"Alcoholism is a hidden disease," says Garbutt. "Only about 25 percent of alcoholics ever get treatment. Patients who are addicted don't want to change. Physicians don't ask and patients don't tell, which is why so many go untreated."
Dr. Mark Willenbring, at the National Institute on Alcohol Abuse and Alcoholism, agrees that alcoholism is undertreated and says that the problem needs to be addressed by physicians.
"One potential solution is for primary care physicians and psychiatrists to begin systematically identifying and treating alcohol dependence in their patients," Willenbring writes in an editorial accompanying the study.
"Unfortunately, physicians receive minimal education in this area, being exposed primarily to hospitalized, severely ill patients with alcoholism," he continues. "Consequently, many clinicians may feel ill-equipped to care for patients with alcohol disorders, except to refer to specialty treatment."
And of those who do get treatment, only a very small number — 10 percent — receive medications. Currently, there are three drugs approved by the FDA to treat alcohol dependence: Anabuse, Naltrexone and Campral, but they are not widely used.
"It has been a great disappointment," says Garbutt. "There is a lack of understanding in both patients and physicians. We need to get the word out that there are medications that can help."
And unlike the current medications available, topiramate can be given to patients seeking immediate treatment.
"Current drugs are for relapse prevention," says Johnson. "Patients have to stop drinking before they can be put on the drugs. Topamax can be given immediately, at the time of crisis. It helps people reduce the number of heavy drinking days, and it prevents relapse — a dual action."
The drug may be able to treat other addictions as well. "We are just finishing up a trial for the National Institutes of Health, looking at Topamax as a possible treatment for methamphetamine addiction," says Johnson. "There is also preliminary evidence that it could reduce smoking and cocaine use."
However, topiramate will not necessarily be the new cure for addictions. It has the potential to work well for some patients but not for others, because different people have different brain chemistry — which means that, for some patients, existing drugs may be best.
"The comparison of Topamax with Campral and Naltrexone should not be viewed as a competition for treatment of the same patient," says Boris Tabakoff, a professor of pharmacology at the University of Colorado's school of medicine.
He explains that personalized medicine — matching specific patients to specific medications — may be available in the near future.
"It has already been demonstrated that significant differences in patient characteristics distinguish success from failure," Tabakoff says. "In essence, the three medications may, in fact, be each more effective in particular subpopulations of excessive drinkers."
Garbutt also agrees that topiramate could help a specific group of people.
"Because Topamax has a different mechanism of action, it may be helpful for patients who do not respond to other medications," he explains.
And medication is only one component of the toolbox for treating alcoholism. Counseling, peer support and family encouragement can also play a major role in helping someone overcome alcohol addiction.