Alcoholism Drugs Effective but Underutilized

alcoholismAlcoholism drugs are effective when combined with some type of behavioral intervention a new study analysis published in the journal of the American Medical Association revealed on Tuesday, but they are also underutilized. According to the National Institutes of Health, approximately 18 million Americans abuse, or are dependent on alcohol. Dr. Daniel E. Jonas, associate professor of medicine at the University of North Carolina and lead author of the new study, explained that only about one-third of people suffering from alcoholism get treatment for the condition, and fewer than 10 percent receive medication.

Researchers analyzed over 120 trials involving about 23,000 people, that assessed many medications that have been used to treat alcoholism, going back several decades. Three of these medications are approved by the U.S. Food and Drug Administration (FDA), and close to two dozen are medications approved for other ailments, but used as “off label” treatment for alcoholics. The patients in the studies received counseling along with a placebo, or the study drug. Dr. Jonas said that it is not clear if the drugs would be as effective if used without behavioral therapy.

The analyzed studies showed four medications that were successful in helping alcoholics drink less alcohol. They are naltrexone, acamprosate also known by its brand name Campral, the seizure medication Topamax, and Selincro, which is not sold in the U.S. In a majority of the studies naltrexone and acamprosate were the study drugs. To measure efficacy, researchers used a system called “number needed to treat,” which indicates how many people must take the medication in order for one person to be helped. According to Dr. Jonas, information from the studies showed that an average of 12 people needed treatment with acamprosate for one person to benefit. With naltrexone, 20 people needed to be treated for one person to benefit. There was no difference noted between the two drugs when their abilities to control alcohol consumption were directly compared.

Topamax and Selincro were successful at slightly reducing the number of drinks consumed when a person was drinking. According to the study when people took either of these medications they had an average of one drink fewer. Study measures were different for each of the drugs, so analysts could not calculate the “number needed to treat.” Another drug, disulfiram or Antabuse, is the oldest drug approved to treat alcoholism in the United States, and makes users sick if they consume alcohol while taking it. The research showed that Antabuse did not prevent the user’s return to drinking.

Although several alcoholism drugs were proven to be effective by the study, they are still underutilized, but this is due in part to the historic uncertainty of their effectiveness, explained Dr. Jonas. He went on to state that alcoholism is a serious problem for those who suffer from it, and these people need help, but often are not getting it. “One piece of the treatment is these medicines,” he said. The community programs available like Alcoholics Anonymous, and drug counselors are not able to prescribe medications for the people who may benefit from them, thus contributing to their underutilization.¬†Dr. Jonas admitted that the medications won’t work for everyone, but they can still make a difference for many others.

In Seattle, a senior investigator at the Group Health Research Institute, Dr. Katharine A. Bradley, said that in the past, treatment for addictions such as alcoholism have been referred to rehabilitation programs, support groups, and other behavioral therapy programs. She also claims that this is starting to change as doctors are beginning to see addiction as a chronic illness that needs to be treated in a health care setting. Dr. Bradley also said that it has been a slow process getting the alcoholism medications on the medical agenda, “but patients need to know that addiction is a biological condition of the brain, and that we have treatments to improve it.”

A fairly new anti-seizure drug may also be cause for hope among alcoholics. Boston University School of Medicine researchers discovered that ezogabine, also known by the brand name Potiga, can potentially reduce an alcoholic’s desire to drink. Use for alcoholism would be off-label since it is only FDA approved to treat seizure disorders. According to a study published online in the American Journal of Alcohol and Drug Abuse, the ezogabine regulated brain activity by a new mechanism called a Kv7 channel modulation.

The effectiveness of the underutilized drugs available to treat alcoholism remains an important but complex topic. According to a report from the World Health Organization (WHO), 3.3 million people died from alcohol abuse in 2012, so there is great potential for lives to be saved.

By Twanna Harps


Bloomberg News
New York Times

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