Alcohol Consumption In Heavy Drinkers Research Articles

Exploring the effects of reduced alcohol consumption on major adverse cardiovascular and cerebrovascular events in chronic heavy drinkers: a nationwide population-based cohort study

Abstract Background/Introduction Chronic heavy alcohol consumption is a well-established risk factor for cardiovascular disease (CVD), and the potential cardiovascular benefits of mild to moderate alcohol consumption need validation, particularly in the context of behavioral change from heavy drinking. Currently, there is a lack of research examining the potential benefits of reduced alcohol consumption in chronic heavy drinkers, specifically in relation to different subtypes of CVD. We hypothesized that habitual changes in alcohol consumption among chronic heavy drinkers would have a long-term prognostic effect on future CVD outcomes. Purpose We investigated the association between reduced alcohol consumption and the risk of major adverse cardiovascular and cerebrovascular events (MACCE) in chronic heavy drinkers. Methods From the Korean National Health Insurance Service-Health Screening database, we included a cohort of chronic heavy drinkers who underwent serial health examinations over two consecutive time-periods (first period: 2005–2008; second period: 2009–2012). Heavy drinking was defined according to the National Institute on Alcohol Abuse and Alcoholism criteria as >56 g/day or >196 g/week for men, and >42 g/day or >98 g/week for women. Overall, 13,854 heavy drinkers at baseline (mean age 55.84 ± 5.98 years; 91.6 % men) were categorized into two groups based on the alcohol consumption changes in the second period: sustained heavy drinking (n=9,403; 67.9%) or reduced drinking (n=4,451; 32.5%). The primary outcome was MACCE, a composite of nonfatal myocardial infarction or angina undergoing revascularization, any stroke accompanied by hospitalization, and all-cause death during follow-up. Results In this nationwide population-based cohort study, during a total follow-up of 107,102 person-years, the sustained heavy drinking group experienced a significantly higher incidence of MACCE than the reduced drinking group (incidence rate, 825 vs. 655 per 100,000 person-years; log-rank p=0.004). Reduced alcohol consumption was associated with a 28% lower risk of MACCE compared to sustained heavy drinking (adjusted-hazard ratio [HR]: 0.780, 95% confidence interval [CI] 0.656–0.928). These benefits were mostly driven by a significant reduction in the incidence of angina (adjusted-HR: 0.631, 95% CI 0.425–0.926) and ischemic stroke (adjusted-HR: 0.657, 95% CI 0.472–0.914). The preventive effects of reduced alcohol intake were consistently observed across various subgroups of heavy drinkers, except for smoking status (p-interaction=0.015) and even after including abstainers in the sensitivity analysis. Conclusion Reduced alcohol consumption in heavy drinkers could lower the future risk of CVD, with the most pronounced benefits expected for stable/unstable angina and ischemic stroke. Further research is warranted to explore the optimal strategies for promoting sustained reductions in alcohol intake.Cumulative MACCE incidence curves

The effectiveness of reduction in alcohol consumption achieved by the provision of non-alcoholic beverages associates with Alcohol Use Disorders Identification Test scores: a secondary analysis of a randomized controlled trial

