The epilepsy drug topirimate, long given in the initial stages of alcohol detox to reduce convulsions, has been clinically proven effective in reducing the amount alcoholics participating in a study drank.
Previous relapse prevention medications like antabuse, which made the user very sick if they drank alcohol, have never proven very effective, simply because all the alcoholic needs to do is stop taking the pills at any point, and resume drinking without consequence. They don’t offer any help for the cravings or impulses that lead to a desire to drink – but Topiramate seems different.
Topiramate works through a modification of dopamine in the pleasure centers of the brain. When talking Topiramate, drinking causes less dopamine to be released, and as a result, the act of drinking is not as pleasurable as it was when not taking the medication. This reduction of pleasure seems to be effective both in helping alcoholics drink less, and drink less often.
A recent double blind and placebo study, gave half of the candidates Topiramate, and the other half a placebo, although neither group was aware of what medication they were taking. All study participants were alcoholics and heavy drinkers, and the researchers wanted to see what effect long term usage of Topiramate would have on amount and frequency of alcohol consumption. The study participants began with a low dosage, and the dosage of the medication was gradually tapered up to a daily dose of 300 mg.
The results were astonishing, and researchers reported that the group taking Topiramate drank far less and far less often over time than the group receiving a placebo, and the difference between the groups increased as the dosage of the drug increased. Alcoholics taking Topiramate drank fewer drinks in a sitting (down by almost 3 drinks on average) and also had more days of light drinking and even more days of alcohol abstinence.
More research and study needs to be done on the drug, and some would argue that since the drug doesn’t seem to cause the complete cessation of drinking that it is not a beneficial treatment for alcohol addiction, but I would argue that anything that reduces the quantity and frequency of consumption, reduces the harm created during abuse, and also increases the probability of being able to successfully stop drinking.
Researchers say that the best way to use the medication is in conjunction with other therapies, and that if used in isolation, it is unlikely to have a significant long term benefit. It’s very encouraging in any case, that for the first time ever, there seems to be a drug available that helps drinking alcoholics minimize their consumption, reduce the harm they cause, and improve their ability to benefit from other treatments.