examined their initial hospital screening. Participants were then enrolled in a randomized trial of brief alcohol counseling and interviews were conducted at enrollment and three months after hospitalization.

Researchers found that among inpatients with unhealthy alcohol use whose drinking is less severe, alcohol-attributable illness may serve as a strong catalyst of changes in drinking. At the same time, alcohol-attributable illnesses could become a focus of hospital-based brief counseling interventions.
 

It is believed that topiramate dampens the desire to drink, perhaps by reducing dopamine release by neurons in the brain’s reward circuitry. Dopamine is the surge experienced by alcoholics when they consume a drink.

Results of International Research

As recently as February 2009, the Director’s Report of NIDA published findings of an international research study in Brazil, “Comparing Topiramate with Naltrexone in the Treatment of Alcohol Dependence.” The double-blind, 12-week, placebo-controlled Brazil study included 155 patients between the ages of 18 and 60 who had been diagnosed with alcohol dependence. After a 1-week detoxification period, patients were randomly assigned to receive either topiramate (induction to 300mg/day), naltrexone (50 mg/day) or a placebo.

Measurement consisted of time to relapse – designated as consumption of more than 60 grams of ethyl alcohol, duration of cumulative abstinence, and weeks of heavy drinking. The analyses of intention-to-treat showed topiramate to be superior to the placebo in a number of important measures. These included time to first relapse (7.8 versus 5.0 weeks), duration of cumulative abstinence (8.2 versus 5.6 weeks), weeks of heavy drinking (3.4 versus 5.9 weeks), and percentage of study subjects abstinent at 4 weeks (67.3 versus 42.6 percent), and 8 weeks (61.5 versus 31.5 percent), but not 12 weeks (46.2 versus 27.8 percent). Authors of the study report that results remained significant after controlling for attendance in Alcoholics Anonymous, which was also higher in topiramate than in other groups.

While there were reportedly no significant differences between the naltrexone versus placebo or naltrexone versus topiramate groups, naltrexone did show trends toward inferior outcomes compared to those of topiramate. The study authors conclude that the results support the efficacy of topiramate in relapse prevention of alcoholism. They point to the need for future research with larger sample sizes to verify the suggestive evidence obtained for topiramate’ superiority versus naltrexone in the treatment of alcoholism.

Previous U.S. Study

Published in the June 2008 issue of Archives of Internal Medicine, a 14-week trial by the University of Virginia Health System team found that topiramate decreased heavy drinking and reduced the physical and psychosocial damage caused by dependence on alcohol. Among heavy alcohol drinkers, physical organs are at risk, particularly the heart and liver. The overall quality of life of alcoholics also suffers to a great degree.

Topiramate has the following benefits, according to the study authors:

• Reduces hypertension – Topiramate significantly reduces drinking and also significantly decreases blood pressure. Many alcoholics are prescribed anti-hypertensive medication for their hypertension, which can complicate alcohol-dependence treatment. Topiramate alone can be used instead of several medications.
• Lowers blood pressure and cholesterol levels – By lowering plasma cholesterol levels a significant amount, and reducing systolic and diastolic blood pressure levels, topiramate may reduce the heart disease risk in alcohol-dependent patients.
• May reduce risk of fatty liver disease – As a result of lowering cholesterol and liver enzyme levels, topiramate may help reduce the risk of fatty liver disease – which often leads to cirrhosis of the liver. Cirrhosis is a consequence of end-stage liver disease which often ends in death of alcoholics.
• Reduces alcohol cravings – Researchers found that topiramate contgributed to a significant decease in drug cravings, the obsessive compulsions and thoughts about using alcohol.
• Improved quality of life – Overall quality of life improved among subjects taking topiramate, as copared to a placebo, in areas such as general and leisure activities, performing household chores and tasks, and in limiting sleep disturbances.

Following release of the trial findings, Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) commented that topiramate’s “level of effectiveness seemed to be at least as good as naltrexone and maybe better.”

Ortho-McNeil Neurologics, Inc., the manufacturer of topiramate, funded the UVA study.

Status of Topiramate for Alcohol Treatment

Following three promising trials, much still needs to be done to clear the way for topiramate to be approved for the treatment of alcoholism. Currently, the U.S. Federal Drug Administration (FDA) has only approved topiramate, marketed as Topamax, for the treatment of epileptic seizures and migraine headaches.

Before the drug can be considered for approval for alcohol treatment, further and more in-depth studies with larger sample sizes need to be conducted.

Current FDA-Approved Drugs for Treatment of Alcoholism

Currently, only three drugs have been approved by the FDA for the treatment of alcoholism.

