Drug to Treat Nausea Also May Help Alcoholics Stop Drinking

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Aug. 22, 2000 -- The first time Francisco Gomez took a drink at age 15, it was like a "runaway train," he says. "From the beginning, I would drink until I blacked out. From that point on, I basically lived to drink. I joined the military and was stationed on a nuclear submarine that went on 90-day patrols. Of course, there was no drinking, but the minute we hit shore I went straight to a bar."

Alcohol had cost the 48-year-old Texas man three marriages, countless jobs, and the right to see his two children by the time he sought help for his addiction last year through the University of Texas Health Science Center in San Antonio. It was there that he learned he fit the classic profile of an early-onset alcoholic, and it was there that he got the help he needed to stop drinking.

Gomez was one of 321 alcoholics who took part in a study combining intensive behavioral therapy with the drug Zofran (ondansetron), now used to treat nausea caused by chemotherapy. The therapy, known as cognitive behavioral therapy, helps alcoholics to abstain by improving their ability to deal with situations that can cause them to seek out alcohol, the researchers say.

Researcher Bankole A. Johnson, MD, PhD, and colleagues found that Zofran, which targets the chemical messenger serotonin in the brain, appeared to help those patients who fit the profile for early-onset alcoholism. Their findings were reported in the Journal of the American Medical Association.

"We have learned that one of the important features of early-onset alcoholism is that these people have an abnormality in their serotonin system," Johnson tells WebMD. "This does not mean that they don't have other abnormalities, but that the abnormality of serotonin is important."

Studies suggest that 25 to 30% of alcoholics fit the early-onset profile, which includes having family members who are alcoholic; binge or problem drinking beginning in the teens or early 20s; and the early development of social problems related to drinking. Most early-onset alcoholics also are born risk-takers, according to James Mulligan, MD, medical director of Pennsylvania's Caron Foundation. The Caron Foundation is one of the nation's oldest alcohol centers, treating some 6,000 patients each year.

"About 95% of the kids in our adolescent center fit the profile," Mulligan tells WebMD. "They know they are different, and it is good that they know that. We believe that substituting the risk-taking behavior of drinking for some other risk-taking behavior is important. We take our young people rock climbing."

Drug therapies are not widely used to treat alcoholism, mainly because they have not been shown to be very effective in the past. There currently are only two drugs approved for use in the U.S. -- Antabuse (disulfiram), which makes people sick when they drink, and ReVia (naltrexone), which seems to dull the rewarding or "buzz" effect of alcohol. A third drug, acamprosate, which works by curbing cravings for alcohol, is expected to win FDA approval soon.

Although Zofran affects the brain's serotonin levels, it works in an opposite way from widely prescribed antidepressants that affect the serotonin system, known as SSRIs, such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine), Johnson says.

"A few years ago, when we learned that these genetically predisposed alcoholics had a deficiency in serotonin, it was widely believed the SSRIs like Prozac would help these people stop drinking, but that has not proven to be the case," Johnson says. "That's why our findings are so exciting. This serotonin interaction seems to help."

Although Zofran is widely available, it can be expensive, with a 30-day supply of the 4 mg tablets ranging from about $450 to more than $600, according to an informal survey of pharmacies across the country.

About three-fourths of the patients enrolled in the San Antonio study received varying doses of the drug and the others received a placebo. Johnson says those patients receiving Zofran reported that they had a decreased craving for alcohol, and that drinking did not give them the same "rush" as it had in the past. All of the patients, regardless of whether they were given the drug or a placebo, received behavioral therapy.

The alcoholics who took Zofran stayed away from alcohol 70% of the time, compared to 50% of the time for those who took a placebo.

Gomez, who still does not know whether he received Zofran or the placebo, says his drive to drink was definitely diminished during the 12-week study. He attributes much of this to the group therapy sessions he attended religiously during that time, but he says the medication could have played a large part. He has not had a drink in more than a year.

"I spent 30 days in a Maryland treatment center back in the late 1980s, and I came out of there with the idea that if I was going to keep drinking, I had to cut down," he says. "So I worked my way down to 10 or 12 beers a day, and I thought I was doing good. When I joined this study, my counselor asked me what I wanted to achieve, and I said it might be nice to get down to a six-pack a day. But little by little, I realized that I couldn't just cut back. I had to quit."

It is not clear how big a role drug therapy played in Gomez's recovery, but all those interviewed agreed that it is likely to play a big role in the treatment of alcoholism and drug addiction in the future.

"Over the next decade, we are going to see more and more medications aimed at treating substance abuse," Henry R. Kranzler, MD, tells WebMD. "I think it is similar to where we were with cigarettes back in 1991, when the nicotine patch was approved. Since that time, we have seen a substantial decline in smoking, and with the availability of these new drugs, we may see a substantial impact on alcoholism over the next 10 years." Kranzler wrote an editorial accompanying the study.

For Gomez, the study and the year of sobriety have allowed him to see things clearly for the first time in his adult life.

"I used to be a photography major, I was a cook in the Navy, I enjoy doing macramé, but I didn't do any of those things when I was drinking because drinking was a full-time job," he says. "The study helped me remember all those things that I had stashed in the attic of my brain, and now I am bringing those things back into my life. I've just registered for a photography class that begins in the fall."

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