![]() 4 Although the quantity and frequency of drinking might predict who is at risk for AWS, there is considerable variation (some likely genetic) as to who will experience AWS on the cessation of drinking. One understudied phenotype or subtype of AUD are people who experience alcohol withdrawal syndrome (AWS). 3 However, there is reason to believe that some subgroups of patients might respond better to available treatments. ![]() One reason is that available medications are not universally efficacious. 2 However, only 20% of those who might benefit from treatment receive it, and of those individuals, only 20% (or less than 1 million individuals) receive medication to help them with maintaining abstinence or reducing drinking. Quiz Ref ID Up to 30 million people in the United States meet criteria for alcohol use disorder (AUD), and the number is increasing over time, 1 accounting for considerable morbidity and mortality. Trial Registration Identifier: NCT02349477 Future studies should evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy. Gabapentin caused more dizziness, but this did not affect efficacy.Ĭonclusions and Relevance These data, combined with others, suggest gabapentin might be most efficacious in people with AUD and a history of alcohol withdrawal symptoms. These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high–alcohol withdrawal group only. The prestudy high–alcohol withdrawal group had positive gabapentin effects on no heavy drinking days ( P < .02 NNT, 3.1) and total abstinence ( P = .003 NNT, 2.7) compared with placebo, while within the low–alcohol withdrawal group, there were no significant differences. ![]() More gabapentin-treated individuals had no heavy drinking days (12 of 44 participants ) compared with placebo (4 of 46 participants ), a difference of 18.6% (95% CI, 3.1-34.1 P = .02 number needed to treat, 5.4), and more total abstinence (8 of 44 ) compared with placebo (2 of 46 ), a difference of 13.8% (95% CI, 1.0-26.7 P = .04 NNT, 6.2). The evaluable participants had 83% baseline heavy drinking days (4 or more drinks/day for women, 5 or more for men) and met 4.5 alcohol withdrawal criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Results Of 96 randomized individuals, 90 were evaluable (44 in the gabapentin arm and 46 in the placebo arm), with a mean (SD) age of 49.6 (10.1) years 69 were men (77%) and 85 were white (94%). Main Outcomes and Measures The percentage of individuals with no heavy drinking days and those with total abstinence were compared between treatment groups and further evaluated based on prestudy alcohol withdrawal symptoms. Interventions Gabapentin up to 1200 mg/d, orally, vs placebo along with 9 medical management visits (20 minutes each). Daily drinking was recorded, and percentage of disialo carbohydrate-deficient transferrin in the blood, a heavy drinking marker, was collected at baseline and monthly during treatment. A total of 145 treatment-seeking individuals who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for AUD and were not receiving other AUD intervention were screened, and 96 who also met recent alcohol withdrawal criteria were randomized to treatment after 3 abstinent days. Objective To examine whether gabapentin would be useful in the treatment of AUD, especially in those with the most alcohol withdrawal symptoms.ĭesign, Setting, and Participants This double-blind randomized clinical trial conducted between November 2014 and June 2018 evaluated gabapentin vs placebo in community-recruited participants screened and treated in an academic outpatient setting over a 16-week treatment period. ![]() A more personalized, symptom-specific, approach might improve efficacy and acceptance. Importance Although an estimated 30 million people meet criteria for alcohol use disorder (AUD), few receive appropriate pharmacotherapy. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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