Topiramate Helps Alcoholics by Reducing Cravings
Topiramate is the generic name of a medication that doctors in the U.S. increasingly use as an adapted treatment for people in recovery for alcoholism. The medication appears to make drinking less likely to occur during the recovery process, but no one knows precisely how or why. In a study published in October 2014 in the journal Addiction Biology, researchers from three U.S. institutions sought to determine the specific reasons why topiramate improves the prospects for successful alcoholism treatment. These researchers concluded that the medication produces its primary effects by reducing the body’s sensitivity to alcohol cravings.
Apart from topiramate, doctors can use several FDA-approved medications to help people recover from alcoholism. One medication, disulfiram (Antabuse), promotes drinking avoidance by triggering exaggerated forms of alcohol-related side effects. Another medication, acamprosate (Campral), produces adjustments in brain chemistry that make it less likely that a person heavily affected by alcoholism will experience severe withdrawal symptoms after going through alcohol detoxification. A third medication, Naltrexone (Vivitrol), blocks some of the pathways that alcohol uses to reach the brain and makes a relapse less likely by reducing the amount of pleasure produced by alcohol intake. Some alcohol programs rely primarily on a type of psychotherapy called behavioral therapy rather than a medication-based approach.
Topiramate is sold in the U.S. as Topamax. Pharmaceutical researchers developed the medication as a treatment for epilepsy and another seizure disorder called Lennox-Gastaut syndrome, not as a treatment for alcoholism (alcohol dependence). In a seizure context, topiramate is typically used to help people who don’t respond to other medications designed to reduce the frequency or severity of uncontrolled convulsions. Doctors also sometimes prescribe the medication for people with migraine headaches in order to reduce the frequency (but not the severity) of these types of headaches. Whether used for seizure treatment or migraine prevention, topiramate apparently produces its benefits by reducing the amount of excessive and potentially chaotic cell-to-cell nerve communication inside the brain. It does this by increasing the level of a key chemical that slows down brain activity and decreasing the level of a second key chemical that speeds up brain activity.
In the context of alcoholism treatment, topiramate is an “off-label” medication. This means that while the U.S. Food and Drug Administration (FDA) has not specifically approved the use of topiramate in people affected by alcoholism, practical experience among doctors has shown that the medication has a beneficial effect. Specifically, topiramate use can decrease the chances that a person trying to establish a pattern of alcohol abstinence will drink substantial amounts of alcohol.
How Does Topiramate Work?
In the study published in Addiction Biology, researchers from Brown University, Providence Veterans Affairs Medical Center and the University of Georgia used an assessment of 96 adults to help determine exactly how topiramate decreases the likelihood of drinking in people recovering from alcoholism. All of these adults qualified as heavy drinkers and therefore had increased risks for developing diagnosable alcohol use disorder (alcoholism and/or alcohol abuse); however, none of them merited a current alcohol-related diagnosis or were seeking treatment for alcohol problems. The researchers tested the effects of topiramate in laboratory-based experiments as well as in experiments carried out in more natural drinking situations.
After evaluating the effects of topiramate on the consumption behaviors of the study participants, the researchers concluded that the medication produces its effects by decreasing the intensity of the urges or cravings that support excessive alcohol intake. Specifically, the medication reduced the participants’ craving levels when they were actively consuming alcohol; in turn, this reduced level of craving led to a reduced level of intake on days when alcohol use occurred.
The study’s authors note that topiramate does not appear to alter the intoxicating effects of alcohol. They believe that they are among the first researchers to demonstrate the impact that the medication has on alcohol cravings in a real-world situation. In addition, the authors believe that their work underscores the relevance of the reduction of alcohol cravings (one of the 11 potential diagnosable symptoms of alcohol use disorder) as a meaningful and achievable goal for alcoholism medications in general.