Alcohol abuse is a major risk factor for morbidity and disability throughout the world, and treatment options are limited for this complex psychiatric condition. In this episode, Leandro Vendruscolo and colleagues demonstrate that administration of the glucocorticoid receptor antagonist mifepristone reduces alcohol intake in alcohol-dependent rats, but not in nondependent animals. Moreover, in a double-blinded study of 56 alcohol-dependent human subjects, mifepristone treatment substantially reduced alcohol craving and alcohol consumption compared to placebo. The results of this study support further evaluation of mifepristone as a therapeutic strategy for the treatment of alcoholism.
Alcoholism, or alcohol use disorder, is a major public health concern that is a considerable risk factor for morbidity and disability; therefore, effective treatments are urgently needed. Here, we demonstrated that the glucocorticoid receptor (GR) antagonist mifepristone reduces alcohol intake in alcohol-dependent rats but not in nondependent animals. Both systemic delivery and direct administration into the central nucleus of the amygdala, a critical stress-related brain region, were sufficient to reduce alcohol consumption in dependent animals. We also tested the use of mifepristone in 56 alcohol-dependent human subjects as part of a double-blind clinical and laboratory-based study. Relative to placebo, individuals who received mifepristone (600 mg daily taken orally for 1 week) exhibited a substantial reduction in alcohol-cued craving in the laboratory, and naturalistic measures revealed reduced alcohol consumption during the 1-week treatment phase and 1-week post-treatment phase in mifepristone-treated individuals. Mifepristone was well tolerated and improved liver-function markers. Together, these results support further exploration of GR antagonism via mifepristone as a therapeutic strategy for alcoholism.
Leandro F. Vendruscolo, David Estey, Vivian Goodell, Lauren G. Macshane, Marian L. Logrip, Joel E. Schlosburg, M. Adrienne McGinn, Eva R. Zamora-Martinez, Joseph K. Belanoff, Hazel J. Hunt, Pietro P. Sanna, Olivier George, George F. Koob, Scott Edwards, Barbara J. Mason