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The use of drugs in the treatment of alcohol addiction is the subject of some controversy among health professionals. The major objection to such treatments is that they do not address an individual’s underlying reason for his alcohol abuse. The individual needs to change his outlook on life, and tinkering with the individual’s biochemistry cannot alter that simple fact. This view, while it may reflect a simple home truth about the psychology of addiction, is nonetheless a little too simplistic. No pharmacologist would regard any of the drugs currently available as an alternative to other therapies, but merely an adjunct to them. And in a disorder as difficult to treat as alcohol addiction, every advantage that can be gained through drug treatment is worth considering.
The drugs that are used to combat alcohol addiction are of two kinds: those that create a disturbing or uncomfortable physical response to alcohol consumption, and those that work by altering the brain chemistry so that the brain’s chemical rewards for consuming alcohol- the endorphins- do not arrive.
The most well-known example of the first type is Antabuse, also known as Disulfiram. Antabuse stops the body from eliminating acetaldehyde, a chemical the body produces when breaking down alcohol in the bloodstream. It is this chemical that produces most of the discomfort associated with a hangover. In other words, the alcohol abuser gets a hangover, with a very rapid onset that is both severe and long-lasting. This, it is hoped, will change the behavior of the alcohol abuser by reinforcing the painful consequences of that behavior. The obvious problem with this drug, and in fact with all such medications, is that the individual may choose not to take it. Another problem that health professionals have encountered is that some individuals are still not dissuaded from drinking alcohol in spite of the ensuing painful consequences. This, in fact, has led to deaths. For this reason, a similar drug, Temposil, based on calcium carbimide, is often prescribed. This drug does not have quite the same problems with toxicity or drowsiness that are occasionally encountered with Antabuse.
Most of the more recent research has been into the second type of drug: those that block the chemical rewards of drinking- the endorphins and dopamine. The medication most often utilized is Naltrexone, also marketed under the trade name Revia. When Naltrexone is in the body, there is a reduction of the pleasurable effects of alcohol consumption. In other words, the alcohol abuser gets to experience all the down sides of alcohol consumption: the hangover, the consequences of their behavior while under the influence of alcohol, and so on; but none of the pleasurable experiences associated with it. Another, more recently developed drug is Acamprosate, also marketed under the trade name Campral. This works on the brain in a slightly different way, but produces the same effect. This has been used for a number of years in Europe but is not yet licensed for use in the USA
Trials are now under way in the USA, and FDA approval is expected soon. Incidentally, both these drugs are also used in the treatment of addiction to opiates. Yet another new drug now under development is Topiramate, which may prove superior to either Naltrexone or Acamprosate. This will, however, take several more years of testing before it becomes generally available.
None of the drugs mentioned in this article are a magic bullet. In the case of Naltrexone and Acamprosate, the effects are not huge, but they may be of significant assistance to people trying to fight their addiction. All of these drugs should only be taken as part of a course of treatment that includes proper counseling, support and aftercare.
Their exact level of effectiveness is still the subject of debate, but overall, statistically, they improve the chances of recovery from alcohol addiction. A study of more than 27,000 insurance claims related to alcohol dependency in the USA found that drug therapies resulted in significantly reduced healthcare utilization by patients undergoing treatment for such problems.
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