Aripiprazole Reduces Alcohol Use

Abstract

Dear Editor: Few pharmacotherapy options exist for the treatment of alcohol dependence. Recent reports suggest that newer atypical antipsychotic medications may reduce alcohol craving and use when prescribed to patients with alcohol abuse or dependence (1). Aripiprazole, a new atypical antipsychotic, has partial dopamine agonist and antagonist effects (2). Since dopamine stimulation in the nucleus accumbens has been suggested to cause addictive behaviour, aripiprazole's partial dopamine agonist effects in this area of the brain may reduce this behaviour (3). We present a case wherein aripiprazole reduced alcohol craving and use. Case Report Mr S is white, aged 39 years, and diagnosed with schizophrenia, paranoid type, according to DSM-IV criteria. He received outpatient psychiatric treatment with psychotherapy and pharmacotherapy (olanzapinc 20 mg daily). He continued to experience delusions of reference and periodic auditory hallucinations. His Brief Psychiatric Rating Scale (BPRS) score was 31. Mr S also met the DSM-IV diagnostic criteria for alcohol dependence, which started at age 18 years with an occasional beer and progressed to his drinking a 12-pack daily. He denied any medical problems, but admitted to problems with employment and relationships caused by his alcohol use. Despite several attempts to quit, including treatment in 2 substance use treatment programs, he relapsed repeatedly. His current use amounted to 6 cans of beer daily. He refused to attend any addiction program, including Alcoholics Anonymous. He also suffered from glaucoma. During treatment, he discovered through the Internet that olanzapine might exacerbate glaucoma, which led him to stop olanzapine on his own. At his next meeting, his psychiatrist discussed several options, including the newer atypical antipsychotic, aripiprazole. Mr S finally agreed to try this medication, which has limited anticholinergic effects and therefore might not worsen glaucoma. Aripiprazole was started at 10 mg initially and increased to 20 mg daily over 2 months. During follow-up, Mr S reported reduced psychotic symptoms (his BPRS score decreased to 23). He stopped daily drinking and reported decreased alcohol craving (his Pennsylvania Craving Scale score decreased from 27 to 5; his Self-Report Likert Craving Scale score decreased from 7 to 3; and his Addiction Severity Index score for alcohol decreased from 6 to 2). His only reported side effect was increased anxiety, which resolved within a week. Discussion Approximately 50% of patients with schizophrenia abuse alcohol and (or) drugs. …