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is commonly used in clinical settings to assess the severity of alcohol-related problems, with the effectiveness of alcohol reduction interventions varying across this spectrum. In a recent study, we demonstrated that a 12-week intervention involving the provision of free non-alcoholic beverages reduced alcohol consumption among heavy drinkers for up to 8 weeks post-intervention. However, it remains unclear whether this effect was consistent across different AUDIT score ranges. Therefore, this secondary analysis aimed to examine whether the severity of alcohol-related problems, as indicated by AUDIT scores, influences the effectiveness of non-alcoholic beverage provision in reducing alcohol consumption.MethodsThis was a single-center, open-label, randomized, parallel-group study. Participants were Japanese individuals who frequently consumed large quantities of alcohol (at least 40 g/day for men and 20 g/day for women) but were not diagnosed with alcohol dependence. Participants were randomly assigned to either an intervention or control group. The intervention group received free non-alcoholic beverages once every 4 weeks over a 12-week period (24 bottles of 350 mL per case, up to three cases per session, for a total of three sessions). Alcohol and non-alcoholic beverage consumption over the previous 4 weeks was tracked using a drinking diary. For this secondary analysis, participants were categorized into four groups based on their AUDIT scores (group 1: ≤ 7 points, group 2: 8–11 points, group 3: 12–14 points, and group 4: ≥ 15 points), and changes in alcohol consumption were compared across these groups in both the intervention and control participants.ResultsThe provision of non-alcoholic beverages significantly increased non-alcoholic beverage consumption in all groups. However, alcohol consumption was significantly reduced in the intervention groups compared to controls only in groups 1–3. The reduction in alcohol consumption was less pronounced in groups 3 and 4 compared to group 1 (both, p < 0.05). Importantly, the provision of non-alcoholic beverages did not lead to an increase in alcohol consumption, even among individuals with higher AUDIT scores.ConclusionsThese findings suggest that individuals with higher AUDIT scores may experience a reduced benefit from a 12-week non-alcoholic beverage intervention in terms of alcohol consumption reduction. Nevertheless, this intervention appears to be a safe and effective strategy for reducing alcohol consumption in heavy drinkers who do not have alcohol dependence.Trial registrationUMIN UMIN000047949. Registered 4 June 2022.

Effects of a digital cognitive behavioral therapy for insomnia on sleep and alcohol consumption in heavy drinkers: A randomized pilot study.

Insomnia is a well-established, prospective risk factor for Alcohol Use Disorder. Thus, targeting sleep problems could serve as a novel and efficacious means of reducing problematic drinking. Here, we examined the potential utility of a well-validated, interactive, easy to use, self-paced digital cognitive behavioral therapy for insomnia program. In a randomized, single-blind pilot study, we examined the impact of treatment with Sleep Healthy Using the Internet (SHUTi) on drinking and sleep outcomes in a sample of heavy drinkers with insomnia. Heavy drinking men (n = 28) and women (n = 42) with insomnia were randomly assigned to complete either the SHUTi program or a control patient education program. Subjective measures of sleep and alcohol use were administered at baseline, immediately following completion of the intervention, 3 months post-intervention, and 6 months post-intervention. Sleep outcomes were assessed using the Insomnia Severity Index and Pittsburgh Sleep Quality Index. Drinking outcomes were assessed using the 30-Day Timeline Follow-Back calendar. We used linear mixed effects models to compare groups on both insomnia and drinking outcomes. Data from all 70 subjects (SHUTI: n = 40; control: n = 30) were analyzed. Linear mixed effects models showed that SHUTi significantly reduced insomnia symptoms (p = 0.01) and drinking outcomes (ps < 0.05) more than the control condition over time. Trend-level effects on sleep quality (p = 0.06) were also observed. No adverse events were reported. Improving sleep may be an effective treatment intervention for reducing hazardous drinking in at-risk individuals. Further, findings provide preliminary support for the implementation of an easily accessible health behavior intervention with significant public health impact in a high-risk population.

Individualized, High-Dose Baclofen for Reduction in Alcohol Intake in Persons With High Levels of Consumption.

Alcohol use disorders (AUD) are common and impairing. Many pharmacologic interventions have been approved for AUD; baclofen is one among these. More than a dozen randomized controlled trials (RCTs) have examined the safety and efficacy of baclofen in AUD; these RCTs have been pooled in 4 recent meta-analyses, each with different study selection criteria, different objectives, different methods, and different results. The general impression from these meta-analyses is that the benefits with baclofen are unimpressive in patients with AUD. With the background that individualized, rather than fixed, high dosing with baclofen could be critical for success, a large (n = 320), industry-independent, 62-center French RCT (the Bacloville trial) examined whether individually uptitrated, high-dose baclofen could reduce alcohol consumption in heavy drinkers across a year of treatment. The study design, the high dropout rate, and the statistical methods of this trial threw up several complexities; in consequence, the main primary and secondary outcomes could not be satisfactorily interpreted. However, there were many other secondary outcomes that seemed to favor baclofen over placebo, though certain concerns remained. This RCT is explained and its findings are carefully dissected and interpreted. It is concluded that individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers who wish to reduce levels of alcohol intake; baclofen may be particularly useful in patients with liver disease, for whom certain other pharmacologic interventions are relatively contraindicated. However, the risk of serious adverse events with high-dose baclofen, and its pharmacodynamic interaction with alcohol, must both be kept in mind. Practical issues are discussed.

