Can You Drink Your Way to Sobriety? AA Not Working?
IT IS NOT YOUR FAULT...THERE IS A MIRACLE CURE
What if you were a problem drinker or alcoholic, and a medical professional could give you a drug to take away your urge to drink...while you were still permitted to continue drinking?
A controversial method using an opiate blocker may help alcoholics—but claims they need to continue to drink during treatment.
By Coeli Carr for MSN Health & Fitness
Advocates of this treatment approach, called the Sinclair method, claim you'd likely experience no withdrawal symptoms. According to proponents, after three or four months on the medication, all while still being able to continue to drink, you'd experience diminished cravings or even find that your urge to imbibe goes away.
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"Drinking alcohol releases endorphins, the body's own feel-good substances," says Eskapa. These endorphins, he says, head straight for the brain's opiate receptors, which are especially sensitive in people who are genetically predisposed to alcoholism.
Naltrexone drinking, causes the endorphins to bounce off the opiate receptors, according to Eskapa. If these endorphins don't make contact with the receptors, reinforcement does not occur, the addictive
In his book, Eskapa, who treats alcohol addiction in South Africa, England and India, describes extensive research and dozens of clinical trials on Naltrexone's use in treating alcohol dependency. He points out that, most recently, results of the COMBINE study—the largest controlled clinical trial in the field of alcohol dependence, published in the Journal of the American Medical Association in 2006—found Naltrexone was effective in treating alcoholism even without intensive counseling.
In 2000, studies conducted in Finland by David Sinclair, Ph.D.—who developed the method that Eskapa recommends—established that a patient has to continue to drink alcohol while taking Naltrexone for the treatment to work. "The medication, taken without drinking, won't work and is entirely ineffective," says Eskapa.
Despite that study published in JAMA, Eskapa claims Naltrexone is still very much under the radar as a treatment for alcohol in the U.S., mainly because medical professionals here focus on abstinence-based treatments. So is Naltrexone the "cure" for alcohol that Eskapa claims? Many addiction experts disagree.
Does Naltrexone work? Experts weigh in; The fundamental issue with Naltrexone has nothing to do with acceptance by treatments centers, says David Sack, M.D., an addiction psychiatrist and the CEO of Promises Treatment Centers in Malibu and Los Angeles, famous for its treatment of celebrities. "We use Naltrexone, we're not opposed to it, but the problem is it doesn't work that well."
"Naltrexone has an effect, but it's a weak effect," he says, noting that humans are different from the rodents on which much of the research was done. "In animals, the opiate system—the system that Naltrexone affects—has a very powerful effect on regulating alcohol consumption," he says. "In humans, the same does not appear to be true."
"Even though Naltrexone is my first-line drug in treating alcoholism—it's safe, easy to take and easily prescribed—the fact is Naltrexone doesn't work in everyone," says Mark L. Willenbring, M.D., an addiction psychiatrist in private practice, and the director of the division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism. The reason, he says, may be genetic. "It appears that some people with a certain configuration of genes that code for the opiate receptors in the brain are highly responsive to Naltrexone," he says. Another issue, adds Willenbring, is that genes associated with a positive response to Naltrexone may differ according to ethnicity.
People who work in the alcohol addiction field are aware of Naltrexone, adds Daniel Angres, M.D., a psychiatrist and medical director of Resurrection Behavioral Health Addiction Services in Chicago. Angres, who considers Naltrexone to be an effective medication, has observed that some people who take it are unable to get a high from drinking alcohol, and that some feel that their cravings for alcohol are reduced. In fact, according to Angres, some people who take Naltrexone experience reduced cravings for alcohol whether they're problem drinkers or not.
The downside of Naltrexone, says Angres, is poor compliance. Studies have shown that half of the people who take it don't refill their prescription or stop taking it after 30 days, he says. That lack of follow-through was what led to the development of an injectable form of the drug called Vivitrol. Angres, who has spoken on behalf of Alkermes, Inc., the pharmaceutical company that produces Vivitrol, says that because the injectable form stays in your system for a month, it's ideal for people who either forget—or purposely neglect—to take Naltrexone orally. Many health insurance plans pay for the injections, which cost around $700 per dose.
