Vincent Van Gogh's Glass
of Absinthe |
A drug long used to treat migraines
and epilepsy also helps alcoholics reduce or even quit
drinking, finds a US study in the October 10 JAMA.
Topiramate appears to reduce the urge to drink. Unlike
most alcohol addiction studies, subjects didn't have
to abstain to be included. "You can come in drinking
a bottle of scotch a day and get treatment without detox,"
lead author Dr Bankole Johnson told AP.
Trouble is, very few MDs prescribe
alcoholism meds anyway. "It's no magic bullet but it
can make a difference when used in conjunction with
therapy," says Dr Mark Willenbring, a psychiatrist at
the US's National Institute on Alcohol Abuse and Alcoholism
(NIAAA).
Dr Willenbring wrote an editorial
accompanying the JAMA topiramate study in which
he urges primary care docs to get past their frustrations
and fears of treating alcoholism because they're best-placed
to tackle it. Here are some simple ways you can approach
this complex disorder:
De-stigmatize "It reminds
me of the conversation 30 years ago about depression,"
says Dr Willenbring. "Back then depression wasn't coffee
table talk. There's been a complete sea change. Now
people are starting to see alcoholism as a disease."
He says docs still have to contend with the same society-driven
prejudice as everyone else — namely, that addicts
need to suffer or they won't develop the skills to cope.
"It's cruel. Non-adherence is the sine qua non
of chronic illness," he says.
Talk about it Bring up drinking
with all your patients. "Research has shown that the
problem is not so much that the patients are reluctant
but that the doctors are," says Dr Willenbring. There
are a bunch of reasons for this, he says. "Doctors haven't
been trained, they have no experience. And doctors hate
appearing to not know what to do."
Gauge severity The NIAAA's
clinical guidelines on drinking cessation suggest you
get the ball rolling with this question: "How many times
in the past year have you had . . . 5 or more drinks
in a day (for men) or 4 or more drinks in a day (for
women)?" Keep asking followup questions to ascertain
whether they are at risk to become or are alcohol dependent.
(The guidelines, complete with baseline charts, are
available here: www.niaaa.nih.gov/guide.
Also available as CME: http://www.medscape.com/viewprogram/6771.)
Know who to screen "We think
of the alcohol dependent as a middle-aged person who's
been drinking for decades," says Dr Willenbring. But
new research published this summer in Archives of
General Psychiatry, challenges our stereotypes about
alcoholism. "Alcohol dependence is primarily a disorder
of youth [18-21 years old]... In most cases, the disorder
is episodic rather than chronic and unrelenting," writes
Dr Willenbring in his editorial. But just because they
may mature out of it, that doesn't mean they shouldn't
be treated in hopes of preventing a bad episode, says
Dr Willenbring.
How to treat Dr Willenbring
suggests you prescribe medication while the patient
also gets behavioural therapy or attends AA. "A lot
of research shows that AA really works," he says.
Follow up "I like to see
patients no later than a month after a prescription,"
says Dr Willenbring. "If you have a nurse doing the
medication management, they should see them more often
and let you know if there's a problem." He said you
should also "ask if they've gotten alcohol out of the
house, whether they're hanging out with drinkers, should
I change the medication, should I refer?"
print
and keep info for your patients
9
strategies to help you quit drinking
- Set limits Decide
with your doctor how many days and how much
you want to drink. In general, men should have
no more than 14 drinks a week; for women, the
maximum is half that - seven drinks per week.
Depending on your situation and health status,
you may wish to drink less
- Keep track Jot down
your consumption in a little notebook, calendar
or on your PDA. When you reach your daily limit,
stop
- Measure your drinks
Get in the habit of using a measuring glass
when pouring drinks. One standard drink is 355ml
(12oz) of beer, 148ml (5oz) of wine or 44ml
(1.5oz) of spirits. When you're out, ask the
bartender or server how many measures of alcohol
there are in the drink you're ordering
- Recognize triggers
If there are certain people, activities or places
that make you drink, try to avoid them as much
as possible. If it's a feeling (drinking when
feeling down or elated), be aware and consciously
choose another way to cope
- Avoid temptation Keep
little or no alcohol at home if you're in the
habit of drinking there. If you drink at certain
places or events or with certain people, plan
alternative activities and try to cultivate
new companions
- Plan ahead for urges
When an urge hits, remind yourself of your reasons
for changing or talk to someone you trust. Take
your mind off it with a distracting activity
- Have "No" at the tip of
your tongue Be prepared to be offered drinks
and be prepared to quickly, politely say "No,
thanks"
- Don't go it alone
If you know you're badly addicted to alcohol
and need to stop completely, don't try to quit
on your own. Sudden withdrawal for heavy drinkers
can have dangerous side effects, like seizures.
Talk to your doctor
- Join a support group
Taking part in Alcoholics Anonymous or similar
meetings can help you build a solid support
network and meet people going through the same
experience and share coping strategies
Adapted from NIAAA
Clinician's Guide Helping Patients Who Drink
Too Much: A Clinician's Guide
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