It is established that 30-50% of alcoholics relapse during the first three months after stopping drinking. Whythis period is particularly vulnerable for relapse is not clear. Clinical research has confirmed impaired sleep,mood instability, and anxiety, indicators of brain hyperexcitability, during the early abstinence period. Theseearly abstinence, or protracted withdrawal, symptoms, although not yet well characterized or quantified, arereported to be poorly tolerated by the client and are suggested to play a role in craving and relapse toalcohol use. Targeting these symptoms with a medication that does not, itself, have abuse potential ishypothesized to result in improved treatment outcome.The medication chosen to target these early abstinence symptoms is the anticonvulsant gabapentin. Theproposal takes advantage of a unique program at our affiliated Veterans Administration Medical Center(VAMC) that provides residential housing and intensive substance abuse treatment for 4 weeks, as long asa client is verified as alcohol-free. This setting is ideal, since the dependent variables of interest (sleep,mood, brain activity) will not be influenced by the presence of alcohol. The hypothesis being tested is thatthe gabapentin-treated group, as compared to the placebo-treated group, will show improvements inbehavioral (i.e., sleep, anxiety, mood) and neurological (i.e., acoustic startle and transcranial magneticstimulation) indices. In addition, the study will explore if treatment with gabapentin during this 4-week earlyabstinence period decreases relapse to drinking in the month following discontinuation of pharmacotherapyand discharge from the intensive outpatient residential treatment program and will explore if gabapentin isequally effective in medically detoxified alcoholics as in non-medically detoxified alcoholics.This proposal builds on our previous experience with pharmacotherapy and behavioral/neurologicalcharacterization of acute alcohol detoxification. It extends our investigations to the early abstinence periodand to a clinical treatment setting, specifically targeting protracted withdrawal symptoms with theanticonvulsant gabapentin. By using behavior, acoustic startle reflex and transcranial magnetic stimulationtechnologies, the study will also allow a systematic investigation of the relationship between persistent brainabnormalities and self-reported craving. This information has important implications for relapse prevention.
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