Pharmacological Treatment of Early Abstinence Symptoms

Medical University Of South Carolina, Charleston SC

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Linked publications & trials

Abstract

It is established that 30-50% of alcoholics relapse during the first three months after stopping drinking. Why[unreadable] this period is particularly vulnerable for relapse is not clear. Clinical research has confirmed impaired sleep,[unreadable] mood instability, and anxiety, indicators of brain hyperexcitability, during the early abstinence period. These[unreadable] early abstinence, or protracted withdrawal, symptoms, although not yet well characterized or quantified, are[unreadable] reported to be poorly tolerated by the client and are suggested to play a role in craving and relapse to[unreadable] alcohol use. Targeting these symptoms with a medication that does not, itself, have abuse potential is[unreadable] hypothesized to result in improved treatment outcome.[unreadable] The medication chosen to target these early abstinence symptoms is the anticonvulsant gabapentin. The[unreadable] proposal takes advantage of a unique program at our affiliated Veterans Administration Medical Center[unreadable] (VAMC) that provides residential housing and intensive substance abuse treatment for 4 weeks, as long as[unreadable] a client is verified as alcohol-free. This setting is ideal, since the dependent variables of interest (sleep,[unreadable] mood, brain activity) will not be influenced by the presence of alcohol. The hypothesis being tested is that[unreadable] the gabapentin-treated group, as compared to the placebo-treated group, will show improvements in[unreadable] behavioral (i.e., sleep, anxiety, mood) and neurological (i.e., acoustic startle and transcranial magnetic[unreadable] stimulation) indices. In addition, the study will explore if treatment with gabapentin during this 4-week early[unreadable] abstinence period decreases relapse to drinking in the month following discontinuation of pharmacotherapy[unreadable] and discharge from the intensive outpatient residential treatment program and will explore if gabapentin is[unreadable] equally effective in medically detoxified alcoholics as in non-medically detoxified alcoholics.[unreadable] This proposal builds on our previous experience with pharmacotherapy and behavioral/neurological[unreadable] characterization of acute alcohol detoxification. It extends our investigations to the early abstinence period[unreadable] and to a clinical treatment setting, specifically targeting protracted withdrawal symptoms with the[unreadable] anticonvulsant gabapentin. By using behavior, acoustic startle reflex and transcranial magnetic stimulation[unreadable] technologies, the study will also allow a systematic investigation of the relationship between persistent brain[unreadable] abnormalities and self-reported craving. This information has important implications for relapse prevention.[unreadable]