Windsor Doctors Offer New Hope For Alcoholics
Pill takes pleasure out of booze
By Craig Pearson
March 13, 2010
"Jack" who wishes to remain anonymous displays the pills he
takes to help him deal with his alcoholism.Photograph by: Dan Janisse, What
if someone suggested alcoholics could keep right on drinking, as long as
they took their meds?
Sounds implausible? Counter-intuitive? Crazy?
A couple of Windsor doctors say the time has come to take a medical approach to treating alcoholism -- by prescribing a simple pill.
The prescription medication, called naltrexone, is an opioid antagonist -- in lay terms, a drug that blocks endorphins from reaching the pleasure-reward centre of the brain.
But the idea of allowing alcoholics to continue drinking is sacrilegious to devotees of 12-step, abstinence programs.
"This is the gorilla in the parlour," said Dr. Tony Hammer, who began prescribing naltrexone along with Dr. Robert McKay -- they work together on harm-reduction strategies at the Drouillard Road Clinic -- in the fall.
"Suggestions of alternative treatments tend to be regarded by people who have been successful on the abstinence-based model as undermining their journey," said Hammer.
"Abstinence is absolutely fantastic. But to regard it as the benchmark for all is wrong. There's also a kind of puritanical thing that if you set expectations you can't achieve, you're imposing a sense of failure in patients."
Many 12-step graduates would rightly point out that their method delves deeper than simple substance abuse.
Nevertheless, naltrexone treatment was created in the 1970s by Dr. David Sinclair -- and later named the Sinclair Method -- a British doctor who developed the technique in Finland where he secured research funding.
It was approved in the U.S. in 1994, though has caught on rather slowly, given the hurdles it faces with perception. How many people think allowing an alcoholic to continue drinking makes sense?
"The reason it hasn't been promoted is: A, it's up against the abstinence-based people, who object to it; B, because the drug is generic, so no drug company has a patent and there's no drug company pushing it; and C, because there are so few doctors practising addictions medicine, and you need a doctor to prescribe it," Hammer said.
The neuro-chemistry approach requires patients to take the drug for the rest of their lives -- though only before hitting the bottle. Hammer and McKay consider the success rate of traditional psychotherapy abysmal. They say established success rates of achieving long-term abstinence through "talk treatment" are no more than 20 per cent.
But they say studies show a 60 to 70 per cent success rate with naltrexone in helping patients reduce drinking to social levels, and eliminating it altogether in about 20 per cent of cases.
Hammer has three patients taking naltrexone in Windsor, while McKay has prescribed it to a fourth.
One of Hammer's patients "Jack," a 60-something salesman who did not want his name used, considers naltrexone a life-saver.
After being diagnosed with colon cancer three years ago and going through chemo therapy, the longtime social drinker begin drinking heavily. Between his home and a local bar he consumed half a 40-ouncer a night, if not more, and felt his life spiralling out of control.
Jack asked to enter a 90-day treatment program. Hammer suggested he try a pill instead.
"He said, 'Keep drinking,'" Jack recalled. "I said, yeah, right. He said, 'No, whatever you want, drink it, but take this first.'"
Jack gave the booze-pill a whirl an hour before binging. At first, Jack said, he might have three or four drinks after taking naltrexone.
"I felt nothing," he said. "I didn't feel the old buzz. I didn't feel the old feeling that I wanted another drink."
Jack said he soon reduced his post-pill drinking to perhaps one glass -- and would sometimes leave that on the table.
The Windsor-area man says that after only five months on naltrexone, his urge to drink has fallen to once a week or less. Better still, he said, even without the pill he has lost much of his appetite for spirits, though he admits: "If I want to get a buzz on, I don't take the pill."
He nevertheless feels happy. His wife concurs, saying his mood has improved remarkably.
"This works for me," Jack said. "I'm not saying it's going to work for everyone. On the other hand, if this goes the way it should, this could be a total turnaround for everybody."
The Brentwood Recovery Home for treating substance abuse did not provide comment for this story.
But 12-step programs, started in the 1930s by Alcoholics Anonymous -- which currently has more than two million members -- often promote wellness in three areas: mental, physical and spiritual.
Deborah Gatenby, executive director of the House of Sophrosyne, a residential substance-abuse treatment centre for women, prefers some combination of counselling and naltrexone.
"Naltrexone has tremendous benefit in terms of breaking the pattern of habitual behaviour," Gatenby said. "But I do not agree that then there's no psychotherapy required.
"You're likely to still see that unresolved conflict play out in other areas -- it could be over-spending or overeating or something else. You don't want the problem to just morph into something else, you want to successfully treat the underlying issue."
Gatenby supports harm-reduction strategies. Sophrosyne, after all, is the Greek goddess of moderation. Yet she said most women with dependency problems have undergone past trauma, usually sexual or physical abuse, which even a miracle pill cannot cure.
Treating alcoholism with medication is not new. In 1948, researchers found that disulfiram made people who drank alcohol ill -- a serious deterrent. Many alcoholics, however, simply ditched the prescription.
While naltrexone can cause headaches or nausea with first-time users, generally it doesn't produce ill effects. It apparently just stops the cravings for more.
"Naltrexone on its own would help people improve to a certain extent," said Rebecca Jesseman, a research and policy analyst with the Canadian Centre on Substance Abuse, who believes traditional therapy also helps. "But if you really want to look at significant improvement, it would be offered in combination with other services."
According to Statistics Canada, in 2008, 24.1 per cent of males and 9.6 per cent of females reported heavy drinking, described as five or more drinks at least 12 times a year.
Jesseman said the CCSA, which in 2002 pegged the annual cost of substance abuse on health care and enforcement in Canada at $39 billion -- almost $15 billion from alcohol alone -- advocates a range of treatments.
"Naltrexone is a good approach to reduce drinking to safer levels," Jesseman said. "Abstinence isn't a realistic goal for everybody."
Doctors Hammer and McKay see the naltrexone advantage as more than curbing cravings for drink, since some patients perceive a near-religious tinge to 12-step programs.
He notes that patients who use naltrexone need not go through withdrawal or detoxification, need not put their lives on hold for up to three months as they go through group or psychotherapy, need not call friends and family to apologize, need not turn themselves over to a higher power, and need not radically change their lifestyles.
Naltrexone is expensive, though. One 50-milligram pill costs between $5 and $10, and is not covered by all drug plans. A longer-lasting injectable version is available in the U.S., but not in Canada.
In the end, the biggest hurdle remains societal acceptance.
"You can still drink," Mckay said. "There's nothing even stopping you from getting drunk, because it won't make you sick. You just won't feel like it.
"But you have to be willing to believe in the medical treatment of addiction."
HOW IT WORKS
Naltrexone is an "opioid antagonist," which means a drug that curbs opioids, a family of pain-reduction chemicals. Naltrexone blocks receptors in the pleasure-reward centre of the brain, thereby preventing opioid-resembling endorphins -- compounds that produce a sense of well-being -- from entering the neurons, which fire off good feelings.