Buspirone in the treatment of alcoholic patients

Buspirone is a unique anxiolytic drug with established efficacy in the treatment of anxiety. In animals, buspirone has been shown to alter drinking preference from alcohol to water. The following study was conducted to evaluate the behavioral effects of buspirone in patients meeting the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III) criteria of alcohol abuse. These patients were motivated to reduce or stop drinking, though none were abstinent at baseline. Buspirone was compared with placebo in a double-blind, 8-week trial in 50 outpatients with mild to moderate alcohol abuse. Patients were assessed at baseline and at end point using the following psychometric and alcohol behavior measures: Drinking Behavior Interview (DBI), Alcohol Craving Scale, the Hamilton Anxiety (HAM-A) Rating Scale, the Hamilton Depression (HAM-D) Rating Scale, and the Physician Questionnaire. Dosage was initiated at 5 mg buspirone 3 times a day (15 mg/day), with a flexible regimen to a maximum of 30 mg/day. The mean daily dose was 20.5 mg buspirone, which is comparable to the anxiolytic dose. Efficacy measures were available for 45 patients (24 buspirone, 21 placebo). The treatment discontinuation rate was markedly lower (p = 0.002) on buspirone; 12 placebo patients and 2 buspirone patients discontinued due to lack of effect (p = 0.001). No patients discontinued due to adverse effect. Buspirone reduced alcohol craving by 40% (p = 0.001), in association with reduced HAM-A and HAM-D scores (p = 0.006) and improved the physician's assessment of global psychopathology. Buspirone treatment was also associated with a 57% decrease in DBI scores; statistical comparison of the DBI data with placebo was precluded by the high discontinuation rate in the placebo group. While these results should be interpreted with caution due to the limited sample size and high placebo discontinuation rate, the findings suggest that further evaluation of buspirone in the management of alcoholism, especially abstinent alcoholics, is warranted.