Medication treatment of different types of alcoholism

Johnson, Bankole A.

doi:10.1176/appi.ajp.2010.08101500

Cited by 152Substance Abuse Treatment and OutcomesNeurotransmitter Receptor Influence on BehaviorAlcohol Consumption and Health Effects

Medication treatment of different types of alcoholism

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Johnson, Bankole A.·2010·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2010.08101500PMC PMC2939449

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Abstract

Alcoholism remains a serious cause of morbidity and mortality despite progress through neurobiological research in identifying new pharmacological strategies for its treatment. Drugs that affect neural pathways that modulate the activity of the cortico-mesolimbic dopamine system have been shown to alter drinking behavior, presumably because this dopaminergic system is closely associated with rewarding behavior. Ondansetron, naltrexone, topiramate, and baclofen are examples. Subtyping alcoholism in adults into an early-onset type, with chronic symptoms and a strong biological predisposition to the disease, and a late-onset type, typically brought on by psychosocial triggers and associated with mood symptoms, may help in the selection of optimal therapy. Emerging adults with binge drinking patterns also might be aided by selective treatments. Although preliminary work on the pharmacogenetics of alcoholism and its treatment has been promising, the assignment to treatment still depends on clinical assessment. Brief behavioral interventions that encourage the patient to set goals for a reduction in heavy drinking or abstinence also are part of optimal therapy.

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The psychological or cognitive threat of a DER is thought to be dominant and active and thus dissuade use.
“To prevent the first drink, however, the psychological or cognitive threat is thought to be dominant and active and thus dissuade use [5], [6], [7].”
From Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis (2014) · cites this paper as [7]

