Drug Helps Alcoholics Avoid Liquor, Studies Find : Therapy: Naltrexone, combined with conventional treatment, reduces relapses to 23%, researchers say.

In a finding that promises to revolutionize the treatment of alcoholism, two groups of researchers have independently found a drug that reduces an alcoholic’s craving for liquor.

Use of the medication, called naltrexone, in combination with conventional behavioral treatment reduced relapses from 54% of alcoholic patients to 23%, according to one of the reports that will appear Saturday in the Archives of General Psychiatry.

The medication also made it easier for alcoholics who relapsed while on the program to return to abstinence, said Dr. Joseph Volpicelli, a psychiatrist at the University of Pennsylvania Medical Center.

“These are very important observations and we will be issuing new grants to reproduce and extend them,” said Dr. Enoch Gordis, director of the National Institute on Alcohol and Alcoholism in Bethesda, Md.

“But more important,” he added, “this is the beginning of a new era in which both pharmacotherapy and verbal therapy will be incorporated into alcoholism treatment. Naltrexone is promising, but others will come down the road in the next decade.”

The discovery could have an immediate impact on alcoholism treatment because naltrexone is widely available for use in treating narcotics addiction. Any physician is able to prescribe the drug for other purposes, such as treatment of alcohol abuse.

Alcoholism is the most significant drug abuse problem in the United States. Government studies have shown that at least 10.5 million Americans are victims of alcoholism, and many researchers believe that the figure significantly underestimates the problem.

At least 100,000 deaths are associated with alcohol abuse each year, either from cirrhosis of the liver or from accidents caused by intoxication.

But perhaps even more important are the social costs. Nearly half of all Americans have been exposed to alcoholism in their families, according to a 1991 government report, and alcoholism is a major cause of divorce.

But few alcoholics--no more than one in 10, according to Volpicelli--seek treatment for their addiction. And many who seek treatment quickly drop out of programs, perhaps because the craving for liquor is so strong that they are unable to resist the temptation.

Current medical treatment--as opposed to the 12-step counseling programs exemplified by Alcoholics Anonymous--relies on the medication Antabuse. Patients who drink alcohol after taking Antabuse suffer severe nausea and vomiting. The drug serves as “a threat to the patient not to drink, but does nothing to reduce craving,” Gordis said.

Antabuse is a valuable medication for patients who are committed to stopping their drinking, he added, but is of little value for those who are not strongly motivated. Naltrexone is likely to be viewed as being much more desirable because its effects are positive--reducing the craving--rather than negative.

Naltrexone was developed for treating heroin abuse. It targets the same receptors in the brain that produce feelings of pleasure when heroin or other opiates bind to them. Naltrexone also binds to those sites, but does not produce a pleasurable “high.” Its action is thus similar to that of methadone, but it is not as potent.

Alcohol does not bind to those receptors in the brain. But recent research, Volpicelli said, suggests that alcohol causes the release of the brain’s endorphins, which bind to the receptors and produce a pleasurable sensation. He reasoned that naltrexone might help in treating alcohol abuse.

Preliminary studies in 1991 hinted that that might be the case, but controlled studies were necessary in which neither the patient nor physician knew that the medication was being given. The new studies appear to accomplish that.

Volpicelli and his colleagues studied 70 male alcoholics. Independently, Dr. Bruce Rounsaville and his colleagues at Yale University studied 97 alcoholics of both sexes. All patients were enrolled in traditional behavioral modification programs designed to halt alcohol abuse. Half the patients in each study received naltrexone and the other half received a placebo.

After 12 weeks, only 23% of Volpicelli’s patients who received naltrexone had suffered a relapse, compared to 54% of those who received a placebo. In Rounsaville’s study, which used different criteria for defining relapse, 39% of the naltrexone patients relapsed, compared to 79% of those who received only counseling.

The greatest effects of naltrexone related to the patients’ behavior when they were exposed to alcohol during treatment. Such exposure typically produces very strong craving that induces a relapse. In Volpicelli’s study, 19 of 20 placebo-treated patients relapsed after they sampled alcohol, compared to only eight of 16 patients treated with naltrexone.

Both researchers emphasized that naltrexone is not a cure for alcoholism and that it is not a substitute for 12-step or other recovery programs.

Naltrexone can help tremendously, Volpicelli said, “but it is essential that recovering alcoholics also undergo a comprehensive treatment program, which helps them cope with the social, legal, family, physical and psychological problems that occur as a result of their drinking behavior.”