Antibiotic Cuts Alcohol Cravings, May Enhance Psychotherapy

Liam Davenport

An antibiotic typically used to treat tuberculosis reduces alcohol cravings and may enhance cue-related extinction therapies in individuals with alcohol use disorders, new research shows.

The study, which was funded by the National Institutes of Health, showed that low doses of D-cycloserine significantly reduce alcohol cravings for up to 3 weeks, leading to significant reductions in alcohol consumption.

The researchers believe that the drug could also be used to enhance the effect of psychotherapies, such as cognitive-behavioral therapy (CBT), to provide a more durable outcome.

"We're trying to turn up the gas on this CBT intervention that focuses on helping people cope with their cravings better," lead author James MacKillop, PhD, Peter Boris Center for Addictions Research, McMaster University, Hamilton, Ontario, Canada, told Medscape Medical News.

"What we're trying to take are the most critical points in treatment and try to tune up the brain's responsiveness to those points to ultimately not just affect the person the most but lead to new learning that will be more robust over time and improve outcomes," Dr. MacKillop added.

The study was published online April 7 in Translational Psychiatry.

Unique Approach

D-cycloserine is the dextrorotary form of cycloserine and is a partial agonist of N-methyl-D-aspartate receptors, which play a central role in memory and learning.

To examine whether the drug could accelerate the extinction of cue-elicited craving for alcohol, the team studied individuals with alcohol use disorders who were seeking alcohol treatment and had evidence of reacting to alcohol cues.

Participants underwent an alcohol extinction paradigm, given as four sessions of manualized motivational enhancement therapy akin to cue exposure therapy, over 2 weeks in a naturalistic bar laboratory environment.

For sessions 1 and 3, which took place 1 week apart, the participants received D-cycloserine, 50 mg (n = 16), or placebo (n = 14) 1 hour beforehand. Follow-up cue reactivity sessions were then conducted 1 week and 3 weeks later.

At study outset, participants had significant and robust alcohol cue reactivity, with no significant differences between the two groups.

Those who received the study medication had significant reductions in alcohol craving and significant increases in extinction during the first session compared with those given placebo (P ≤ .05 for both). The significant impact of D-cycloserine on alcohol cravings was maintained at week 3 (P ≤ .05).

At the end of the study, participants who received the medication reported significantly fewer drinks per day, lower percentage of drinking days, and lower percentage of heavy drinking days (P ≤ .05, P ≤ .05, and P ≤ .01, respectively). However, these effects were no longer significant at the 3-week follow-up.

Minimal adverse effects occurred with the study drug. The only notable effect was a nonsignificant increase in drowsiness after the second administration.

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