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BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP
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Rat animal models for screening medications to treat alcohol use disorders
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Comparison of the Effect of the GABAB Receptor Agonist, Baclofen, and the Positive Allosteric Modulator of the GABAB Receptor, GS 39783, on Alcohol Self‐Administration in 3 Different Lines of Alcohol‐Preferring Rats
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“As such, development of effective treatments for AUDs represents an important public health goal (Bouchery et al., 2011; Heilig and Egli, 2006; Johnson, 2010; Johnson et al., 2007; Steensland et al., 2007).”
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“Abstinence from alcohol along with proper pharmacological (Johnson, 2010) and behavioral therapies (Hagedorn et al., 2016) can effectively minimize recidivism and reverse steatosis in people with AUDs.”
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“…a particular typology predict’s the efficacy of certain pharmacotherapies (Cherpitel, Moskalewicz, & Swiatkiewicz, 2004; Dundon, Lynch, Pettinati, & Lipkin, 2004; Epstein et al., 1995; Forray & Sofuoglu, 2014; Hulse, 2012; Johnson, 2005, 2010; Johnson, Ait-Daoud, Ma, & Wang, 2003; Keating, 2013).”
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“For example, clinical presentation can vary widely, and there is little consensus as to what constructs should be used to delineate subgroups (Johnson 2010).”
Background
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“While genetic factors are undoubtedly important to NTX efficacy (Johnson, 2010; Kimura and Higuchi, 2011), other individual differences may also be important.”
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Ripley, T. L., & Stephens, D. (2011) · British Journal of Pharmacology · doi:10.1111/j.1476-5381.2011.01406.x · Cited by 38 · see citing works
“However, the effectiveness of these treatments is not universal across alcoholic patients (Egli, 2005; Heilig and Egli, 2006; Johnson, 2008; Johnson, 2010), suggesting that a single treatment for all forms of alcoholism may not be possible.”
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“With the exception of disulfiram, medications for relapse prevention target brain receptors thought to be involved in relapse, including subsets of opioidergic, serotenergic, glutamatergic, and dopaminergic receptors [88], and complete abstinence may not be realized.”
Background
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Shi, X., DeLucia, A. L., Bao, J., & Ping, Z. (2019) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2019.03.001 · Cited by 34 · see citing works
“psychosocial as well as psychotherapeutic approaches to treat alcohol addiction and abuse should be the primary choice for treatment (Johnson, 2010).”
Background
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“Two subtypes of alcoholism have been widely recognized: TypeA, or late onset, alcoholism develops after age 25; and Type-B, or early onset, alcoholism develops before age 25 (Johnson, 2010).”
Background
Alternative Splicing of AMPA Subunits in Prefrontal Cortical Fields of Cynomolgus Monkeys Following Chronic Ethanol Self-Administration
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Background
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Lynch, W. J., Bond, C. W., Breslin, F. J., & Johnson, B. A. (2011) · Psychopharmacology · doi:10.1007/s00213-011-2253-0 · Cited by 32 · see citing works
“Both ondansetron and topiramate are believed to modulate dopaminergic signaling (Johnson 2010), and when combined, it is possible that their effects on dopamine depend on basal levels.”
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“These drugs attempt to deter alcohol intake by blocking its metabolism or by targeting the neurochemical and neuropeptide systems in the downstream cascades leading to craving and dependence (Gewiss et al., 1991; Colombo et al., 2007; Steensland et al., 2007; Johnson, 2010; Litten et al., 2012).”
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“As such, the development of effective medications to treat AUD is an important public health goal (Bouchery et al., 2011; Heilig and Egli, 2006; Johnson et al., 2007; Johnson, 2010; Steensland et al., 2007).”
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“Understanding the neurobiological components of hedonic substitution will provide for further comprehension of the addiction process, and additional strategies for combating alcohol use disorders (AUDs).”
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“As such, development of effective treatments for AUDs represents an important public health goal (Bouchery et al., 2011; Heilig and Egli, 2006; Johnson, 2010; Johnson et al., 2007; Steensland et al., 2007).”
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Pharmacological means of reducing human drug dependence: a selective and narrative review of the clinical literature
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“1999) and/or decreasing motivation to drink (Johnson et al. 2004; Johnson 2010), although specific effects on urges to drink in clinical trials are unclear.”
Operant, oral alcoholic beer self-administration by C57BL/6J mice: effect of BHF177, a positive allosteric modulator of GABAB receptors
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“The idea that certain medications may be more or less effective for certain types of drinkers has been proposed (Johnson, 2010).”
Background
Multidisciplinary View of Alcohol Use Disorder: From a Psychiatric Illness to a Major Liver Disease
Gitto, S., Golfieri, L., Caputo, F., Grandi, S., & Andreoné, P. (2016) · Biomolecules · doi:10.3390/biom6010011 · Cited by 20 · see citing works
“A substantial heterogeneity can be found among patients with AUD regarding age of onset, kind of drinking (continuous or binge), alcohol metabolism (worst in females) and presence or absence of associated psychiatric disorder [12].”
Background
The Lesch alcoholism typology - psychiatric and psychosocial treatment approaches.
Schlaff, G., Walter, H., & Lesch, O. (2011) · Europe PMC (PubMed Central) · Cited by 20 · see citing works
Alcoholism and Substance Abuse
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“In recent years, researchers have focused on identifying AUD subgroups with shared pathophysiology who may be more likely to respond to certain medications to improve medication efficacy (e.g., Johnson, 2010).”
