Better treatments needed for alcoholism

Times have changed since the days when alcoholism was regarded as a failure of will. Thanks to advances in science and medicine, however, alcohol addiction is now recognized as a biologically-based chronic disease requiring long-term management, not unlike diabetes or hypertension. And it's this recognition that has led to recent efforts to develop effective therapies that can assist with the long-term management of this disease. Progress toward this goal is slow, writes Douglas Quenqua in his coverage of this topic for The New York Times. Yet the fact that such research is still continuing in earnest demonstrates the significant change in attitude toward alcoholism that has occurred over recent years.

There remain two divergent schools of thought about treating alcoholism. The more traditional methodologies, exemplified by establishments such as the Betty Ford Center and Alcoholics Anonymous, emphasize abstinence and frown on what they see as treating addiction to one drug with a prescription for another. However, other groups place more emphasis on the biological basis of the disease and imagine a future where alcoholics can combine medication with behavioral therapy similar to the model used for clinical depression.

The concept that total abstinence is the only path forward is simply flawed reasoning, says ACSH s Dr. Josh Bloom. Should heroin addicts be denied methadone to help them through withdrawal? No. If a pill exists that can modify the need for alcohol it needs to be used. The pill is not another addiction, nor will it result in the drunk driving, cirrhosis, absence from work, or family problems that alcohol does. Rather, it would help alleviate a very serious societal problem.

Of the three approved medications for alcoholism, two reduce a person's craving for drink the preferred mechanism for this type of drug. Unfortunately, these drugs naltrexone (Alkermes) and acamprosate (Campral) were effective in only about 14 percent of alcoholics in clinical trials. The other drug option, disulfiram (Antabuse) does nothing to reduce cravings; its effect is to make people violently ill when they drink even one sip of alcohol. Yet the potential of other medications to treat alcoholism is being scrutinized. For instance, antiseizure, antispasm, and antinausea drugs have all been used off-label to treat alcoholism with mixed results.

The most difficult part of developing a pharmaceutical treatment is that alcoholics are not a homogeneous group; the basis for their addictions varies. This is why addiction experts say that a range of treatments is necessary, and that moral absolutism consigning alcoholics to abstinence-only programs is often unsuccessful.

As ACSH's Dr. Gilbert Ross notes, the changing treatment paradigm for an addiction like alcohol, which now recognizes the serious drawbacks of abstinence-only treatment, is promising in more than one respect. Not only does it offer higher rates of success, and thus greater hope, for those struggling with alcohol dependency, but widespread acceptance of this more flexible treatment model may help a similar model for treatment of cigarette addiction to eventually receive the recognition it deserves. And this, says Dr. Ross, is undeniably more productive than the inflexible quit or die mantra adhered to by our public health officials.