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Study Favors Treating Alcoholism With Drugs, Therapy

Posted on: Monday, 8 May 2006, 03:05 CDT

By Kawanza Newson, Milwaukee Journal Sentinel

May 8--Combination therapy using an anti-craving drug and traditional talk therapy is the most effective treatment for helping people who want to stop drinking, according to a study that was partially conducted in Milwaukee.

Though experts say the results confirm that the addiction is treatable, they warn that this treatment regimen may not work for everyone.

"Alcohol dependence is a bio-psychosocial illness, meaning that the way it affects one person may not be the way it affects another," said Lance Longo, medical director of addiction services at Aurora Psychiatric Hospital.

Thus, individual patients may respond differently to certain medications and therapy, he said.

According to the National Council on Alcoholism and Drug Dependence, about 18 million people in the United States abuse alcohol. Studies indicate that half or more of those treated for alcoholism will relapse within three months and 75% will within a year. The rate increases to 90% after four years.

The current study, which was published in the Journal of the American Medical Association, looked at the effectiveness of acamprosate and naltrexone -- two anti-craving medications -- alone and in combination with behavioral counseling to eliminate the desire to drink. All patients also received an intervention, called medical management, that consisted of nine brief, structured outpatient sessions provided a health care professional.

Naltrexone is used to block painkilling and pleasure-producing receptors in the brain, dampening the euphoria produced alcohol.

Acamprosate reduces nerve transmission activity in the brain and has been shown to reduce the desire to drink, increase abstinence and reduce the relapse rate.

Both medications already are approved for use the Food and Drug Administration.

The study analyzed data obtained from 1,385 participants, including 133 from Milwaukee, at 11 centers in the U.S. In Milwaukee, the Aurora Sinai Medical Center involved researchers from the Center for Addiction and Behavioral Health Research at the University of Wisconsin-Milwaukee and Aurora Behavioral Health Services. The median age of the participants was 44.

Overall, alcohol consumption decreased 80% during the study period. Participants who received naltrexone, medical management or both had the most abstinent days after 16 weeks of outpatient treatment. However, people who received only behavioral counseling had the fewest number of days abstinent.

"The beneficial effects of naltrexone were seen in the context of medical management similar to what is routinely available in primary care practice," said Henry Kranzler, a professor of psychiatry at the University of Connecticut School of Medicine in an accompanying editorial.

Acamprosate, which previously had been shown to help people remain abstinent throughout their alcohol-abuse treatment, did not produce similar results in the current study.

"We were a little surprised," said Ron Cisler, co-author of the study and director of the Center for Urban Population Health at UW-Milwaukee. "But we have to remember that everybody in the study did better than they had been before the beginning of the study.

"This study argues for providing alcohol treatment in the same context as other health care conditions, such as diabetes and asthma, so medical providers will be involved in the process," he said.

Studies show that moderate alcohol use -- up to two drinks per day for men and one drink per day for women and older people -- is not harmful for most adults. However, heavy drinking has been shown to increase the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx, according to the National Institute on Alcohol Abuse and Alcoholism. Heavy drinking can also cause liver cirrhosis, immune system problems, brain damage, and harm to a fetus during pregnancy, the agency says.

Wisconsin leads the nation in the percentage of drinkers and is among the leaders in total alcohol consumption, according to a report the U.S. Centers for Disease Control and Prevention.

In 2004, the agency says that 7.4% of adults in Wisconsin were considered heavy drinkers -- ranking it the highest in the U.S. in a tie with Rhode Island.

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Copyright (c) 2006, Milwaukee Journal Sentinel

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Source: The Milwaukee Journal Sentinel

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