Pharmacotherapy for alcohol use disorder.
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Acute and chronic administration of a low-dose combination of topiramate and ondansetron reduces ethanol’s reinforcing effects in male alcohol preferring (P) rats.
Moore, C. F., Lycas, M. D., Bond, C. W., Johnson, B. A., & Lynch, W. J. (2014) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0035215 · Cited by 17 · see citing works
“, serotonin, glutamate, GABA), this combination has potential for a promising treatment, particularly for early onset alcoholics (Johnson, 2008; Johnson, 2010).”
Self-citation
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“To that end, a major goal is to further identify subgroups of treatment responders and possible factors that mediate pharmacotherapy treatment response [9].”
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Soufia, M., Plaze, M., Gueguen, B., Demigneux, G., Olié, J., & Raphaël Gaillard, B. (2010) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3181fb7b97 · Cited by 16 · see citing works
Multiday administration of ivermectin is effective in reducing alcohol intake in mice at doses shown to be safe in humans
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Cocaine reverses the naltrexone-induced reduction in operant ethanol self-administration: The effects on immediate-early gene expression in the rat prefrontal cortex
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“), two clinically approved medications to treat binge ethanol consumption, ethanol abuse and dependence and to prevent relapse (Fuller and Gordis, 2001; Johnson, 2010; Mason, 2003; O'Brien et al., 1996; Spanagel and Zieglgänsberger, 1997).”
Cannabis Use Disorders
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“It is evident that different subgroups, even if the subtype classification of alcoholism remains controversial, need different therapy approaches, concerning medical withdrawal and relapse prevention treatment (Johnson, 2010; Lesch et al., 2011).”
Background
Analysis of alcohol use disorders from the Nathan Kline Institute—Rockland Sample: Correlation of brain cortical thickness with neuroticism
Zhao, Y., Zheng, Z., & Castellanos, F. X. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.10.040 · Cited by 10 · see citing works
“To reduce deleterious health impacts and the associated economic loss, mechanistic understanding of AUD pathogenesis is required for developing more effective strategies for AUD prevention and treatment (Johnson, 2010; Litten et al., 2015; Reilly et al., 2014; Zahr et al., 2011).”
Background
Low-dose ondansetron: A candidate prospective precision medicine to treat alcohol use disorder endophenotypes
Johnson, B. A., Alho, H., Addolorato, G., Lesch, O. M., Chick, J., Liu, L., & Schuyler, V. (2024) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2024.06.001 · Cited by 9 · see citing works
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Should the Reorganization of Addiction-Related Research Across All the National Institutes of Health Be Structural?-The Devil Is Truly in the Details
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“…and alcohol activate similar reward pathways and that cannabinoid receptors may be associated with the reinforcing effects of alcohol (SUAA Working Group, 2010), it has not been proven that targeting cannabinoid signaling is an efficacious strategy for treating alcohol dependence (Johnson, 2010b).”
Self-citation
Pharmacologically-mediated reactivation and reconsolidation blockade of the psychostimulant-abuse circuit: A novel treatment strategy
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“Ondansetron has also shown to be useful in the treatment of alcohol withdrawal (Johnson, 2010).”
Response to Skodol Letter
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Introduction to the Special Issue “Pharmacotherapies for the Treatment of Alcohol Abuse and Dependence” and a Summary of Patents Targeting other Neurotransmitter Systems
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“profile [131–135].”
Abstinence dans l’alcoolodépendance : approche critique et actualisée des recommandations nationales de 2001
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“boire (traitements anticraving), devra également s’intégrer à une médecine personnalisée du patient alcoolodépendant [29].”
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Pattern of prescription, dispensation and administration of disulfiram among patients with alcohol use disorder attending a general hospital psychiatry unit in rural India
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Health Psychology in Australia
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“sants [30–34].”
Psychometric Properties of the CAGE Questionnaire Amongst Middle-Aged and Older Adults in Khuzistan Province of Iran
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“Johnson (2010) reported that one quarter of college students indicated that their drinking had contributed to academic problems like missing classes, poor grades, or missing assignments.”
Background
Alcoholism and Sleep
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Authors: Johnson, B. A.
Affiliations: University of Virginia (US)
Corresponding author: Johnson, Bankole A.
ORCID: Johnson, Bankole A.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2010-06-01
Volume: 167
Issue: 6
Pages: 630-639
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2010.08101500
PMC: PMC2939449
OpenAlex: W2142440641
Cited by: 151
References: 72
Citations by year: 2026: 1 · 2025: 1 · 2024: 4 · 2023: 4 · 2021: 2 · 2020: 23 · 2019: 11 · 2018: 3 · 2017: 10 · 2016: 8 · 2015: 10 · 2014: 10 · 2013: 11 · 2012: 31
FWCI: 14.89
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Alcohol Abuse and Alcoholism (R01AA010522, R01AA013964, R01AA014628, U10AA011776, R01AA012964)
National Center for Research Resources (M01RR000847, M01-RR 00847)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
Keywords: alcoholism, pharmacological treatment of alcoholism, dopaminergic system, ondansetron, naltrexone, topiramate, baclofen, early-onset alcoholism, late-onset alcoholism, binge drinking, pharmacogenetics, brief behavioral intervention, abstinence
MeSH terms: Topiramate, Adult, Aged, Alcohol Deterrents, Alcoholism, Baclofen, Chronic Disease, Depressive Disorder, Female, Fructose, Humans, Hypothalamo-Hypophyseal System, Limbic System, Male, Naltrexone, Pituitary-Adrenal System, Ondansetron, Prefrontal Cortex, Receptors, Dopamine D2, Receptors, GABA, Young Adult

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