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Alcohol dependence remains difficult to treat pharmacologically. Disulfiram requires regular compliance, and acamprosate and naltrexone have only small-to-medium effect sizes. Two research groups examined other pharmacologic agents added to brief behavioral interventions.
In 2003, researchers conducting a randomized controlled trial established the efficacy of topiramate for alcohol dependence. Now, the same group has conducted a longer and larger (14 vs. 8 weeks; n=371 vs. 150), multisite, randomized, placebo-controlled, manufacturer-funded trial of topiramate. Topiramate (dose, ≤300 mg/day, titrated over 6 weeks [titration lasted 8 weeks in the previous study]), was superior to placebo in reducing the percentage of heavy drinking days, red…