A New Way to Treat Alcoholism
Ten years ago, the gold standard for treatment of alcohol addiction was a month at the Betty Ford Center or another long-term chemical dependency program, followed by regular visits to Alcoholics Anonymous meetings.
Now, scientists are rewriting the book on treatment as research about alcohol’s effect on the brain points toward an approach that adds drug therapy and scientifically tested psychotherapy to such mainstays as AA. And doctors are hoping to gain a new tool for this evolving treatment regimen if a drug called acamprosate is approved by the Food and Drug Administration later this month--the first new alcoholism drug in eight years.
To be sure, acamprosate is no wonder drug. Studies in the United States show that alcoholics who took the drug were able to stay sober 16% longer than a comparable study group that did not receive it.
Despite those modest results, the drug is appealing to doctors looking for a more sophisticated method of treating alcohol dependency--one that acknowledges the physiological aspects of an addiction that affects an estimated 14 million Americans. (About 8 million Americans have alcoholism, and another 6 million are believed to suffer from alcohol abuse disorder, defined as a harmful pattern of drinking that causes problems but does not entail physiological addiction.)
“There is still a stigma that [drug dependency] is a willpower thing,” says Dr. Lance Longo, clinical associate professor of psychiatry at University of Wisconsin Medical School. “But we’re learning that brain chemistry does get messed up by using drugs or alcohol, and we can speed up recovery if we use medication in a proactive way.”
Medication, however, is only helpful when used in tandem with behavioral therapy, scientists say, and experts hope to get a better handle on how such treatment works with the results of a long-awaited study conducted for the National Institute on Alcohol Abuse and Alcoholism. The study, expected to be completed next year, is examining which particular combination of medications and psychotherapy appears most successful.
Though health insurance restrictions have curtailed the use of long hospital stays to overcome alcohol addiction, new research has convinced doctors that their patients do best if treated with a combination of therapies tailored to an individual’s needs.
“In the past decade, we’ve learned that other things work [besides] Alcoholics Anonymous,” says Longo. “In the grand scheme of things, there are many pieces of the pie to recovery.”
Acamprosate and another alcoholism drug, naltrexone, are not abusable or addictive. And doctors are using other nonaddictive drugs, such as anxiety and depression remedies, to augment alcohol treatment strategies, says Dr. Richard Rosenthal, president elect of the American Academy of Addiction Psychiatry.
In the not-so-distant past, addiction was often viewed--even by experts in the field--as a problem resulting from a person not taking responsibility for his own behavior. “There is a moral model of addiction that blames the patient for the addiction and, therefore, taking medications to undo that is wrong,” explains Rosenthal. “ ... Fortunately, I think that kind of attitude is slowly going away.”
Though many doctors embrace medications to treat alcoholism, there is still some reluctance, says Dr. Sylvie Chabac, international project manager for Merck KGaA, which has marketed acamprosate in Europe for 15 years. In Europe, Chabac says, “it was difficult to convince self-help groups because they have a very strong message based on self-motivation and not on pharmacotherapy. Now, we are used to working with them. And we have good clinical experience that shows it is not sufficient to treat with acamprosate without psychosocial support.”
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Experts agree that medications for alcoholism are useless in the absence of behavioral therapy. “The core of treatment is cognitive behavioral therapy: What is the motivation for abstinence, and how do you rebuild your life without using substances?” says Dr. Mark Schuckit, director of alcohol and drug treatment programs at the Veterans Administration in San Diego. He cannot foresee a time when medication therapy alone would be the standard treatment for substance abuse disorders.
Drugs do give doctors more ways to individualize treatment, says Rosenthal.
“If people are engaged in reasonably good treatment and they stay in treatment, they get better over time,” he says. “Unfortunately, there are a lot of mediocre treatments out there. It’s because people aren’t getting treatment matched to their situation.”
An FDA advisory committee voted 8 to 2 last month to recommend approval of acamprosate under an expedited review program.
The agency is expected to accept or reject that recommendation by the end of June, although it could also delay approval pending more information about the drug.
Acamprosate, if approved, will be most helpful to people who are motivated to stay sober but who are bothered by withdrawal symptoms like insomnia, irritability and agitation.
The symptoms are caused by the overstimulation of a type of neurotransmitter in the brain. Some people may begin drinking again to get relief from the symptoms. Acamprosate is thought to help calm overactivity in the brain, reduce the symptoms and help prevent relapse.
In European studies, acamprosate doubled the period of time during which people stopped drinking, contrasted with the 16% gain seen in the U.S. study.
The U.S. study may have had less impressive results, however, because it included all kinds of drinkers, including people who were abusing other drugs and those who weren’t committed to abstinence.
Experts believe that acamprosate is best suited for people who have stopped drinking and are motivated to recover from their addiction.
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Other Drug Treatments
* ReVia (naltrexone). Blocks the high of alcohol to curtail the amount of drinking during a relapse. May also reduce craving for alcohol.
* Antabuse (disulfiram). Used as a deterrent by causing a person to become nauseated if they consume alcohol.
* Acamprosate. Not yet approved by the FDA, the drug helps to ease long-term symptoms of alcohol withdrawal and thus helps reduce the likelihood of relapse.
* Benzodiazepines. Used during detoxification to help with withdrawal symptoms.
* Antidepressants, anticonvulsants, anti-anxiety drugs. Often used in patients with psychiatric disorders, such as depression or panic disorder.
* Ondansetron. An anti-nausea drug that is under study for alcoholics 25 and younger. May act on serotonin system in the brain to affect the urge to drink.
Source: Dr. Lance Longo, University of Wisconsin Medical School.
