Given that one person in the world dies every 10 seconds from alcohol consumption, the need for help in staying sober is starkly clear. So why has more than a decade passed with little use of two effective medications for alcoholics?
That was the question undertaken by researchers at the University of North Carolina at Chapel Hill, who assembled findings from 122 randomized drug trials of alcoholism medications spanning more than 20 years and involving 23,000 subjects. The brain’s craving for alcohol, a leading cause for relapse, is eased with the drugs naltrexone and acamprosate. So why aren’t more doctors and patients using them?
The study’s answer: A simple lack of awareness the drugs exist — and a lack of knowledge that they don’t cause the miserable side effects of earlier drugs such as Antabuse (disulfiram).
Federal data show that as many as 18 million Americans have issues with alcohol abuse and roughly 88,000 people die every year due to excessive drinking. Medications that could bring these numbers down and save lives are “considerably underused,” the authors concluded in the study, published May 13 in JAMA, the Journal of the American Medical Association.
Along with concurrent counseling through professional or self-help programs, both acamprosate and naltrexone are associated with a reduction in the return to drinking, the study found.
“The underutilization of medications available to treat alcoholism, especially in the Unites States, is a tremendous irony,” said Dr. Ash Bhatt, an addiction specialist and medical director at The Recovery Place and chief medical officer for the Florida region of Elements Behavioral Health.
“The two drugs have potential and real-life efficacy in reducing cravings and potentially rebalancing the brain chemistry, which is altered by long-term alcohol abuse,” Dr. Bhatt said. “Many people suffering from alcoholism are treated by various practitioners in a variety of venues, yet these reasonably safe, non-narcotic, non-addictive medications are not being prescribed on a first-hand basis. This is extremely sad.”
The study authors did not attempt to explain why the medical profession remains uninformed about alcoholism drugs approved by the Food and Drug Administration back in the 1990s.
“It’s been quite a bit of a secret,” Dr. Dan Jonas, assistant professor of medicine at the University of North Carolina at Chapel Hill and one of the study authors, told National Public Radio. “It doesn’t get advertised.”
Few in Need Get Treatment
Part of the puzzle is this math: Few alcohol abusers get help of any kind. About 3.1 million people in the U.S. need treatment for some form of substance abuse, according to the National Survey on Drug Use and Health. Less than a third of alcoholics get any treatment, and only 10 percent are given the medications approved a decade ago for recovery from alcoholism, according to the New York Times. In reporting the study findings, the paper noted that addiction specialists are predicting more problem drinkers will seek treatment given that the Affordable Care Act requires insurers to provide coverage for substance abuse treatment.
One factor in the underuse of the drugs is that doctors — and thus patients who have tried unsuccessfully to quit drinking — assume they will cause the same unpleasant physical reactions associated with Antabuse, including severe nausea, vomiting and headaches.
As a hands-on addiction treatment practitioner, Dr. Bhatt offered the general approach taken with the pair of drugs studied:
“At The Recovery Place, at the time of initial treatment planning,” Dr. Bhatt said, “clients addicted to alcohol are educated and offered anti-craving medication such as naltrexone and given data from prominent research studies to help them assess whether the medication is right for them.”
Concurring with the research findings by the University of North Carolina at Chapel Hill, Dr. Bhatt said many people in treatment for alcoholism have heard only horror stories about drugs for alcohol cravings.
“They have misconceptions of these non-aversive medications due to a negative stigma carried along from previous agents, such as disulfiram, which caused people to become violently ill if they consumed alcohol.”
But the research has shown that while addiction is complicated and there is no magic potion, naltrexone and the newer acamprosate reduce cravings and dull the euphoria from alcohol, reducing heavy drinking days and perhaps a full-blown relapse.
Meds Are ‘Ammunition’
“It’s an additional level of ammunition,” Dr. Bhatt said. “Although acamprosate’s mechanism of action is not greatly understood, it has shown in many studies to work on balancing the neurotransmitters altered by long-term alcohol exposure to the brain, potentially to help ‘rebalance’ the brain’s chemistry.”
Use of any medicine in treatment has to be weighed for individual risks, but “the fact that many patients are not even given an opportunity to be considered for these effective medications limits our ability to decrease alcoholism in the U.S.,” Dr. Bhatt said.
Addiction treatment experts called for better education of primary care physicians and other non-addiction specialists, as well as an ongoing view of addiction as a medical disease.
George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, said the new study should reassure doctors that naltrexone and acamprosate can help many patients.
“This is an important paper,” Dr. Koob, who was not involved in the study, told The Times. “There are effective medications for the treatment of alcoholism, and it would be great if the world would use them.”
According to the CDC, the scale of the problem is daunting.
- More than 10 percent of U.S. children live with a parent with an alcohol problem.
- By age 15, more than 50 percent of teens have had at least one drink.
- Alcohol use is the third-leading preventable cause of death in the U.S.
- In 2006, there were more than 1.2 million emergency room visits and 2.7 million physician office visits due to excessive drinking.
- The economic costs of excessive alcohol consumption in 2006 were estimated at $223.5 billion, primarily from lost productivity but also from health care and property damage costs. These issues affect all Americans, whether they drink or not.
Globally, one person every 10 seconds dies from alcohol consumption– 3.3 million in 2012 — according to a World Health Organization study released earlier this month.