Evidence That Implementation Intentions Enhance Cognitive Training and Reduce Alcohol Consumption in Heavy Drinkers: A Randomized Trial.

Current training tasks to improve the cognitive deficits thought to be involved in sustained heavy drinking need further investigation to optimize their effectiveness. The present study investigated whether combining implementation intention provision with a cognitive training task had a measurable effect on alcohol consumption in heavy drinkers and explored the neural mechanisms underpinning any reductions in subsequent alcohol consumption. Thirty-two heavy-drinking participants completed approach-avoidance and visual probe training tasks preintervention and postintervention during functional Magnetic Resonance Imaging. Participants in the intervention group were randomized to form implementation intentions and participants in the control condition read a goal intention. Alcohol consumption was recorded preintervention and at 1 month follow-up. Compared to the control group, implementation intention provision significantly improved performance on alcohol-avoidance tasks postintervention, t(30) = -2.315, p = .028, d = .85, and reduced alcohol consumption by 6.9 units/week (1 unit = 10 mL or 8 g ethanol), F(1,30) = 4.263, p = .048 (d = .74), at follow-up. However, the analysis of functional Magnetic Resonance Imaging data revealed no significant differences between groups. These findings show for the first time that implementation intentions targeting cognitive processes can significantly reduce alcohol consumption among heavy drinkers. However, there was no evidence that the effects were mediated by changes in neural activity. Further work is required to explore the neural mechanisms underpinning the operation of implementation intentions. This trial was registered (ISRCTN:35503634) and is available at https://www.isrctn.com/ISRCTN35503634.

2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults

Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals.

Effects of varenicline on alcohol self-administration and craving in drinkers with depressive symptoms.

Varenicline (VAR) is approved to aid in smoking cessation and has been shown to be effective for reducing alcohol consumption in heavy drinkers. Little is known, however, about treatment moderators that may influence efficacy. The current study reanalyzed data from a human laboratory study (Verplaetse et al., 2016) to determine whether VAR was more effective at reducing alcohol use among drinkers reporting symptoms of depression. Participants were 60 adults meeting DSM-IV criteria for alcohol use disorders ( n = 60) who were randomly assigned to receive VAR (1 mg/day, 2 mg/day) or placebo. Following 7 days of medication pretreatment, participants attended a laboratory testing session. They provided self-reported ratings of alcohol craving and performed an ad libitum alcohol consumption task after receiving a priming dose of alcohol (target blood alcohol concentration = 0.030 g/dL). Higher blood VAR plasma levels were associated with less alcohol craving and less drinking among participants with more depressive symptoms. Among participants with fewer depressive symptoms, VAR was associated with more drinking during the ad libitum drinking task. These findings show that depression symptoms may be a moderator of VAR efficacy in alcohol users and provides evidence for the role of nAChRs in depression and alcohol use.

Oxytocin, Tolerance, and the Dark Side of Addiction.

Substance use disorders blight the lives of millions of people and inflict a heavy financial burden on society. There is a compelling need for new pharmacological treatments as current drugs have limited efficacy and other major drawbacks. A substantial number of animal and recent clinical studies indicate that the neuropeptide, oxytocin, is a particularly promising therapeutic agent for human addictions, especially alcohol use disorders. In preliminary trials, we found that oxytocin administered by the intranasal route, which produces some neuropeptide penetration into the CNS, potently blocked withdrawal and reduced alcohol consumption in heavy drinkers. A considerable body of earlier animal studies demonstrated that oxytocin inhibits tolerance to alcohol, opioids, and stimulants as well as withdrawal from alcohol and opioids. Based on these preclinical findings and our clinical results, we hypothesize that oxytocin may exert therapeutic effects in substance dependence by the novel mechanism of diminishing established tolerance. A newer wave of studies has almost unanimously found that oxytocin decreases self-administration of a number of addictive substances in several animal models of addiction. Reduction of established tolerance should be included among the potential explanations of oxytocin effects in these studies and changes in tolerance should be examined in future studies in relationship to oxytocin influences on acquisition and reinstatement of self-administration as well as extinction of drug seeking. Oxytocin efficacy in reducing anxiety and stress responses as well as established tolerance suggests it may be uniquely effective in reducing negative reinforcement (Koob's "dark side" of addiction) that maintains chronic substance use.

