Thursday, December 26, 2013

Sober Day #58- Medication help for Quitting Alcohol (long post!)

All of us who have struggled with addiction are wary of adding another medication to our intake- wary of another dependence, wary of in-authenticity, wary of adding to our woes.  But a recently-published study offers a potentially axis-altering option for making quitting a bit easier.  (The full reference is below)

This was a 12 week randomized double-blinded placebo-controlled trial  (DBPCRT).  This is the gold standard for clinical studies:

Randomized:  Participants are randomly assigned to treatment (in this case, active medication) or control (placebo, inactive medication) arms.  This avoids the potential bias of patients ending up in a group because of their own or the researchers expectations of which arm they'll do better in.

Double Blinded:  Neither the participants nor the researchers interacting with the patients are aware of which ones are getting active vs. placebo medication.  This is important because many many studies have shown that expectations (on the part of the patient or the research) can subtly influence interactions, and actually affect outcome.

Like one study of grade school kids and their teachers.  The teachers were told that tests showed certain students were expected to excel during this school year.  Analysis at the end of the year showed that these students had indeed done very well, achieving excellent grades and great evaluations from the teachers.  EXCEPT:  There was no testing.  The students were randomly chosen for the 'expected to excel group'.  Which means this group included the extra-smart and the not-so-smart, the previous-thrivers and the previously-indifferent students.  Expectations of excellence on the part of the teacher apparently helped each student to achieve his/her best.

The medication used in this study was gabapentin (trade name Neurontin), basically an anti-seizure medication.  It has, however, proved useful for lots of other problems.  Chronic cough and laryngeal sensory disorder are areas I have experience with using it, and it can work very well for these.  One really important thing about this medication in the alcohol-context is that is has no abuse potential.  Unlike the benzodiazepenes (valium, klonopin, xanax, etc) frequently used for alcohol withdrawal, and sometimes for help with anxiety in early sobriety, which have major abuse potential.  People have inadvertently replaced an alcohol addiction with a pill addiction!  Other medications like Antabuse cause physical sickness (nausea, vomiting) when alcohol is consumed while taking them.  So these options make Neurontin look like a less disagreeable or dangerous option!

This current study included 150 men and women who were alcohol-dependent, and lasted for 12 weeks.  The participants were divided into 3 groups.  One received placebo tablets, the second received a total of 900 mg of gabapentin daily, and the third received 1800 mg daily.  (The pharmacy prepared special versions of the medication so that the pills received by each of the three groups appeared identical, even though the active medication was different).

The outcomes measures tabulated by the researchers were whether complete abstinence occurred.  And if not complete abstinence,  did the patient at least have no episodes of heavy drinking.  They also looked at some secondary outcomes like changes in mood, sleep, cravings.

Here's where the results get fascinating:

Abstinence rates were 4.1% for the placebo group, 11.1% for the 900 mg a day group, and 17% for the 1800 mg a day group.  This shows a dose-dependent improvement in abstinence, that is, more of the medication was associated with higher abstinence rates.  Further statistical analysis showed that there was a very small chance of such a result occurring by chance alone, allowing presumption of a cause and effect relationship between more medication and better abstinence rates.

Occurrence of No Heavy Drinking showed a similar spread:  22.5% in the placebo group, 29.6% in the 900 mg a day group, and 44.7% in the 1800 mg per day group.

My editorializing:  that means that over 12 weeks,  over 60%, nearly two thirds, of the alcohol-dependent subjects in the 1800 mg per day group made a major change in their alcohol consumption:  17% did not drink at all, and another 44.7% did no heavy drinking.  Wow!

My Epocrates iPhone app says that the maximum dose per day of neurontin is 3600 mg, which obviously leaves more room for research about the optimal dose.

There is no Magic Bullet for quitting alcohol.  And Neurontin (Gabapentin) is not one either.  But perhaps, especially for those who have cycled through Day #1 of Abstinence again and again, getting more and more frustrated-  maybe, just maybe, this could be the little shove over the top that is needed to get to longer abstinence.

CAVEAT:  Although I am a medical doctor, I do not know you individually.  I have not sat with you, listened to your medical history, and examined you.  So this post is tantalizing information to consider, not a prescription for you to start taking Neurontin on your own.  Although impressive, this study mainly opens the door to further questions that need to be answered before this medication is recommended on a routine basis.  What is the best dose?  How long should the medication be continued?  What ancillary services best reinforce this anti-alcohol effect?  Are there particular types of people/drinking patterns for whom this works better/doesn't work?

In the US, at least, this remains a prescription-required medication.   Even if you could get some on your own, it would be A VERY BAD IDEA to experiment with this without the approval of your personal physician!!

Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A.  Gabapentin treatment for alcohol dependence:  a randomized controlled trial.  JAMA Int Med 2013.  doi: 10.1001/jamaintmed.2013.11950


  1. Carrie I'm a nurse here in the UK and there is no way that I would take Gabapentin even if it did help. That is one seriously neurotoxic drug with a huge list of contra-indications including anxiety and depression and rarely suicidal ideation and psychosis. I have only seen it used for epilepsy, phantom limb pain and some other rare chronic neuropathic pain conditions. I appreciate that in the States it may has a wider spectrum of uses than here but even in an RCT I would like to see a larger sample size for the results. Thank you for sharing the research findings. Congrats on yesterday! x

    1. Interesting! Gabapentin seems to be thought of a bit differently here in the States, with much broader indications and not such a horrific reputation. This particular study was from the Scripps Institute in La Jolla, and mentions that there were no serious adverse drug-related events. As you say, further studies will undoubtedly be illuminating! Anything without abuse potential that may facilitate drinking cessation seems definitely worth a closer look!

  2. My boyfriend, a veteran, was prescribed Gabapentin recently for nerve damage in his leg. Oddly, just as he was prescribed this medication, I read about it on the internet and the effects it had on alcoholism.

    After he took it for a while I mentioned the side effects Gabapentin had in regards to alcohol consumption. I had noticed that his drinking had significantly slowed down and he could not explain what had changed.

    Interesting, for sure.

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