Alcohol use disorders are present across medical specialties, with alcohol-related deaths
particularly prevalent in the categories of injury, liver cirrhosis, cancer, cardiovascular
disease, disorders of the peripheral nerves and of the central nervous system. Alcohol
dependence, also referred to as alcohol use disorder, is a chronic, relapsing disorder marked
by compulsive alcohol use, an inability to stop drinking despite harmful consequences, and
the emergence of a withdrawal syndrome upon cessation of use. Early abstinence is associated
with activation of brain stress systems in the extended amygdala. Clinically, protracted
abstinence involves symptoms of craving, mood and sleep disturbance, all of which have been
identified as risk factors for relapse. Nonetheless, implementation of alcohol-specific
medications remains limited across most medical specialties. Medications for treating alcohol
dependence primarily have been adjunctive interventions, and only three
medications-disulfiram, naltrexone, and acamprosate-are approved for this indication by the
United States Food and Drug Administration. Baclofen, an inhibitor of synaptic transmission
through spinal reflex arcs via hyper polarization of primary afferent fiber terminals, was
originally approved by the Food and Drug Administration in 1977 for use in spasticity
associated with neurologic conditions, such as multiple sclerosis and spinal cord lesions.
However, due to its pharmacologic properties it has also been investigated for the treatment
of alcohol dependence. But in the clinical practice of study physicians, it was observed that
most of the patients who were prescribed baclofen for alcohol dependence hit back to alcohol
very soon despite being on the drug. Therefore there is a need to search for an alternative
drug which could be beneficial for this population of patients. Gabapentin is Food and Drug
Administration-approved for the management of epileptic seizures and neuropathic pain. It is
believed to act by blocking a specific alpha-2d subunit of the voltage-gated calcium channel
at selective presynaptic sites and, as a result, to indirectly modulate Gamma Butyric Acid
neurotransmission. Pre-clinical findings indicate that gabapentin normalizes the
stress-induced Gamma Butyric Acid activation in the amygdala that is associated with alcohol
dependence, and provide an excellent pre-clinical rationale for evaluating gabapentin as a
treatment for alcohol dependence. Earlier studies of gabapentin in alcohol dependent
subjects, attempting to abstain following withdrawal support the safety and potential
efficacy of gabapentin in alcohol dependent patients, but definitive conclusions were limited
by either small sample size, methodological, or dosing issues.