Proof-of-concept human laboratory study for protracted abstinence in alcohol dependence: effects of gabapentin

Abstract

There is a need for safe medications that can effectively support recovery by treating symptoms of protracted abstinence that may precipitate relapse in alcoholics, e.g. craving and disturbances in sleep and mood. This proof-of-concept study reports on the effectiveness of gabapentin 1200 mg for attenuating these symptoms in a non-treatment-seeking sample of cue-reactive, alcohol-dependent individuals. Subjects were 33 paid volunteers with current Diagnostic and Statistical Manual of Mental Disorders-IV alcohol dependence and a strength of craving rating 1 SD or greater for alcohol than water cues. Subjects were randomly assigned to gabapentin or placebo for 1 week and then participated in a within-subjects trial where each was exposed to standardized sets of pleasant, neutral and unpleasant visual stimuli followed by alcohol or water cues. Gabapentin was associated with significantly greater reductions than placebo on several measures of subjective craving for alcohol as well as for affectively evoked craving. Gabapentin was also associated with significant improvement on several measures of sleep quality. Side effects were minimal, and gabapentin effects were not found to resemble any major classes of abused drugs. Results suggest that gabapentin may be effective for treating the protracted abstinence phase in alcohol dependence and that a randomized clinical trial would be an appropriate next step. The study also suggests the value of cue-reactivity studies as proof-of-concept screens for potential antirelapse drugs.

Figure 1. Effects of gabapentin vs. placebo on alcohol and affective cue-induced craving

Legend. Craving was measured by visual analogue scale (VAS; range: 0–20). Strength = strength of craving (“How strong is your craving to drink alcohol”); Drink = intent (“If I could drink alcohol now, I would drink it”); Difficult = lack of control (“It would be hard to turn down a drink right now”); Alc = alcohol cues; Aff+ = positive affective cues.

Figure 2. Effects of gabapentin vs. placebo on affective cue-induced SAM arousal

Legend. Arousal was measured by the Self Assessment Manikin (SAM; Bradley and Lang, 1994) that has a range of 0–20.