Center Line Newsletter

Dr. Fulton T. Crews Director, Bowles Center for Alcohol Studies

This is an exciting time in alcohol research. This issue highlights translational efforts to move animal models of alcohol dependence and relapse to new therapies for those who have problems with alcohol. An interesting and sometimes frustrating aspect of translating animal models to humans is that people who are recruited must be treated with behavioral therapy as well as any investigational drug. Animal studies do not address the contribution of psychotherapy. Psychotherapy, usually motivational or cognitive behavioral therapy has helped many with alcohol problems. Psychotherapy helps those seeking help and most treatment clinics have patients who walk in needing help or who have been referred by the justice system. Often therapists run addiction clinics without a physician. Unfortunately, few physicians identify and refer patients for treatment. Pharmacotherapy requires physician supervision and most medication trials are run by physicians.

Multiple issues challenge the development of new medications. In many clinical trials, patients are recruited from radio, newspaper or other forms of advertisements. This process recruits motivated individuals who seek treatment. Interestingly, almost everyone who is treated by minimally supportive or other more intense psychotherapy in a clinical trial has some degree of recovery. This makes pharmacotherapy trials such as those being done by Dr. Garbutt particularly difficult. Placebo controls have a very high response rate, making it difficult to determine if pharmacotherapy helps, e.g. it is hard to show a difference in response rates when 70-80% of all groups respond. Experience among therapists practicing in the community suggests that 80-90% recovery rates are uncommon, but appear unique to clinical trial patients. The common practice of exclusion of subjects with co-morbid mental disease, low motivation, and/or other complicating factors creates a group of motivated individuals, most of whom respond to whatever therapy is provided. Further, trials are often short, following patients for a few months, whereas life is much longer. Cancer researchers use five years of recovery as an end point. This standard would benefit the alcoholism field as well.

More studies are needed in high risk individuals and heavy drinkers who do not seek treatment. There are drugs that help maintain abstinence and reduce heavy drinking days, and most of these were first found to reduce animal drinking. New approaches to clinical trials with varied end points are needed to better translate efficacy from animal models to humans. In addition, physicians need to be engaged to identify and treat risk for dependence, e.g. heavy drinking. Science and medicine can reduce alcoholic pathology, but greater innovation and efforts to involve the majority of individuals with alcohol problems is needed to translate discoveries to improved health.