New approaches in the treatment of alcohol dependency
It is estimated that around one in three Australians drink alcohol at levels considered harmful.
But despite how common alcohol related disorders are – particularly in the Northern Sydney area, where data shows more people use alcohol compared to other drugs – treatment choices are still limited. This gap has driven the Northern Sydney Local Health District Drug and Alcohol Services (DAS) Research Unit – overseen by Clinical Director and Associate Professor Mark Montebello and Research Lead Dr Lauren Monds – to prioritise clinical trials that explore new therapies and seek to improve outcomes. “If you look at antidepressants, there are about 30 to choose from,” Mark says. “In alcohol dependence treatment, we have only three approved mediations.” In 2024, Mark and the DAS team conducted a landmark NHMRC-funded study (led by Chief Investigators Professors Kirsten Morley and Paul Haber, University of Sydney) involving the “gold standard” medication naltrexone, one of the few approved medications for alcohol dependence in Australia. People with alcohol dependence often have a high tolerance for drinking alcohol or experience withdrawal symptoms when they stop. Naltrexone helps reduce the rewarding effects of drinking by blocking opioid receptors and can help lessen cravings and reduce relapse to drinking. It is usually used alongside counselling or other support rather than as a standalone treatment.
In the 12- week trial, NSLHD patients with severe alcohol dependence were given either naltrexone or topiramate – a medication originally used to prevent seizures that has also been shown to reduce alcohol cravings. While earlier trials had shown topiramate to be more effective than a placebo, Mark and his research team wanted to see how it stacked up against naltrexone. The results were striking: topiramate performed remarkably well. “We weren’t the first to discover it,” says Mark, “but we were the first to do it locally in a rigorous way, head-to-head with the gold standard [medication].” Their upcoming trial involves using cannabidiol (CBD), a medicinal cannabis product, to treat alcohol dependence. The study builds on earlier work showing CBD’s potential to reduce cravings in cannabis use disorder. “There’s evidence it decreases alcohol use as well. We’re looking at whether it can be part of the package of treatments we offer.” The service takes a holistic approach to treatment. “It’s not just about: ‘here take this medication’. It’s also what else can we do to help that person with associated issues such as mental health concerns,” he says. According to Mark, the ability to recruit people to alcohol dependence clinical trials has become one of Northern Sydney’s key research strengths. With more patients presenting with alcohol related issues than drug related ones – and many willing to take part in studies – the service has quickly built a reputation as a leading site for alcohol research.
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