This double-blind, placebo controlled study will evaluate the therapeutic efficacy of bromocriptine and nortriptyline in modifying the drinking behavior of 240 male alcoholics subtyped according to the presence or absence of additional psychiatric disorders. The study is based on the premise that the efficacy of therapeutic interventions can be enhanced by """"""""matching"""""""" patients to particular treatments. This study will determine whether alcoholic patients subtyped by the criterion referenced structured Psychiatric Diagnostic Interview (PDI-R) as Alcoholism only, Alcoholism plus Affective Disorder, Alcoholism plus Anxiety Disorder, or Alcoholism plus Antisocial Personality respond differently to two medications when compared to a placebo. Bromocriptine and nortriptyline were selected for study because: putative neurotransmitters reportedly mediate the initiation, maintenance and cessation of alcohol intake; both drugs relieve symptoms associated with affective and/or anxiety disorders; a large number of alcoholic patients satisfy diagnostic criteria for one or more additional psychiatric disorders; preliminary studies suggest that bromocriptine directly decreases the desire of some alcoholics to drink. One third of the patients in each of the four subgroups will be randomly assigned to treatment with bromocriptine, nortriptyline and placebo. Patients will be followed at monthly clinics for a minimum of six and a maximum of twelve months and a comprehensive series of descriptive measures will be obtained at specific time intervals. This 3 (drug) x 4 (subtype) experimental design with repeated measures will examine the independent effects of treatment and alcoholic subtype upon various outcome measures over time, as well as their interactions. We anticipate a significant treatment X subtype interaction with nortriptyline providing the greatest benefit for the depressed and anxiety disorder subtypes since their abusive drinking may be partially sustained by the presence of the additional disorder. In contrast, bromocriptine should provide the greatest benefit to the alcoholism only and antisocial subtypes because of the drug's presumed direct effect on the desire to drink. The relative contribution of treatment and subtype in combination with other patient characteristics will provide the opportunity to empirically explore the very attractive, but thus far unproven, hypothesis that """"""""matching"""""""" patients to treatment can result in more optimal outcomes.
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