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Pregabalin Matches Naltrexone in Lowering Alcohol Craving

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Pregabalin Matches Naltrexone in Lowering Alcohol Craving 28 Addiction Psychiatry C LINICAL P SYCHIATRY N EWS • October 2008 Type of Drink Is More Critical Than Number BY KERRI WACHTER Amee J. Epler, a graduate student in psychological sci- tired than usual,” “headache,” “nauseous,” “very weak,” Senior Writer ences at the University of Missouri, Columbia, and her “extremely thirsty,” or “dehydrated.” colleagues. The mood states included “scared,” “upset,” “dis- B ALTIMORE — Drinking clear liquors—such as vodka The researchers studied the drinking habits of 127 tressed,” “enthusiastic,” “interested,” and “proud.” and gin—and drinking more than one type of alcoholic students at a large Midwestern university over a 14-day Almost three-quarters (73%) reported at least one beverage are both associated with an increased risk of period. The sample was predominantly white (85%), drinking episode over the 14-day study; 41% reported at having a hangover among college students, even after con- with slightly more women (61%). Smokers accounted least one hangover. Among participants who reported at trolling for the number of drinks. for 43%. least one hangover, the number of hangovers ranged Students who drank clear liquors were twice as likely The students monitored their experiences several times from one to seven (median two). Drinking episodes and to have a hangover as those who drank beer, even after a day during a 14-day period using an electronic diary. The reports of hangover were associated primarily with controlling for the number first question asked each day weekends—75% of each occurred on Fridays, Saturdays, of drinks, according to a Students who drank clear liquors were was whether the student had or Sundays. poster presented at a joint drunk alcohol on the previ- Students reporting a hangover consumed 10 drinks, meeting sponsored by the twice as likely to have a hangover as ous day. Those who an- compared with 6 drinks for those without a hangover. Research Society on Alco- those who drank beer, even after swered “yes” were asked sev- The number of drinks consumed was a significant pre- holism and the Internation- controlling for the number of drinks. eral follow-up questions dictor of hangover. al Society for Biomedical Re- about the drinking episode: The most frequently consumed beverage was beer— search on Alcoholism. number of drinks, duration 74% of drinking records. Beer was followed by clear Likewise, consuming more than one type of beverage of the episode, types of beverages consumed, and pres- liquors (37%), dark liquors (24%), non–beer malt bever- also was associated with hangover, even after controlling ence of a hangover. ages (9%), white wine (6%), liqueur/schnapps (5%), and for the number of drinks. The researchers also found that women might be red wine (4%), the investigators found. “Although these results suggest that consuming more more susceptible to hangover at similar levels of con- Symptoms more likely to be reported on hangover days than one beverage type or consuming clear liquors is as- sumption. included “extreme thirst or dehydration,” “more tired sociated with hangover endorsement, it is not clear In addition, the students were asked about several hang- than usual,” “headache,” and “nausea.” whether this is due to the specific beverages consumed over symptoms and mood states, regardless of whether “Interestingly, none of the mood symptoms (with the or to other factors than may contribute to hangover, they reported a hangover. possible exception of ‘upset’) were significantly associat- such as rate of consumption and drinking style,” wrote Hangover symptoms included these categories: “more ed with hangover,” the investigators wrote. ■ Comorbid Mental Disorders Pregabalin Matches Naltrexone Predict Chronic Medical Illness In Lowering Alcohol Craving BY KERRI WACHTER quarters (72.5%) were male. Forty-five BY MICHELE G. SULLIVAN scores were found over the treatment pe- Senior Writer percent were white, 39% were African Mid-Atlantic Bureau riod. More patients taking pregabalin re- American, 2% were American Indian, mained alcohol free for the entire study WASHINGTON — Chronic medical con- and 14% were mixed or other. Slightly B ARCELONA — Pregabalin reduced (15 vs. 11) and, although this was not sta- ditions are very common among patients more than half (55%) had a diagnosis of alcohol craving scores just as effectively tistically significant, a survival curve with co-occurring schizophrenia and al- schizophrenia; 45% had schizoaffective as did naltrexone and was associated showed that those taking pregabalin re- cohol use disorder. In one study of 80 pa- disorder. with a longer period of alcohol absti- mained abstinent for a significantly tients, 83% of the patients had at least one Almost all (95%) were diagnosed with