Naltrexone and Alcoholism – Treating a Disease with Medicine
Alcoholism is one of the most pervasive diseases in the United States and the statistics are staggering. More than 15 million adults over the age of 18 suffer from alcohol use disorder, reports the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and that number falls short because these are just the diagnosed cases.
Despite scientific advances, most treatment for alcoholism is still rooted in the 1950’s idea that it’s a moral failure, which requires a spiritual fix. Unfortunately, that approach dismisses new and effective medical treatments for the disease.
This is why a growing number of addiction specialists are moving away from 12-step models, such as Alcoholics Anonymous and Narcotics Anonymous, and using Food and Drug Administration approved medications for alcoholism, like naltrexone.
When asked by NBC News Reporter Craig Melvin, on “Sunday Night with Megan Kelly,” how he would characterize the treatment of alcohol use disorder in the U.S., Dr. Mark Willenbring didn’t hesitate at all. “It’s an abomination,” he replied.
Only about 8 percent of people who suffer from alcoholism receive “treatment” at a specialized facility. As a result, around 90,000 people a year die from alcohol related causes, making alcohol use disorder the fourth leading cause of preventable death in America.
“People don’t have access to professional, dignified, scientifically based treatment,” said Willenbring, who ran alcohol recovery research at the National Institutes of Health and spent 30 years investigating the cause of alcohol abuse.
Willenbring explained to Melvin that in the treatment of diabetes, the approach is not to send a patient to a spa for a month, teach them about exercise and diet and then prescribe them 90 meetings in 90 days at a support group, all while suggesting they abstain from insulin.
“That’s the absurdity of what we’re doing now,” he said. “We’re still providing the same kind of pseudo treatment that we provided in 1950 and 85 percent of rehabs in the country are 12-step rehabs. People don’t have any choice.”
Evidence Based Treatment
More progressive and evidence based addiction experts, like Willenbring, run facilities that use psychiatric tools, like cognitive behavioral therapy (CBT), in combination with a drug like naltrexone and the Sinclair Method.
An opioid inhibitor, naltrexone blocks receptors in the brain that making drinking pleasurable. In other words, naltrexone can reduce cravings for alcohol and, as the National Institute on Drug Abuse reports, reduces the risk of relapse in some cases.
While 12-step groups have worked for some people, most notably after treatment, there is very little hard data because of the anonymous nature of the programs. An article in The Atlantic – The Surprising Failures of 12 Steps – suggests that peer reviewed studies put the success rate for Alcoholics Anonymous somewhere between five and 10 percent. Many people who need treatment, however, buck at the one-size-fits-all spiritual method of the 12-steps.
The move to treat alcoholism as a healthcare condition and not a moral failure is gaining more and more ground as the field advances.
One of the challenges, though, is that many physicians aren’t even aware of approved medications – naltrexone (vivitrol), acamprosate and disulfiram – approved for treating alcoholism, Dr. George Koob told NBC’s Melvin.
Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, offers an informed and scientific opinion on where the direction of alcoholism treatment should go.
“We have tools at our disposal to do a lot better. We need to get those treatments out to the public. We need the public to understand that those treatments are not just rehab and AA.”
As medication assisted treatment gains ground for alcohol and substance dependence, there’s no doubt medications like Naltrexone will play an important role in helping many more people recover successfully.
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