Addiction Medicine: Closing the Gap between Science and Practice

Clonidine (brand name Catapres), a medication
normally used to lower blood pressure, may
reduce withdrawal symptoms and assist in
smoking cessation.^124 However, the many side
effects associated with clonidine suggests that it
only be prescribed to patients seeking to quit
smoking if they are unwilling or unable to use
other first-line cessation medications.^125

Baclofen (brand names Kemstro, Lioresal and
Gablofen), a medication normally used to treat
spasticity, has been found to reduce cravings and
withdrawal symptoms in patients with addiction
involving alcohol, helping them to reduce their
drinking and to achieve and maintain abstinence;
however, the existing evidence is too limited to
recommend baclofen for addiction involving
alcohol.^126 A double-blind placebo-controlled
study* in humans found that more baclofen
patients than placebo patients achieved and
maintained abstinence (70.0 percent vs. 21.1
percent); baclofen patients also demonstrated a
larger reduction in average number of drinks,
alcohol craving, relapse rates and anxiety levels
relative to placebo patients in this study.^127
There appears to be a dose-response relationship
for baclofen, with greater effectiveness at higher
doses.^128

Ondansetron (brand name Zofran), an anti-
nausea drug,^129 has been shown to be effective in
reducing alcohol use cravings and alcohol use
among patients with addiction involving alcohol,
particularly among those with an early onset
addiction.^130 The drug may be more effective in
patients with specific genotypes.† 131 There also
is emerging evidence that ondansetron might be
effective in treating withdrawal symptoms in
patients with addiction involving opioids.^132

Gabapentin (brand names Fanatrex, Gabarone,
Gralise, Neurontin), a medication used to treat
neuropathic pain and epileptic seizures, has been
found to reduce withdrawal symptoms and the

• Sample size of 39.
  † Specifically, those with the L/L genotype of the

5HTTLPR polymorphism. “L” signifies long alleles
and “S” signifies short alleles. Possible genotypes
are L/L, S/S and S/L.

use of marijuana in patients with addiction

involving cannabis.^133

Reward Reduction Medications. Certain

medications work to reduce the rewarding or

pleasurable effects of addictive substances, over

time decreasing their appeal.

Disulfiram (brand name Antabuse), approved by

the FDA in 1949 to treat addiction involving

alcohol, works by producing unpleasant

physiological effects in individuals who

consume alcohol; these aversive reactions serve

as a deterrent to alcohol consumption among

those with addiction involving alcohol.‡ 134

For addiction involving alcohol, disulfiram

blocks the production of the enzyme aldehyde

dehydrogenase which enables the liver to

metabolize alcohol.^135 The obstruction of this

process leads to a build up of acetaldehyde§ in

the system, causing hangover-like symptoms--

nausea, vomiting, flushing, rapid heart rate--

shortly after alcohol consumption.^136 The

medication has not been found to reduce

cravings; its preventive qualities come from

replacing the pleasurable effects of alcohol with

unpleasant effects.^137

Although disulfiram is one of the oldest

pharmaceutical treatments for addiction

involving alcohol, there are few scientifically

valid studies of its efficacy.^138 The medication

appears to be most effective when its use is

supervised^ to assure compliance.^139 Researchers

suggest that the relatively limited evidence of

the efficacy of the drug may be linked to low

adherence rates: in one study only 20 percent of

participants who completed the trial complied

with disulfiram treatment. Among patients who

completed the trial, those who received a

‡ Disulfiram is the most commonly-used aversion

medication for the treatment of addiction involving

alcohol. Another example of a medication that

produces a similar aversive effect in individuals who

consume alcohol is calcium carbimide (brand name

Temposil); other medications used for non-addiction

clinical purposes, such as cephalosporins which are

used to treat bacterial infections, have side effects

similar to disulfiram when alcohol is consumed.

§ The major metabolite of ethanol.