Despite the existence and availability of drugs that have been specifically approved to treat alcohol dependence, they are not prescribed very often. Several reasons have been cited for this. That addiction is biological and a brain-based disease is not understood by all patients and doctors. Some doctors also feel that medication is an inappropriate course of action because it does not treat the underlying symptoms of addiction directly addressed by therapy and twelve-step programs. The efficacy and side effects of these drugs are factors as well. Recently, the issue of efficacy was rigorously addressed, especially with regard to the drugs naltrexone and acamprosate, in a study published online Tuesday by The Journal of the American Medical Association (JAMA).
For the last 20 years, a number of studies have confirmed oral naltrexone’s efficacy for alcohol dependence. The drug’s potential to treat alcoholism has been documented in published findings since 1981, fourteen years before it received FDA approval in 1995 to do so. Acamprosate got its go-ahead in 2004, but it has been legal and used in the treatment of alcohol dependence in Europe since 1989. The recent JAMA study differs than previous studies in that it “compiled findings from the most rigorous trial of medications for alcoholism in the past few decades.” It also stands out in its notation that alcohol use disorders “remain greatly under treated” and “medications are considerably underused.” Based mostly at the University of North Carolina at Chapel Hill, the research team analyzed data from 122 randomized trials that approximately 23,000 people participated in. The study’s lead author and associate professor of medicine Daniel E. Jonas said that drugs will not work for everyone, “but they can make a difference for a lot of people.”
Federal data shows that roughly 18 million people in the U.S. have an alcohol abuse disorder, and less than 33 percent of them receive any type of treatment. Out of that number of people, only 10 percent are prescribed medications as part of that treatment. The study looked at two drugs categorized as anticraving drugs, naltrexone and acamprosate. Anticraving drugs are called opioid antagonists. This means that they reduce the urge to drink as well as the effects of alcohol intoxication. While naltrexone and acamprosate can have some side effects such as headache, dizziness, and nausea, they are not designed to make people ill if they drink in the way that aversion drugs such as disulfiram are designed to do. Rather than blocking the body’s ability to metabolize alcohol, the underlying biology of addiction is addressed by mitigating the brain’s reward system. Naltrexone blocks both the craving of alcohol and the pleasure one receives from it. This helps with abstention, and it also reduces the amount of alcohol that is consumed by those patients who do drink.
However, these drugs are not magic bullets. The Animated Dissection of Anatomy for Medicine (A.D.A.M.), in the New York Times Health Guide, states that “Naltrexone does not work for all patients” and that its efficacy may depend on whether or not a user has or is missing a specific gene variant. Additionally, a 2006 study conducted by Princess Alexandra Hospital in Brisbane showed that a combination of naltrexone and acamprosate yielded better results than using either drug alone. Lastly, in the JAMA study, despite its conclusion that “both acamprosate and oral naltrexone were associated with reduction in return to drinking,” lead researcher Daniel E. Jonas said the drugs should be used along with other treatments. Referring to the 122 randomized trials the researchers analyzed, Jonas pointed out that they are always studied “in conjunction with psychological intervention, whether it’s AA or cognitive behavioral therapy.” The medication is an addition to standard care. “But,” added Jonas, “we do have treatments that work, and we should be using them more than we are.”
By Donna Westlund