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.

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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

Italian Youths Who Drink With Meals Are Less Often Adult Problem-Drinkers

Underage Drinking
Underage Drinking

Italian youths whose parents allowed them to have alcohol with meals while they were growing up are less likely to develop harmful drinking patterns in the future, according to a new study led by a Boston University School of Public Health (BUSPH) researcher.

In a paper published in the journal Addiction, Research and Theory,a research team led by Lee Strunin, PhD, a professor of community health sciences at BUSPH, detailed their study of the drinking patterns and histories of 160 Italian adolescents and young adults who identified themselves as regular or heavy drinkers. The authors concluded that the introduction of a moderate amount of alcohol in a family setting could prevent young people from binge drinking and nurture healthier drinking behaviors.

“Young people allowed alcohol with meals when growing up were more likely to never drink 5 [or more drinks] or get drunk,” the authors wrote. If they did drink more heavily, it was typically at a “later age than participants who weren’t allowed alcohol in a family setting.”

The researchers interviewed two groups of young people in the Italian regions of Abruzzo and Umbria. One consisted of 80 young adults aged 25-30; the second consisted of 80 adolescents, 16 to18 years old. “We were fortunate to be able to have such a large study sample to interview to help us understand this phenomenon,” said Strunin.

Although the results focused on Italy, Strunin said they could be applied to different countries and could “assist in the design of policies to reduce alcohol problems and harmful behavior among young people.”

Other reports have also suggested that alcohol introduced in a family setting may reduce alcohol-related risk behavior among young people, according to Strunin. Part of the reason, she said, could be that when alcohol is allowed, it is in a context in which there is openness about drinking, and moderate drinking with meals is considered normal.

“Youths in these cultures learn to drink more responsibly than their U.S. counterparts because drinking is culturally normative, exposure occurs at a younger age, and alcohol is part of the fabric of family mores,” said the report.

It is important to note, the authors wrote, that the study focused on youths and young adults who drank wine during a meal with their family. “In talking about drinking in the family, we are talking about meal drinking, not sitting down with your child watching the football or baseball game with a six-pack,” Strunin said. “The wine drinking is part of the meal.

In addition to Strunin, co-authors of the study are: Kirstin Lindeman of BUSPH; Enrico Tempesta and Simona Anav of Osservatorio Permanente sui Giovani e l’Alcool, Rome, Italy; and Pierluigi Ascani and Luza Parisi of Format Research, Rome, Italy.

Funding for this study came from a grant from the National Institute of Alcohol Abuse and Alcoholism.

Story originally published at: http://www.sciencedaily.com/releases/2010/08/100819112224.htm