Popping a Pill Can Help Some Alcoholics Curb Drinking

ScienceDaily (Dec. 16, 2010)

A little-used medication can help treat alcoholism, an updated review of studies confirms. At any given time, about 5 percent of the population suffers from an addiction to alcohol, often with devastating consequences to work, family, friends and health. Twelve-step programs have been the mainstay for helping alcoholics to quit drinking, but a significant number of people who try these programs do not find them helpful or suffer relapses.

The Cochrane review finds that the medication naltrexone — brand names are Depade and ReVia — when combined with counseling or interventions like Alcoholics Anonymous, can help cut the risk of heavy drinking in patients who are dependent on alcohol.

Naltrexone works by blocking the pleasurable feelings, or “high,” a person gets from drinking alcohol, thereby reducing motivation to drink. Naltrexone can be taken daily as a pill and is available as a long-acting injection.

The review was published by the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“Hundreds of drugs have been tried for relapse prevention [in alcoholism] and basically all others have failed,” said Michael Soyka, M.D., senior author of the review. “From a clinical point of view, there are few pharmacologic options for the treatment of alcohol dependence, so it is important to study those options that look promising.” Soyka and lead review author Suanne Roesner are associated with the psychiatric hospital at the University of Munich.

Alcohol dependence is different from alcohol abuse or misuse. The symptoms of alcohol dependence include craving for alcohol, an inability to control drinking, the presence of withdrawal symptoms if one tries to quit and tolerance — the need to increase alcohol amounts to feel the same effect. People who only abuse alcohol and are not dependent on it have no trouble controlling their drinking, once they decide to do so.

Soyka and colleagues examined the results of 50 previously published high-quality studies on naltrexone and alcohol dependence. Overall, the studies enrolled nearly 7,800 patients diagnosed with alcohol dependence. Of these, about 4,200 patients took naltrexone or a similar drug called nalmefene. The rest of the patients took a placebo or had some other type of treatment. Treatment with naltrexone ranged from four weeks to a year, with most patients receiving about 12 weeks of treatment. Most patients also received counseling.

Researchers found that patients who received naltrexone were 17 percent less likely to return to heavy drinking than were patients who received a placebo treatment. “That would mean that naltrexone can be expected to prevent heavy drinking in one out of eight patients who would otherwise have returned to a heavy drinking pattern,” Soyka said.

Naltrexone also increased the number of people who were able to stay abstinent by 4 percent.

While at first glance that might not seem like a miracle cure for alcoholism, Soyka said that the effectiveness of naltrexone is on par with medications used for other psychiatric conditions.

“Naltrexone is moderately effective in reducing alcohol intake. It’s about as effective as antidepressants in depressive disorders,” he said. “From a safety point of view, there are few safety concerns. Nausea is the most frequent side effect.”

Carlton Erickson, Ph.D., director of the Addiction Science Research and Education Center at the University of Texas in Austin, says naltrexone can help a person with alcohol dependence move toward the goal of abstinence.

“Anytime you reduce the severity of drinking, the individual is more open to treatment for abstinence,” he said. “It’s almost like putting them through a series of steps if you can get them to cut down; once they start to cut down they are more likely to become abstinent with continued treatment and continued exposure to 12-step programs.” Erickson is not associated with the review or any of its authors.

Despite its possible benefits in treating alcohol dependency, naltrexone is not widely used in the United States or elsewhere, Erickson said. Some addiction specialists fear that the widespread use of naltrexone or other medications will result in patients not receiving the counseling or psychological interventions they need.

There is also a lingering attitude that the treatment of alcohol dependency must rely solely on psychological or spiritual methods.

“People in 12-step programs typically don’t believe in medications for the treatment of alcoholism,” Erickson said. “Therefore they are unlikely to accept anyone into their 12-step meetings who is on a medication like naltrexone. Secondly, they would not want to accept it for themselves, unless a physician talked them into it as part of their treatment plan.”

In addition, most large alcohol treatment centers, with the exception of Hazelden, do not advocate for the use of medications in the management of addiction, he said.