Acute stress increases ad-libitum alcohol consumption in heavy drinkers, but not through impaired inhibitory control.

RationaleStress increases alcohol consumption and the risk of relapse, but little is known about the psychological mechanisms that underlie these effects. One candidate mechanism is inhibitory control, which may be impaired by acute stress and is believed to exert a causal influence on alcohol consumption.ObjectivesWe investigated if acute stress would impair inhibitory control and if impaired inhibitory control would be associated with subsequent ad-libitum alcohol consumption in a naturalistic laboratory setting.Materials and methodsOne hundred heavy drinkers took part in an experimental study in a naturalistic ‘bar laboratory’. Participants were randomly assigned to an acute stress (n = 50) or control (n = 50) group. In the stress group, participants were exposed to the social evaluative threat of giving a self-critical presentation, whereas the control group completed simple anagrams. Prior to and following the manipulation, participants completed the stop signal task as a measure of inhibitory control. Finally, participants completed a bogus taste test, as a measure of ad-libitum alcohol consumption.ResultsThe stress manipulation had no effect on performance on the stop signal task. However, there was a small but significant increase in ad-libitum alcohol consumption in the acute stress group compared to that in the control group.ConclusionsAcute stress increased alcohol consumption in heavy drinkers, in a semi-naturalistic setting. However, this was not through the hypothesised mechanism of a transient impairment in inhibitory control.Electronic supplementary materialThe online version of this article (doi:10.1007/s00213-016-4205-1) contains supplementary material, which is available to authorized users.

Operant responding for alcohol following alcohol cue exposure in social drinkers

IntroductionCue reactivity paradigms have found that alcohol-related cues increase alcohol consumption in heavy drinkers and alcoholics. However, evidence of this relationship among non-alcohol dependent “social” drinkers is mixed, suggesting that individual differences must be considered when examining cue-induced drinking behavior. One important individual difference factor that might contribute to cue-induced drinking in the laboratory is the amount of alcohol that participants typically drink during occasions outside the laboratory. That is, those who typically consume more alcohol per occasion could display greater cue-induced drinking than those who typically drink less. The present study examined this hypothesis in healthy, non-dependent beer drinkers. MethodsThe drinkers were exposed to either a series of beer images intended to prime their motivation to drink beer or to a series of non-alcoholic images of food items that served as a control condition. Following cue exposure, motivation to drink was measured by giving participants an opportunity to work for glasses of beer by performing an operant response task. ResultsResults indicated that drinkers exposed to alcohol cues displayed greater operant responding for alcohol and earned more drinks compared with those exposed to non-alcohol (i.e., food) cues. Moreover, individual differences in drinking habits predicted subjects' responding for alcohol following exposure to the alcohol cues, but not following exposure to food cues. ConclusionsThe findings suggest that cue-induced drinking in non-dependent drinkers likely results in consumption levels commensurate with their typical consumption outside the laboratory, but not excessive consumption that is sometimes observed in alcohol-dependent samples.

Stress-related alcohol consumption in heavy drinkers correlates with expression of miR-10a, miR-21, and components of the TAR-RNA-binding protein-associated complex.

