ANTICRAVING DRUGS IN THE TREATMENT OF ALCOHOLISM

Numerous neuro-and molecularbiological studies point at several neurot ransmitters to be involved in the development of alcohol dependence, r elapse and craving including the opiate/endorphine and the mesolimbic dopamine system, excitatory amino acids (glutamate) and serotonin. Whi le recent studies with dopaminergic drugs with the possible exception of tiapride and flupentixol have shown little encouraging results some placebo-controlled trials point at opiate antagonists such as naltrex one and nalmefene to be effective in relapse prevention of alcoholism. Most studies including over 4000 patients have been conducted with th e glutamate-modulator acamprosate who was found to be effective in all but one studies. Despite numerous studies which point at a dysfunctio n in serotonergic neurotransmission in alcoholics recent placebo-contr olled double-blind trials with serotonine-reuptake-inhibitors and the 5-HT-antagonist ritanserin have shown disappointing results. Maybe onl y a subgroup of alcoholics will respond to treatment with serotonergic drugs.