Postgraduate Medical Journal, 1976, 52 (Suppl 4) 166 - 167
Propranolol in the treatment of alcoholism: a review
Nordhemspolikliniken , Gothenburg, Sweden
In the withdrawal phase of chronic alcoholism, hyperkinetic circulation characterized by increased cardiac output is the rule. Even in alcoholics who have been sober for a long time increased cardiac output is very common and these changes are similar to these seen in some patients with labile hypertension. This could be caused by psychic tension. In the withdrawal phase propranolol was found to normalize the circulation and to reverse the decreased peripheral vascular resistance. We observed that the patients seemed to be calm after 40 mg of propranolol by mouth.
In a double blind study of propranolol and placebo this effect was confirmed and in another study 120 mg of propranolol a day was compared to 30 mg of diazepam a day (double-blind crossover). Using different psychological methods all significant differences are in favour of propranolol. The findings are in agreement with other reports. It is our clinical impression that propranolol is a useful drug for psychic tension symptoms in chronic alcoholism. Very few side effects have been found.
Alcoholism seems to be a dependence producing drug if taken at high doses over a long time Cultural and economic factors may perhaps be more important than psychological reasons for drinking. Many mammals can develop alcohol dependence although there are differences between species and even individuals of the same species. There are difficulties in defining such terms as dependence. A new need or a new instinct can be synonymous. The dependence on alcohol may be closely related to dependence on morphine or amphetamine.
If an alcoholic lacks alcohols, psychic tension discomfort and anxiety nearly always occur. This condition corresponds to the defence alarm reaction in animals, a state which is produced when some danger is threatening. There is increased alertness. psychic tension increased cardiac output with increased muscle blood flow and raised values of catecholamines and free fatty acids in the blood tension is often severe
In the withdrawal phase of alcoholism psychic
and all X chronic alcoholics in our series had cardiac outputs above the standard variations of normal people at rest and during exercise on a bicycle ergometer (Callssoll 1969). Due to a low peripherical vascular resistance, the blood pressure was not increased. One hour after 40 mg of propranolol was administered orally, there was a normalization of the circulation. As a 'side effect' in 5 of the 8 alcoholics a marked decrease of the psychic tension symptoms was noted. Clinically it was found that alcoholics in the abstinence phase running around the ward asking for sedative pills normalized their behaviour after 40 -80) mg propranolol by mouth. Even though there were dramatic effects on behaviour they denied the effect perhaps because they wanted drugs with euphorizing effects
In a double blind study with two groups of 18 chronic alcoholics he the abstinence phase a tension decreasing effect of propranolol was confirmed (Carlsson and Johansson 1971) Independently such an effect has been found by others (Gallant Swensson and Guerrero-Figueros 1973).
Later a new study was performed with a broader battery of psychological tests where 120 mg propranolol a day was compared with 30 mg diazepam a day in 52 alcoholics who had passed the abstinence phase but still had tension symptoms. The double blind cross-over technique was used and if there was a relapse to alcohol consumption the patient was excluded. The loss during propranolol treatment was 3 and during diazepam 8; one started drinking when he had stopped taking diazepam but before he got propranolol. With different questionnaires all significant differences were in favour of propranolol (Carlsson and Fasth 1976).
Besides these controlled studies we now have a broad clinical experience that propranolol in a number of cases is a suitable drug in the treatment of alcoholism especially as there is no risk of habituation. Alcoholics are very liable to develop dependence on drugs with cross-dependence on alcohol. We have an impression that propranolol may increase the patients' willingness to continue treatment as out-patients. There is also another such report ( Drew Moon and Buchanan 1973).
by C. CALSSON
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