Abstract
Since alcohol-related problems affect almost 20% of the adult population, effective therapies are needed. Newly developed pharmacological strategies have been tested experimentally in animals and humans and progress is apparent. For example, an imidazobenzodiazepine (Ro15-4513) has recently been found to antagonize ethanol intoxication in rats selectively. However, testing in humans may be prevented by toxicity and ethical concerns. Abrupt discontinuation of ethanol intake in dependent subjects results in a withdrawal syndrome (AWS). With the recently developed benzodiazepine loading dose technique, practically all patients can be effectively treated with oral diazepam. Recent studies in rats suggest that non-sedative calcium channel blockers (e.g. nitrendipine, nifendipine) may also attenuate the AWS. New pharmacological strategies for decreasing alcohol consumption have also been developed. In three randomized, double-blind, controlled studies, serotonin uptake inhibitors (zimelidine, citalopram and viqualine) have consistently attenuated alcohol consumption in early stage problem drinkers. Effects on ethanol intake are distinct from the antidepressant properties of these drugs and they are most likely explained by a facilitation of satiety signals. Recently, new pharmacological approaches for attenuating neurological and hepatic alcohol-related problems have been described. Examples illustrate how the integration of basic and clinical pharmacological strategies may lead to improved pharmacotherapy for alcoholism within the foreseeable future.
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Claudio A. Naranjo
Both authors formerly Public Health Officers, Eastern Sydney Area Public Health Unit Previously general practitioner, Orange NSW, Australia.