Why Aren't We Talking About One of the Most Effective Treatments for Alcoholism?
Published on April 26, 2018
Gregory Marotta
President and CEO at CleanSlate Centers
Alcohol Awareness Month falls in April, a time to reflect on the perils of alcohol addiction and the pathways to recovery. As we close out the month, perhaps the occasion has sparked just a little more discussion and determination around seeking treatment.
But one thing is for certain, this month and every month: few people are discussing one of the most effective forms of treating alcoholism.
Medication.
Why is evidence-based medication treatment for alcoholism such a well-kept secret, something that people suffering from alcohol addiction seldom hear, doctors rarely discuss, and the recovery community usually overlooks?
For those of us in the medication treatment community, it’s an ongoing question.
Alcohol addiction, like opioid addiction, is a chronic brain disease, making it a primary health problem. Two FDA-approved medications, naltrexone and Antabuse, have shown success in helping patients maintain sobriety, whether in concert with counseling or sometimes even on their own. Every patient journey with addiction is different, but medication can have a clear positive effect.
And yet the public consciousness hasn’t been awakened to the medical options for treating alcoholism, because the conversation around treatment has been owned for so many years by traditional counseling alone.
So let’s shift the conversation for a moment.
Medication treatment for opioid vs. alcohol addiction
Evidence-based medication has gained widespread advocacy, if not widespread acceptance, as the standard of care to treat opioid addiction. The Substance Abuse and Mental Health Administration (SAMHSA) recently issued new guidance on treating Opioid Use Disorder (OUD), stating that “It is not sound medical practice to deny people with OUD access to FDA-approved medications for their illness.” Health and Human Services Secretary Alex Azar told the National Governors Association that not offering medication treatment is like "trying to treat an infection without antibiotics."
A recent article in US. News and World Report noted that there’s now rare bipartisan consensus that the use of medication to treat opioid addiction must be expanded. The 2018 spending bill provides $1 billion for opioid crisis grants to states, with requirements that states increase use of treatment supported by clinical evidence, including medications. As Tom Hill, of the National Council for Behavioral Health, put it to U.S. News, "The government is talking about treatment and medication-assisted treatment in a way that the government has never done before.”
But why does the medication conversation stop when it comes to alcohol? This despite the fact that the efficacy of medication to treat alcohol addiction - like opioid addiction - has been long proven.
How medication for alcohol addiction works
My company, CleanSlate, prescribes naltrexone (Vivitrol) to patients suffering from Alcohol Use Disorder (AUD). This medication treats alcohol addiction in three ways:
It eliminates the “high” that comes with alcohol use and lessens cravings for alcohol.
It guards against relapse.
It lessens the number of times that alcohol is consumed and the amount of alcohol consumed in people who take it.
It helps people have more success in remaining alcohol free.
An alternative medication, Antabuse, is a daily medication that has proven effective to keep people from using alcohol by creating a toxic reaction to alcohol. In short, patients become sick when drinking alcohol.
Both medications can play a significant role in helping patients quit drinking or cut back on their consumption. Public health officials are encouraging physicians to consider medication to treat alcohol addiction. "We want people to understand we think AA is wonderful, but there are other options," George Koob, director of the National Institute of Alcohol Abuse and Alcoholism, told NPR. The NIAAA is a part of the federal National Institutes of Health.
Alcoholism: the bigger epidemic
While we don’t use the term “epidemic” to describe the toll of alcohol addiction, it’s a much costlier addiction for society than opioid addiction.
In 2016, statistics show that 42,000 deaths were attributed to overdoses from opioids. But 88,000deaths are attributed to alcoholism each year, making it the third leading lifestyle-related cause of death in America, according to the National Institute on Alcohol Abuse and Alcoholism.
The societal impact of alcohol addiction is staggering:
Alcohol is the most commonly used addictive substance in America
One in every 12 adults suffers from alcohol abuse or dependence, not counting the many who engage in risky, binge drinking patterns
More than half of all adults have a family history of alcoholism or problem drinking
More than 7 million children live in a household where at least one parent is dependent on or has abused alcohol
Up to 40% of all hospital beds in the U.S. (except for those being used by maternity and intensive care patients) are being used to treat health conditions related to alcohol consumption
According to the 2014 World Cancer Report (WCR), issued by the World Health Organization's International Agency for Research on Cancer (IARC), no amount of alcohol is safe. Increased alcohol consumption directly correlates with an increased cancer risk; one in every 20 cancers is related to alcohol use.
