Promising New Treatment for Alcohol Use Disorder

First, the grim statistics on alcohol use disorder (AUD), the challenging and baffling condition formerly known as alcoholism. At least 95,000 people (approximately 68,000 men and 27,000 women) die from alcohol-related causes in the U.S. each year.

Also, alcohol is currently ranked as the third leading preventable cause of death in the United States. And no surprise, recent data shows evidence of increasing heavy alcohol use and associated consequences during the Covid-19 pandemic.

The Current Situation for Medication-Assisted Treatment of Alcohol Use Disorder

The FDA's approved medication-assisted treatment MATs for AUD are Antabuse, Campral, and Naltrexone. These medications are safe and effective but only show modest success.

A quick run-down: Antabuse is an older medication that has not been shown to be effective in controlling cravings, but it can have a helpful deterring effect. Campral, on the other hand, has been shown to reduce cravings for alcohol but does not help during alcohol withdrawal. Naltrexone is well studied and has been shown to reduce the euphoria associated with alcohol, and can help people drink less. It has also been shown to reduce the number of drinking days during a relapse. Interestingly, there is anecdotal evidence that Campral may work better for women, while Naltrexone may work better for men.

Prazosin, Alcohol, and Anxiety-Stress Systems

Chronic alcohol use results in changes to stress biology, irritability, and autonomic arousal. During acute alcohol withdrawal symptoms, the brain and hormonal responses produce anxiety and heightened arousal, which increases craving and the risk of alcohol relapse. Flight or fight response systems, anxiety, and stress are important factors known to increase alcohol and drug relapse risk. Prazosin may normalize these stress system adaptations, reduce alcohol craving, and reduce overall alcohol intake.

Promising New Research From Yale

While researchers and psychiatrists have used Prazosin sporadically for nearly a decade to treat patients with AUD, new research out of Yale shows that it can help patients significantly reduce or eliminate their drinking—and does so through a different mechanism. Unlike the above-mentioned MAT drugs, Prazosin is an alpha-1 adrenergic receptor antagonist. It seems to work by reducing stress-induced alcohol cravings, especially during early abstinence. Prazosin also improves overall stress system functionality.

In the recent Yale study reported in November 2020, researchers completed a double-blind study of 100 people entering outpatient treatment after being diagnosed with AUD. Researchers gave the drug to all patients who had experienced withdrawal symptoms before entering treatment. They found that subjects with high levels of shakes, cravings, anxiety, and sleep difficulties got the most from Prazosin.

That is significant. According to study author Dr. Rajita Sinha, Director of the Yale Stress Center: "There has been no treatment readily available for people who experience severe withdrawal symptoms, and these are the people at highest risk of relapse and who are most likely to end up in hospital emergency rooms.”

Final Thoughts and Some Optimism

As I mentioned, three oral medications (Antabuse, Campral, Naltrexone) and one injectable medication (extended-release Naltrexone) are now FDA-approved for treating AUD. With varying degrees of success, all have been shown to help patients drink less alcohol, avoid relapsing to heavy drinking, and achieve and maintain abstinence.

Prazosin may bring something new to the table. It is the first alpha-1 adrenergic receptor medication to be proposed and tried on AUD. It is safe and has been approved by the FDA for other uses. And it has been tested for over a decade in many alcohol-related studies by investigators around the world.

What we’re now finding, thanks to the work at Yale

1. The brain's stress centers are severely disrupted early in AUD recovery
2. Patients with strong withdrawal symptoms and high cravings may benefit significantly from Prazosin during that critical time.

Prazosin may be able to help people bridge this gap early in recovery, thereby increase their chances of long-term recovery from AUD.