Alterations in stress-related gene expression may play a role in stress-related drinking and the risk of alcohol dependence. Microarrays were used to measure changes in gene expression in peripheral blood in nonsmoking, social drinking subjects exposed to 3 types of personalized imagery: neutral, stressful (but not alcohol related), and alcohol-related cues. Gene expression was measured at baseline, immediately after, and 1hour after stimulus presentation. Subjects were allowed to drink up to 750cc of beer in a "taste test" following stimulus presentation in each imagery condition, and the amount of beer consumed was recorded. Gene-expression levels were compared in 2 groups of nonsmoking subjects (n=11/group): heavy drinkers (HD; defined as regular alcohol use over the past year of at least 8 standard drinks per week for women and at least 15 standard drinks per week for men), and moderate drinkers (MD; defined as up to 7 standard drinks per week for women and 14 standard drinks per week for men). Expression of microRNA-10a (miR-10a) and microRNA-21 (miR-21) was assessed by quantitative real-time polymerase chain reaction. After correction for multiple testing (false discovery rate<0.05), 79 genes were identified that changed by >1.3-fold in the HD group, but not the MD group, following exposure to stress. No changes were observed for any of these genes in either group following exposure to neutral or alcohol-related imagery. Pathway analysis suggested that many of these genes, form part of the transactivation responsive (TAR)-RNA-binding protein (TRBP)-associated complex and are positively regulated by miR-10a and miR-21. Expression of both miR-10a and miR-21 was up-regulated following psychological stress in HD, but not MD subjects; however, the differences between groups were not statistically significant. Expression levels of both microRNAs was correlated (miR-10a, R(2) =0.59, miR-21 R(2) =0.57) with amount drunk in HD, but not MD subjects. Expression of miR-10a, miR-21, and several of their target genes is regulated by acute psychological stress and is correlated with stress-induced drinking in a laboratory setting. Alterations in miRNA expression may be one mechanism linking psychological stress with changes in gene expression and increased alcohol intake in binge/HD.

A comparison of three types of web-based inhibition training for the reduction of alcohol consumption in problem drinkers: study protocol.

BackgroundProblem drinkers have poor inhibitory control (disinhibition). Previous studies have demonstrated that various forms of ‘inhibition training’ can reduce alcohol consumption in the laboratory and at short-term follow-up, but their longer-term efficacy and mechanisms of action are unknown. In this phase 2 randomised controlled trial we will contrast the effects of three forms of inhibition training and a control intervention, delivered via the Internet in multiple sessions over four weeks, on alcohol consumption in heavy drinkers.Methods/designHeavy drinkers who are interested in reducing their alcohol consumption will receive a brief intervention and will monitor their own alcohol intake for one week before being randomised to one of four treatment groups: 1. General inhibition training; 2. Cue-Specific inhibition training; 3. Alcohol No-Go training; or 4. Control. They will complete up to 14 sessions of training via the Internet over a four-week period, and will be followed-up for a further six weeks after the end of the training period. Primary outcome measures are reductions in alcohol consumption and heavy drinking days. The number of abstinent days is a secondary outcome measure. We will also investigate changes in inhibitory control and automatic alcohol affective associations in response to training.DiscussionThis study will establish if web-based inhibition training can help problem drinkers to reduce their alcohol intake, and it will identify which form(s) of inhibition training are most effective.Trial registationTrial Registation number: ISRCTN55671858.

PTU-027 Lifetime alcohol consumption in heavy drinkers with and without liver disease. 1: Threshold effect and male-female differences

IntroductionIt is unclear whether the risk of alcoholic liver disease (ALD) is related to amount of alcohol consumed (dose effect) or is independent of alcohol consumption above a given threshold...

Low-to-Moderate Alcohol Consumption May Be Safe When Taking Methotrexate for Rheumatoid Arthritis or Psoriasis

It is unclear if consumption of small to moderate amounts of alcohol is safe while taking methotrexate. We set out to determine whether there is an association between liver enzyme abnormalities and alcohol consumption in subjects taking methotrexate. The study sample was identified from the database of the South Central Veteran Affairs Healthcare Network, consisting of 10 hospitals in Texas, Oklahoma, Mississippi and Louisiana. From a cohort of 2443 eligible Veterans with rheumatoid arthritis and/or psoriasis taking methotrexate from 10/1/2007 to 9/30/2009, 120 cases with abnormal liver-enzyme elevation were randomly selected to compare with 120 controls. Data were collected from mailed survey forms that inquired about alcohol consumption habits, physicians’ advice on alcohol, and methotrexate compliance. There was no significant difference in the number of non-drinkers and low-to-moderate alcohol drinkers between cases and controls (p = 0.217). Few persons identified themselves as heavy drinkers. Our data suggest that it is likely safe for patients with rheumatoid arthritis and psoriasis to consume low-to-moderate amounts of alcohol while taking methotrexate. However, alternative methods to improve capturing alcohol consumption in heavy drinkers are needed for more comprehensive results.