However, Erickson said that naltrexone is FDA-approved only as an adjunct to abstinence-based therapies, like Alcoholics Anonymous. “Naltrexone is not something you give to someone who says ‘I want to stop drinking, give me a pill.’ Naltrexone is only a helper to that process. The medication itself is not a magic bullet.”

The review discloses that two authors received speaker/consultancy/advisory board honoraria from pharmaceutical companies.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Health Behavior News Service, part of the Center for Advancing Health. The original article was written by Katherine Kahn

Salvia: Miley Cyrus Brought This ‘It’ Drug Into the Spotlight, Is it Dangerous?

Adi Jaffe, Ph.D.

Posted: December 14, 2010 01:45 PM

It causes hallucinations and impairs coordination. The high is almost immediate when smoked. Within five minutes it causes uncontrollable laughter or panic.

While this could be a description for LSD or even marijuana, it can also be used to describe the new “it” drug, salvia. But there is one important difference to note — salvia is legal, at least for now.

Before last week, many people had never heard of the herbal drug salvia, let alone thought about smoking it recreationally. But a leaked video of pop princess Miley Cyrus changed all that, bringing salvia to the mainstream.

As early reports began circulating that there was a video of Miley smoking out of a bong, her camp immediately went on the defense stating that she wasn’t smoking marijuana, rather the herb salvia, which they stressed is legal in California.

Legal or not, the video has stirred up heavy controversy and left many parents wondering what exactly is salvia and whether it is something they need to worry about.

Salvia divinorum is a highly potent herb from the mint and sage families. But unlike its relatives, salvia’s leaves are sold as an alternative to marijuana because of the hallucinogenic effects it produces.

While the drug is currently legal in many of the states, Florida, Virginia and Illinois are among the 15 that have prohibited the substance.

In addition to controversy, the video has stirred up sales for the herbal drug. TMZ is reporting that salvia sales have surged since the release of the video last week.

This increased interest is causing several states, including California, to reconsider their stance on its legal status. Politicians, doctors and parents are concerned about the impact the video will have on kids and young adults, especially considering the accessibility of salvia. Because it is considered a legal substance, in some cases it can be easier for minors to buy salvia than cigarettes.

But again, simply because it’s legal doesn’t mean there isn’t cause for concern. Salvia is often compared to illegal drugs; it is smoked and has a similar appearance to marijuana, and brings on hallucinations, a similar effect to LSD. The high is intense but the trip is substantially shorter than that of other hallucinogens. Often the effects are gone within 20 minutes. Even with the relatively short trip time, the experience can be intense and even scary for some.

Unlike LSD and mushrooms, which act like serotonin, salvia acts through opioid receptors and even more specifically through Kappa opioid receptors. This is in contrast to the receptors that morphine and heroin act on. These receptors are responsible for the feelings of paranoia and anxiety that can lead to dysphoric effects like unease and depression. Despite the increased likelihood that negative side effects will be produced, not all users experience them and they are subject to the individual and dependent on the actual amount consumed.

The number of hits, as with other drugs, has been found to closely correlate with the amount of functionality problems exhibiting themselves in diction and fluency of movements.

The effect salvia has on an individual is subjective, but additional effects that have been tied to the drug include revisiting past memories, sensations of motion, visions of membranes, merging with or becoming objects and a sense of overlapping realities.

Although evidence seems to show that salvia use is relatively safe in the short-term, little is currently known about the long-term effects of salvia and studies are underway to find out if it holds any medicinal value. Studies are also being conducted to learn whether or not the drug holds any addictive properties.

But in the meantime, the medical community stresses caution, as there are still a lot of unknown variables with the drug and its effects, both short and long-term. What we do know is that salvia puts teenagers at high risk for a “bad” trip, which could mean anything from extreme anxiety attacks to sadness and depression. And while the high doesn’t last a significant period of time, the intensity is severe and can lead to severe reactions.

Importantly, the hallucinations and distortions of reality make one thing pretty clear — this drug should NEVER be tried when driving. As for Miley, it seems she has introduced salvia to a new following with her endorsement — so expect this drug to become increasingly popular in the coming months.

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