nence, especially in patients with a co- longer period. There were no significant chronic illness. alcohol dependence; 5% were diagnosed morbid psychiatric disorder, according to differences in posttreatment relapses. The most common chronic illnesses in with alcohol abuse. Roughly three-quar- the first randomized comparison trial of Patients taking pregabalin showed sig- the study were hypertension (46.3%), gas- ters (77.5%) reported having a primary the two drugs. nificantly lower withdrawal scores than troesophageal reflex disease (26.3%), asth- care provider at the study start. Pregabalin also positively affected anx- did those taking naltrexone, with the ma (23.8%), hyperlipidemia (22.5%), and In the past 6 months, 26% reported a iety, hostility, and psy- difference apparent in as osteoarthritis/degenerative joint disease psychiatric hospitalization, 4% reported a choticism—additional Patients taking little as 2 weeks. (21.3%), according to a poster presented at medical hospitalization, and 3% reported benefits for patients with a pregabalin Psychiatric symptoms a joint meeting sponsored by the Research a substance-related hospitalization. Also in combination of alcohol were assessed with the Society on Alcoholism and the Interna- the past 6 months, 29% reported an emer- and psychiatric problems, showed far lower Symptom Checklist 90-Re- tional Society for Biomedical Research on gency department visit for medical rea- Dr. Giovanni Martinotti withdrawal vised. By this measure, Alcoholism. sons, and 16% reported an ED visit for psy- reported in a poster at the those taking pregabalin “Comparing our sample to that of the chiatric reasons. annual congress of the Eu- scores than those showed significant de- CATIE (Clinical Antipsychotic Trials in Illness burden was predicted by demo- ropean College of Neu- taking naltrexone, creases in the general “pos- Intervention Effectiveness) trial, medical graphic factors (e.g., age) and alcohol use ropsychopharmacology. itive symptoms total” in- illness burden appears to be markedly severity (e.g., γ-glutamyl-transferase) and “The mechanisms in- with the dex, as well as in the higher in patients with both schizophre- was less influenced by psychiatric severi- volved in the efficacy of difference subscales for phobic anxi- nia and alcohol dependence than in pa- ty. “The positive correlation between al- pregabalin could be less ety, hostility, and psychoti- tients with schizophrenia only,” wrote cohol use severity and medical illness is related to craving for al- apparent in as cism, he wrote. Dr. Zsuzsa S. Mezaros, who is with the mainly related to γ-glutamyl-transferase cohol and more connect- little as 2 weeks. Among those patients psychiatry department of the State Uni- (GGT) levels, an objective measure of ed to the treatment of with a dual diagnosis of al- versity of New York, Syracuse, and her transaminase elevation possibly due to these comorbid psychiatric disorders,” cohol-use disorder and a psychiatric dis- colleagues. alcohol-related liver injury,” the re- wrote Dr. Martinotti of Catholic Uni- order, pregabalin was associated with a The study involved 80 outpatients with searchers wrote. versity’s treatment unit for alcoholism significantly higher total abstinence score schizophrenia or schizoaffective disorder Patient-reported levels of alcohol/drug and multiple drug abuse, Rome. than was naltrexone (50% vs. 15%). and co-occurring alcohol dependence or use were not significantly related to med- His 16-week study included 59 alcohol- “If it could be confirmed in placebo- abuse who were enrolled in a trial of di- ical severity. “This raises the possibility that dependent patients, with a mean of 15 controlled trials that pregabalin is effica- rectly monitored naltrexone treatment. biological markers of alcohol use may be years’ alcohol addiction; their mean dai- cious in decreasing alcohol use, lessening Patients were prescribed antipsychotic a more reliable or sensitive correlate of ly alcohol consumption was 8 drinks. craving, and attenuating psychopatho- medications by their clinical treatment medical status than self-report in patients These patients (mean age 40 years) were logical symptom severity, we will have providers. However, they were not pre- with schizophrenia.” detoxified over 5-10 days, and then ran- gained a valuable agent for the treatment scribed acamprosate (Campral), naltrex- The study was supported by a grant domized to either naltrexone 50 mg dai- of alcohol-dependent subjects,” Dr. Mar- one (Revia), or disulfiram (Antabuse). from the National Institutes of Health ly (28) or pregabalin at an average dose tinotti wrote. Patients ranged in age from 18 to 69 and the National Institute on Alcohol of 275 mg daily (31). Dr. Martinotti said he had no disclo- years; mean age was 42. Almost three- Abuse and Alcoholism. ■ No significant differences in craving sures to make regarding the study. ■.
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