An answer for addicts

Researchers studying drugs to curb craving

by Jennifer Lorenzo

Dr. Johnson

Jake began drinking at age 10. Beer was always available, at family gatherings, wakes, car races, his familyís dance hall. Thirty years later he could still down "87 beers at one sitting," he said. "I was a binge drinker. I could go for a week or more without drinking. But I was always planning for the next drink."

"I was a mean drunk; my family was in upheaval. I owned a garage, but I alienated all my customers and lost my business," Jake said. "I couldn't function. I had to appease my monster."

Jake, 43, said he tried everything he could think of to stop drinking. Alcoholics Anonymous (AA) didn't help because hearing everyone at the meeting talking about drinking just made him want a drink as soon as the meeting was over.

Between 1984 and 1991, he says he spent $30,000 to $40,000 on treatment programs that didn't work. He did get sober at one point for three years, but he says he was miserable, the thought of a drink always in his mind. Eventually he resumed drinking.

Finally, he saw a newspaper advertisement for a new alcoholism treatment being tested at the Health Science Center. Deciding he had nothing to lose, he signed up for the 12-week program at the Treatment Research Center.

"It was like the difference between night and day," Jake said. "Within five days of starting on the medication, the craving was gone. Now I donít even think of alcohol anymore. My mind is free to do other things."

Jake is still sober after completing the program about eight months ago, even though he is no longer taking the medication. "There is so much more in my life now," he said. "Alcohol is just not a concern at all."

Research breakthroughs

Alcohol is one of the primary concerns of researchers at the Health Science Centerís Division of Alcohol and Drug Addiction, headed by Bankole Johnson, M.D., Ph.D., in the Department of Psychiatry.

"Itís interesting that we donít have specific targets for treatment. With other disorders, we know how to treat them and the problem goes away," Dr. Johnson said. Not so with drug and alcohol addictionóyet.

In the past decade, researchers have learned that addictive drugs affect specific centers in the brain, activating chemicals that produce an over-whelming urge for more. 

Dr. Johnson and his colleagues are working on developing medications, like the one Jake took, that will target these chemicals directly and stop the craving that leads to addiction. They have already made some significant breakthroughs. Last year they discovered that the drug Isradipine stops the dangerous narrowing of brain vessels that can cause a stroke when a person uses cocaine.

Now, a promising treatment for alcoholism is waiting in the wings. Ondansetron, a compound that blocks serotonin in the brain, is one of the two medications being tested at the Treatment Research Center. 

As the five-year clinical study nears its end, Dr. Johnson and his research partners have learned two things. Alcoholics who began drinking at an early age are more likely to have abnormalities in serotonin levels. Secondly, Ondansetron reduces the amount of alcohol they consume as well as increases the number of those who abstain.

These findings will lead to further research into the brain, particularly on the role serotonin plays in addiction. For instance, Dr. Johnson wants to use imaging technology to study how drugs and alcohol affect the brains of people with different biological aspects. In addition, Dr. Johnson plans to study the genetics of alcoholism to identify those who may be especially vulnerable to the disease and likely to respond to Ondansetron treatment.

In addition to overseeing a team of researchers, Bankole Johnson, M.D., Ph.D., a psychiatry professor, also counsels patients suffering from alcohol or drug addition.

Understanding alcoholism

A key part of Dr. Johnsonís research involves understanding the different types of alcoholics. One group could be classified as more impulsive and a second group as more normative, better-adjusted in response to some stressors.

"There is a group of people that has a functional abnormality that predisposes them to addiction. You would hope that you would be able to characterize that predisposition, or even screen for it, which would be very exciting. Why is it that some people can drink without a problem?", Dr. Johnson pondered.

Both Dr. Johnson and his colleague, John Roache, Ph.D., associate director of the addiction division, acknowledge there is an inheritability factor in addictive behavior. For example, Dr. Johnson explained, studies have shown that men, whose fathers were alcoholics but had not abused alcohol themselves, had a different way of processing sensory information than the sons of men who were not alcoholics.

However, say Drs. Roache and Johnson, you need to look at both behavior and brain, and consider the whole person. That person grew up with a history, in an environment. 

"Pills have an important role to play but the individual still needs to be rehabilitated into his or her community. Medications should work best when given in conjunction with therapy, ' Dr. Johnson said. 

Patients at the Treatment Research Center receive cognitive behavioral therapy in addition to medication. Nassima Ait-Daoud, M.D., who is the center's scientific director, has noted an excellent response from patients in the study.

During the initial screening process, which includes a complete physical examination, patients are interviewed at length about their drinking patterns. 

The long-term goal is to target the optimal treatment strategy toward a particular type of alcoholic.

"It is intriguing to think that these addictive disorders, which only a decade ago were considered to be the product of self-inflicted personality problems, can now be understood as brain disorders. Our increasing knowledge opens up new vistas wherein we can now begin to look forward to a time when we can predict those at risk even before they get the disease, observe what alcohol does in the brain, and develop more specific agents to treat our patients," Dr. Johnson said.

Armed with nationally and internationally recognized research leaders, the Division of Alcohol and Drug Addiction is on the cutting edge of new research developments.

For more information about alcohol addiction studies, call (210) 567-8229 (daytime) or (210) 258-5034 (evenings).

Further information can be obtained by e-mail from Michelle Shenberger, M.Ed., administrative head of the Division of Alcohol and Drug Addiction, at shenberger@uthscsa.edu.