By the time consumption levels reach the stage of heavy drinking or binge drinking, the health and social risks are myriad, both to the individual, their families and the public. This includes unborn children, who are subject to fetal alcohol syndrome disorder. A recent Canadian study found that fetal alcohol syndrome is more prevalent than previously thought, and may even be more common than autism.
If it works, work it
One of the mantras of Alcoholics Anonymous - “If it works, work it” - encourages individuals to honor the path that is most effective for their own recovery. But in order to do this, patients need to understand all of their options.
Medication must become a part of the discussion with patients so that they have the opportunity to choose this pathway of recovery. That means that all of us - health providers, political leaders, insurers, community stakeholders, and friends and family members - need to expand the conversation with those suffering from alcohol addiction to include medication that has been specifically designed to treat their disease.
Greg Marotta is the President and CEO of CleanSlate, a leading national medical group that provides office-based outpatient medication treatment for the chronic disease of addiction, primarily alcohol and opioid use disorders.
becky gangte and 352 others like this
Imre Szabó
Statistician
Stating that a drug is one of the most effective tool against drug abuse is part of the problem. This mentality had led you to the opioid crisis.
1hLikeReply
Ilan Orner
Chiropractor
All medications have side effects. So the problem is the side effects Vs the effects.
The only way to really deal with alcohol or drug addiction is to find the cause, usually emotional discomfort. Hypnosis is very effective in treating the issue because it works on the cause even though the patient is not even aware of the issue.
3hLikeReply
Daniel Murray
Truck Driver at Mcgirt Trucking Inc
After 30 years of sobriety and helping others to stay sober and can truly say that this article is written by a drug pushing moron.
4hLikeReply3 Likes
Emma Ramos
Office Manager at Tyree Oil, Inc.
When an addict/alcoholic stops using/drinking, that does not mean they are cured. What AA and NA do for these people is show them how to deal with life. A pill can't do that. It's the same as putting a heroin addict on methdone. You've just replaced one addiction for another. Of course there are physical side effects of drinking, but they go away once the alcohol has left the body. But that's not a curing the disease. The disease has to be cured in the brain. Why do you drink/use? That's the thing that AA helps the alcoholic figure out. After care (continuing meetings after) help prevent slips. It gives the sick person a place to go and be with others who understand and can guide them through the hard times when they feel like drinking again. Are they just supposed to stay on these meds for life?
12hLikeReply1 Like
Sandra Winstead
Drugs do nothing to change all the behavior around the drinking. Until you solve all those issues drugs will do nothing. You are solving the symptom and not the problem. People who are truly alcoholics suffer from really poor decision making and no drug can solve that. Just because they get sober doesn't mean they become good citizens. Alcoholics have a long way to go before they can get there, that is why programs like AA are so effective if you work them.
13hLikeReply
Karen Bawden
Geologist at Orano Canada
The most recent research that I have read has shown that if you offer alcoholics a community and a sense of belonging that works better than any drug.
15hLikeReply3 Likes
Richard Goodwin
Chaplain / Counsellor at Prison Chaplaincy Service of Aotearoa NZ
That's like condemning a medication because the patient who doesn't take it fails to get better. The success rate you should be considering is for those who do attend meetings, not those who stop attending AA meetings.
12hLike
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David conley
at
I was offered Antabuse in my recovery. I was told it weill make you violently ill if you drink while on it. First, replacing a drug with a drug is a bad idea. Second, becoming violently ill if you relapse is not a solution. And third, tell me something will have a negative affect on me, and I WILL TEST IT until I build up an immunity to it! Most alcoholics would! You want a true solution to addiction, it's called willpower! All addicts CHOSE TO USE. So make a different choice, it really is that simple. I know, I'vew beaten 4 different addictions with this method!!!
15hLikeReply1 Like
Ben Vann
Quality Assurance Manager at Armstrong Technology, Inc.
CBD oil is a natural treatment. You won't hear about it from the pharmaceutical companies because they can't patent it.
15hLikeReply
Robin Driscoll
Photographer at RD PhotoServices
Everyone needs to know their options...in the middle of the crisis... as a loved one looking in... this might have been an option that would have made the first steps easier... just wish that it was offered as an option...
15hLikeReply
Tracy Staub
Job Coach at Behavioral Health Services North (BHSN)
What about the use of the medication Campral? I have personally seen this medication to have long term success in the treatment of alcoholism. It is not addictive and can be stopped with continued success in recovery. As for using a drug to replace another, would you recommend that a diabetic stop using insulin? Alcoholism is a disease treated with and an addiction.
16hLikeReply1 Like
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