In an announcement called both "off-base" and "promising" by substance abuse professionals, a Towson doctor stated that treating alcoholic patients with a combination of two appetite suppressants can halt their craving for alcohol.
Dr. Pietr Hitzig, an internist in private practice, said yesterday at a news conference that he has treated 18 alcoholic patients for a period of up to 3 1/2 months and that the patients report having lost their compulsion to drink alcohol. His findings are published in the current issue of the Maryland Medical Journal.
The two drugs, phentermine and fenfluramine, are related to amphetamines and have been approved by the Food and Drug Administration for short-term use as appetite suppressants. When used together, the drugs increase dopamine and serotonin. The chemicals are neurotransmitters, serving as message carriers in the brain. Levels of dopamine and serotonin also increase with use of alcohol or drugs and with sex or addictive behavior.
Another study conducted at the University of Rochester School of Medicine showed that these drugs used together can enable obese people to lose weight and then to keep it off. Dr. Hitzig then theorized that the drugs could be used to suppress alcohol cravings.
In his practice, Dr. Hitzig administered a combination of the drugs to 18 patients who are alcoholics. Sixteen of the patients say their desire for alcohol is gone, said Dr. Hitzig, and two say that the drugs have been partially effective in suppressing the craving. They will have to continue taking the drugs to continue the effects, he said.
In his article, Dr. Hitzig also raised the prospect of extending this treatment to other addictions such as cocaine and deviant sexual behavior. He noted that controlled studies are needed.
"He's made an important and promising observation, which will probably spur other research," said Dr. Richard Rothman, chief of the clinical psycho-pharmacology section of the National Institute of Drug Abuse Research Center.
But it is crucial, Dr. Rothman said, for a double-blind study to be conducted on Dr. Hitzig's observation. In this kind of study, two groups of patients are studied. One group receives the actual medications and one group receives a placebo. Neither researchers nor patients know which group is which.
Indeed, as presented in the journal, Dr. Hitzig's methodology doesn't meet standard research criteria, said Dr. Donald Jasinski, chief of the Center for Chemical Dependency at Francis Scott Key Medical Center. "It's one of those things, whether wrong or right, you can't say, but there is not enough information to advocate using it on people," he said.
Dr. Jasinski and another substance abuse professional objected to the use of these drugs to treat alcohol addiction, saying the drugs are considered addictive and have possible negative side effects.
For example, phentermine can cause restlessness, inability to sleep, psychotic episodes and delusions, according to its manufacturer.
"I think the article is candidly off-base," said Dr. Robert Barney, director of the medical department at Sheppard and Enoch Pratt Hospital. "Combining [the drugs] together is going in the wrong direction that one would hope to go in any kind of an addiction treatment."
The question of transferred addiction is a serious one, said Dr. Hitzig. But he theorizes that use of the two drugs, which work in different ways, will protect patients from addiction. Furthermore, he said, "We are talking about a major league disease here -- something that is destroying our culture. People don't get high on these drugs, they can just lead a normal life."