• The first one approved was Disulfiram, marketed as Antabuse. Antabuse blocks alcohol metabolism, and gives the drinker a toxic reaction when they drink. According to numerous sources, disulfiram has fallen out of favor with many doctors. An alcoholic can easily stop taking the drug before deciding to go on a binge, so it is not truly effective in all cases.
• The second drug approved was naltrexone, marketed as ReVia, Depade, and Vivitrol, which the FDA approved in 1995. Nalrexone works by blocking opoid receptors and, through monthly injections, curtails euphoria of alcohol.
• The third, and most recently approved drug was acamprosate, marketed as Campral, approved in 2004. Campral is a non-addicting drug and appears to reduce the desire to drink, but it may not be effective in those who still drink.
 

There are a number of reasons an individual will report to a treatment facility, but five substances accounted for 96 percent of all TEDS admissions in 2007. These substances included alcohol in a strong lead at 40 percent; opiates, primarily heroin, at 19 percent; marijuana at 16 percent; cocaine at 13 percent; and stimulants at 8 percent. The primary stimulant used was methamphetamine.

While alcohol was the primary substance of use in TEDS admissions, it was still down from 50 percent in 1997. Roughly three-quarters of admissions for alcohol abuse alone and for alcohol use with a secondary drug were male. For alcohol-only admissions, the average age of those admitted was 39 years. The average age for individuals admitted with an alcohol and drug problem was 35 years.

Of those alcohol users admitted in 2007, 45 percent reported using a secondary drug as well. For those alcohol-only admissions, 69 percent were white, 13 percent were of Hispanic origin and 11 percent were non-Hispanic Black. Those admitted with a secondary drug problem also had a mixed population. A full 60 percent were non-Hispanic White, 23 percent were non-Hispanic Black and 11 percent were of Hispanic origin.

Heroin had an interesting change of pace throughout the ten years of data capture. While it was a primary substance for 15 percent of TEDS admissions in 1997, it increased to 16 percent in 2001. Admissions then took a turn as heroin as a primary substance declined to 14 percent in 2004 through 2007.

Males tended to dominate the heroin admissions as 69 percent who reported primary substance were male. Non-Hispanic White accounted for 52 percent of primary heroin admissions, followed by 22 percent who were of Hispanic origin and 22 percent who were non-Hispanic Black.

The average age for primary heroin admissions was 36 years. At the same time, 64 percent of primary heroin admissions reported injection as the primary method of administration. Another 32 percent reported inhalation and 2 percent reported smoking the drug.

Those individuals with TED admissions with marijuana as primary abuse increased from 12 percent in 1997 to 16 percent in 2003 through 2007. Roughly 74 percent of these admissions were male and 51 percent were non-Hispanic White. Another 29 percent were non-Hispanic and 15 percent were of Hispanic origin. The average admission age was 24 years old.

Cocaine and/or crack use also danced around in admission numbers over the ten year data period. Admission numbers sat at 15 percent in 1997 and decreased to 13 percent in 2001 and 2002. Admissions then increased to 14 percent from 2003 through 2006 before declining again to 13 percent in 2007.

Those who smoked cocaine as crack represented 72 percent of all primary cocaine admissions in 2007. 58 percent of those individuals admitted for smoked cocaine as the primary substance were male, versus 65 percent of non-smoked cocaine admissions. The average age for smoked cocaine use was 39 years, while the average age for non-smoked cocaine was 34 years.

For those primary cocaine admissions who smoked the drug, 49 percent were non-Hispanic Black, 40 percent were non-Hispanic White and 8 percent were of Hispanic origin. For non-smoked cocaine use, non-Hispanic Whites represented 54 percent, followed by non-Hispanic Blacks at 23 percent and persons of Hispanic origin at 19 percent.

Individuals who were admitted for cocaine use as a primary who did not smoke the drug inhaled it 81 percent of the time. Another 11 percent reported injection as the method of administration and 5 percent reported oral use.

Overall, those TEDS admissions with methamphetamine or other stimulants as the primary abuse increased from 4 percent in 1997 to a high of 9 percent in 2005. Admissions in 2006 decreased to 8 percent and remained at this level in 2007. Of these admissions, 54 percent were male and the average age was 32 years.

For these primary stimulant users, 66 percent were non-Hispanic White, 21 percent were of Hispanic origin and 3 percent were Asia/Pacific Islander or non-Hispanic Black. The most common method of administration reported was smoking by 66 percent, 18 percent reported injection and 10 percent reported inhalation.

The second part of this summary will include such data as education level, employment status, type of service, sources of referral and race and/or ethnicity.