Hello again, colleagues!
Alcohol use disorder (AUD) is a disease that affects one in seven people. 1 And while treatment options exist, more of them, with more efficacy, are needed. Prazosin has been studied for treatment of nightmares in PTSD and for alcohol use disorder (AUD), two conditions with frequent overlap. The results for alcohol use have been mixed. This paper makes a strong case that the presence of low-level alcohol withdrawal predicts the effectiveness of prazosin in AUD. This may help to untangle the inconsistencies in the existing body of evidence, and reinvigorate the quest to take advantage of alpha blockade in AUD treatment.
While it’s not time to offer clinical guidance based on this study, the effect of 16mg/day of prazosin found here draws attention. With prazosin, there was a 50% reduction in drinking days (OR 0.5 P<0.01) and 76% reduction in heavy drinking days (OR 0.23, p <0.0004) among people with mild alcohol withdrawal symptoms, while no effect of prazosin was seen in people with fewer or no alcohol withdrawal symptoms. Could it be that we’ve had a highly effective option in our midst but we didn’t know who to use with? Maybe. It’s worth thinking about the findings here as we reabsorb prior- and look to future- research, including one just out on prazosin and alcohol use in active duty soldiers (referenced below for eager readers2). I hope this un-patented medication that shows promise for a subset of people with AUD can find its way into quality studies that further elucidate its role.
Thank you for reading,
Andrea Truncali, MD MPH