Harold C. Urschel III, M.D., chief medical strategist at Enterhealth, a residential addiction treatment program in Dallas, and the author of Healing the Addicted Brain (Sourcebooks, 2009), has been prescribing Naltrexone since 1991. He likes that it has very few side effects and that it's easy to take. "But I disagree that you need to drink alcohol in order for the medication to work and decrease cravings," he says. Urschel says that, in his experience, alcoholics taking Naltrexone become so frustrated after not getting pleasure from drinking that, after a few weeks, they stop drinking on their own.
He's also a big fan of Vivitrol. "The beauty of it is you can't stop the medication if you're having a weak moment," he says, because it's already being metabolized by the body.
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Sack, of Promises Treatment Centers, estimates that between five and 10 percent of the patients at his treatment centers are treated with Naltrexone. Those most likely to receive it are people with a history of early relapse—those who have been treated before and have not been able to maintain sobriety for much more than 30 days. The medication provides its greatest benefit, he says, to people who experience intense cravings for alcohol. "Every study done on Naltrexone shows that people on the medication, compared to those on placebos, had significantly fewer heavy-drinking days, and had a longer time to 'first drink,'" he says.
Willenbring says the research shows that Naltrexone works best in people who are trying to stay abstinent, but who are struggling. "Most people will have slips where they drink, so Naltrexone is an insurance policy," he says. "Because Naltrexone reduces relapse—if you're taking it, you don't have this skyrocketing of desire for alcohol which drives the loss of control—it allows patients to stay involved in their treatment." Young people who engage in episodic heavy drinking also appear to benefit from the medication. "They can take Naltrexone as needed an hour before they go out, and it keeps them keep their drinking in control," he says.
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The issue facing many medical professionals is whether it's appropriate to allow or even instruct an alcoholic to drink, even though the Sinclair method espoused by Eskapa insists that consuming alcohol in conjunction with taking Naltrexone is necessary to reduce cravings.
Willenbring believes the vast majority of people who are moderately or severely dependent on alcohol do not achieve long-term success unless they abstain. "I don't think any responsible addiction specialist would encourage an alcohol-dependent person to use alcohol," says Sack. And Urschel doesn't believe we should be encouraging alcoholics to drink their way to sobriety. "It's a scary recommendation," he says.
Angres, the Chicago psychiatrist, says that he and most people who treat alcoholics in this country embrace an abstinence-based philosophy. "I don't use Naltrexone to get people to moderate their drinking," he says. "Moderation management can be a continuous assault on the alcoholic's brain, preventing the rewiring necessary to cultivate non-chemical ways to create a sense of well-being," he says. Besides, he adds, if you do drink while taking Naltrexone, and the drug blocks the pleasant experiences you're looking for, why drink? Angres underscores that Naltrexone and Vivitrol are not "magic bullets, but should be adjuncts to psychosocial and 12-step–oriented treatments."
Michael Pearlman, M.D., a psychiatrist specializing in addiction who works in private practice in Framingham, Mass., adds, "Theoretically, Sinclair is likely correct and it may be optimal to use Naltrexone this way, but I cannot in good conscience ask or insist that my alcoholic patients drink alcohol for the overall treatment with Naltrexone to work effectively."
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Naltrexone and not dealing with these other issues, then your efforts to achieve sobriety will be compromised."
For Willenbring, the use of the word "cure" in the title of Eskapa's book does a disservice. "One size doesn't fit all, and Naltrexone doesn't have the same effect on everyone," says Willenbring. However, he acknowledges that Naltrexone is widely underutilized, and that physicians and the public need to be more educated about this medication.
Willenbring recalls one patient who complained that, even if he took Naltrexone and didn't get the same reward from drinking, he would still miss the buzz. "Even if people are on Naltrexone, the reality is that many will still miss getting high and therefore will still 'want' a drink," he says. "My patient told me, 'I want not to want.' And that's the next goal of medication research—to help people want not to want."