Though he's only 38, this is
the third time Chuck R is heading off to a rehab program
for alcoholics. This time Chuck hopes to stay on the wagon,
and maybe get some more visiting time with his sons. Chuck
may soon have a new treatment choice, according to a review
of the anti-addiction drug naltrexone in the Cochrane
Library, which recommends that the drug should "be
accepted as a short-term treatment for alcoholism."
Naltrexone, which was originally
meant to combat heroin addiction, has been available
in Canada for about 10 years. It's mainly used by narcotics
addiction clinics, and has never been marketed as an
alcoholism treatment.
Naltrexone is non-addictive, and
the alcoholism treatment protocol doesn't require total
abstinence. Rather, naltrexone breaks the cycle where
one drink automatically leads to another. It blocks
the natural opioids released by drinking which make
us feel good shortly after downing a glass.
BEST
OF THE BUNCH
Drs Manit Srisurapanont and Ngamwong Jarusuraisin of
Thailand's Chiang Mai University found "high-quality
evidence" suggesting that naltrexone, marketed in Canada
as Revia, reduces the risk of relapse into heavy drinking
by 36% in the first three months of recovery. Patients
taking naltrexone were also 18% less likely to quit
their treatment program than those relying on counselling
or self-help groups.
Like most Cochrane reviews, their
study is a meta-analysis of existing research, examining
29 trials on four continents. Most tested naltrexone
against non-pharmaceutical interventions. Others compared
the drug to the opioid antagonist nalmefene and the
anti-addiction drug acamprosate (Campral), the only
one of the drugs tested that was designed to fight alcohol
addiction.
Interestingly, this latest research
found that naltrexone, despite its origins as a narcotics
addiction treatment, was more effective than acamprosate
in reducing alcoholics' relapses and cravings.
Dr Joseph Volpicelli, an alcoholism
expert at the University of Pennsylvania School of Medicine,
said naltrexone works best in a program "designed to
support the notion that while one drink is not great,
what you really want to stop is excessive drinking.
We should be flexible enough to get at the 90% of people
who aren't in treatment."
The US Substance Abuse and Mental
Health Services Administration takes an equally flexible
position in its naltrexone treatment protocol, saying,
"Abstinence should be a desired goal for the patient;
however, reductions in drinking may be an acceptable
intermediate outcome... because there are many other
areas of a patient's life that can improve, such as
job performance, social relationships, and general physical
health."
Cochrane Database Systematic Reviews
2005
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