Acute Interaction of Baclofen in Combination With Alcohol in Heavy Social Drinkers

There is growing evidence that gamma-amino butyric acid-B receptor agonists may be effective in the treatment of alcohol abuse or dependence. The primary goal of this study was to determine the safety of baclofen in combination with alcohol consumption in heavy drinkers. In addition, the effects of baclofen alone, and in combination with alcohol, on subjective effects, cognitive performance effects, as well as alcohol craving, were assessed. Eighteen non-treatment-seeking heavy social drinkers (mean of 28 drinks per week), who did not meet the criteria for alcohol dependence participated. All individuals were tested using a double-blind double-dummy design with six 2-day inpatient phases. Baclofen (0, 40, and 80 mg) was administered 2.5 hours before alcohol (1.5 g/l body water or approximately 0.75 g/kg) or placebo beverages, given in 4 divided doses every 20 minutes. Baclofen, either alone or in combination with alcohol, produced only modest increases in heart rate and blood pressure and no adverse effects were reported. Baclofen did not increase positive subjective effects (e.g., Stimulant effects, Drug Liking) but did increase sedation and impair performance. Even though both baclofen and alcohol impaired performance, for the most part performance was not impaired to a greater extent when baclofen was combined with alcohol. Among this population of nondependent drinkers, baclofen did not alter alcohol craving or alcohol-induced positive subjective effects. Baclofen alone has minimal abuse liability in heavy social drinkers, and baclofen is relatively well tolerated and safe when given in combination with intoxicating doses of alcohol.

Buddhist philosophy and the treatment of addictive behavior

The purpose of this paper is to provide an overview of how Buddhist philosophy can be applied in the treatment of individuals with substance abuse problems (alcohol, smoking, and illicit drug use) and other addictive behaviors (e.g., compulsive eating and gambling). First I describe the background of my own interest in meditation and Buddhist psychology, followed by a brief summary of my prior research on the effects of meditation on alcohol consumption in heavy drinkers. In the second section, I outline some of the basic principles of Buddhist philosophy that provide a theoretical underpinning for defining addiction, how it develops, and how it can be alleviated. The third and final section presents four principles within Buddhist psychology that have direct implications for the cognitive-behavioral treatment of addictive behavior: mindfulness meditation, the Middle Way philosophy, the Doctrine of Impermanence, and compassion and the Eightfold Noble Path. Clinical interventions and case examples are described for each of these four principles based on my research and clinical practice with clients seeking help for resolving addictive behavior problems.

Further investigation of citalopram on alcohol consumption in heavy drinkers: responsiveness possibly linked to the DRD2 A2/A2 genotype

Citalopram, a selective serotonin reuptake inhibitor, has been suggested to reduce alcohol intake, at least in some studies. The present study aimed to replicate our earlier finding that citalopram reduces alcohol intake only in subjects with a weekly consumption ranging between 300 and 800 g of pure alcohol. Subjects ( n=37) in this study were therefore randomized into a double-blind treatment with either 40 mg of citalopram daily or placebo for a 4-week period. Another purpose was to investigate whether different measures of central neurotransmission might predict an effect of citalopram or placebo on alcohol consumption. Therefore, prolactin response to d-fenfluramine, platelet monoamine oxidase-B activity, as well as the genotype of the dopamine D2 receptor (DRD2), A1 and A2 alleles, were determined and related to individual changes in alcohol consumption. Citalopram was not found to be superior to placebo in reducing alcohol intake. Prolactin responses to d-fenfluramine and levels of platelet monoamine oxidase-B activities were not related to changes in alcohol consumption, regardless of treatment with citalopram or placebo. When subjects were grouped according to the presence or absence of the DRD2 A1 allele, those with the genotype DRD2 A2/A2 were found to transiently reduce their alcohol consumption during citalopram treatment. This finding seems to indicate that, in subjects with heavy alcohol consumption, possession of the genotype DRD2 A2/A2 may be prerequisite for a treatment effect of citalopram.