Lithium dissolves as alcoholism treatment.

Lithium dissolves as alcoholism treatment

The drug lithium, commonly prescribed for manic depressives, has been periodically touted as an effective treatment for alcoholism over the past 15 years. But an exhaustive study of alcoholics given lithium for one year after hospitalization for their drinking problems, reported last week at the annual meeting of the American Psychiatric Association in San Francisco, douses the optimism of earlier investigators.

"We find lithium, in comparison to an inactive placebo, is not effective in the treatment of alcoholic males with or without depression," says study director Walter Dorus of Loyola University in Maywood, Ill.

Dorus and his colleagues, whose report will appear in an upcoming JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, assembled a sample of 457 men in treatment for alcoholism at seven Veterans Administration Medical Centers around the country. Standardized interviews identified 286 subjects with no other psychiatric disorders and 171 who had been clinically depressed at some time during their lives. Alcoholics with other psychiatric diagnoses were excluded from the study.

Men in the follow-up sample had been drinking heavily for an average of 23 years, beginning at around 25 years of age.

Upon release from the hospital, subjects were randomly assigned to lithium or placebo treatment and reinterviewed every month for one year. A total of 280 alcoholics--172 with no history of depression -- stuck with their treatment for the entire year.

About 31 percent of the year-end sample remained abstinent, a proportion similar to that reported by other researchers. Abstinence was only a few percentage points greater in depressed and nondepressed lithium patients, a statistically insignificant difference, Dorus says.

Furthermore, there were no marked differences during the study between lithium and placebo alcoholics in number of days of drinking, alcohol-related hospitalizations and changes in the severity of depression.

Subjects attending Alcoholics Anonymous regularly did not benefit from lithium treatment either, Dorus adds.

"In my opinion, the VA study is definitive," says psychiatrist James W. Jefferson of the University of Wisconsin Medical School in Madison. "Overall, lithium is not useful in the treatment of alcoholism."

But according to psychiatrist Jan A. Fawcett of Rush-Presbyterian-St. Luke's Medical Center in Chicago, who also presented new data at the psychiatric meeting, lithium still holds promise in some cases of alcoholism. He and his co-workers followed 122 alcoholics for 18 months after release from a private hospital. The 28 subjects maintaining high blood levels of lithium were significantly more abstinent and required fewer returns to the hospital than those with low blood levels of lithium or placebo controls, Fawcett reports. If a patient fell off the wagon, however, high blood levels of lithium did not reduce their drinking, he adds.

Alcoholics in the VA sample with comparably high blood levels of lithium showed no significant improvement, Dorus notes. He says the evidence does not support arguments for including lithium in alcoholism treatment -- the most recent of which appears in a letter in the March ARCHIVES OF GENERAL PSYCHIATRY by psychiatrist Abraham Flemenbaum of the University of Miami School of Medicine.

Psychiatrist Donald W. Goodwin of the University of Kansas Medical Center in Kansas City has not totally given up on lithium. "It may be useful with a subgroup of alcoholics, as Fawcett suggests," Goodwin says. "But further studies probably won't be done after the negative findings of the VA researchers come out."