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Alcoholism

Since about half of all alcoholics relapse after treatment (Johnson and Ait-Dauod, 2000), treatments of alcoholism focus on decreasing, or eliminating the possibility of relapse. Treatments range from therapy classes to drug treatments that suppress the urge to drink.

Possible Drug Treatments

Naltrexone

The FDA has approved naltrexone to be used in the treatment of alcohol dependence (For more information on the FDA approval, see the NIAAA website). Naltrexone is in a class of drugs known as opioids (Johnson and Ait-Dauod, 2000). Opioids include drugs such as heroin and opium.

In 1992, both O’Malley et al, and Volpicelli et al, randomly assigned alcoholics either to a naltrexone treatment or to a placebo treatment group for twelve weeks. Both found that the naltrexone group had a longer period of abstinence, as well as lower relapse rates. In addition, naltrexone has been shown to reduce the positive effects from drinking (Davidson et al, 1999). “Positive effects” include increased sedation and a positive mood. Thus, many studies have shown that naltrexone is successful in reducing the desire to drink. Some of the side effects of this drug include tension, fatigue, decreased vigor, confusion, nausea, and vomiting (Johnson and Ait-Dauod, 2000).

Although these results seem promising, there are many studies that have found conflicting results. For example, in 1997, Volpicelli found that persons in the naltrexone and placebo groups did not significantly differ in the rates of alcohol consumption. Again in 1998, Litten and Allen, in a double blind study, (n=169) found that there was no significant difference in the naltrexone and placebo groups.

Since the literature differs in its findings, it is essential that more research be done before conclusions can be drawn regarding the effectiveness of this drug.

Acamprosate

Acamprosate is an NMDA antagonist. It interacts with EEA (excitatory amino acid) at the NMDA receptor (Johnson and Ait-Dauod, 2000).

In 1990, Lhuintre et al (Johnson and Ait-Dauod, 2000) found in a twelve-week, double-blind study, that the placebo showed relapse rates twice as high as the acamprosate group. A similar study in 1995 by Pailie, et al (Johnson and Ait-Dauod, 2000) produced the same results, though this study also showed that higher doses of acamprosate (1.5g/day) proved to be more effective than lower doses (1.3g/day). In 1997, Poldrugo found that acamprosate increased abstinence rates in alcoholics (41% abstinence for the treatment group, 21% for placebo group). Side effects found with these studies have been very minor, with diarrhea being the most common effect (Johnson and Ait-Dauod, 2000). Thus, many studies have shown that acamprosate is effective in treatment for alcoholism.

Because of the plethora of positive findings for this drug, and the absence of negative findings, this drug is currently the “most widely validated treatment medication” (Johnson and Ait-Dauod, 2000).

Lithium

In 1987, Fawcett et al, found that persons with a minimal lithium blood level of 0.4 mmol/liter had higher abstinence rates than persons who had a lower lithium blood level lower than 0.4 mmol/liter (Fawcett et al, 2000). On the other hand, Dorus et al (1989), found that the abstinence rates were not significantly different between lithium and placebo groups. Thus, in 2000, Fawcett re-examined their findings regarding lithium.

In this study, Fawcett et al tested 156 alcohol-dependent men. The placebo groups showed a retention rate of 52% at three months of “treatment” and 38% at six months. The lithium group showed a retention rate of 61% at the three-month mark, and 46% after six months. The differences in the results proved to be non-significant.

The Serotonin Family

Serotonin affects the 5-HT receptor, which has been found to play a role in alcoholism. A lower level of 5-HT correlates with a decrease in the desire to consume alcohol (Myers and Veale, 1968). Much research has been devoted to drugs that inhibit the function of the 5-HT receptors. Some drugs “of interest” are as follows:

Buspirone

Busipirone is an azapirone, which is a 5-HT partial agonist (Fawcett et al, 2000). Previous studies have indicated that this drug may lower one’s desire to drink (Bruno, 1989). There have been a few other studies with regards to buspirone, though most of the subjects in these studies have had anxiety disorders. Thus the effect of buspirone on alcoholism was not easily determined (Fawcett et al, 2000).

The Fawcett et al (2000) study (discussed above) also tested the effects of buspirone in the treatment of alcoholism. This is the first randomized study of buspirone’s affect on alcoholism. This double-blind study found that the buspirone did not have a significant effect on alcoholism (retention rate of 44% after 3 months and 27% after 6 months). In fact, the overall retention rates for the buspirone group were lower than that of the placebo group. Though this group included members with the lowest abstinence and retention rates, the group was found to have the lowest overall intake of alcohol.

Based on this study, it appears as though buspirone is not effective in the treatment of alcoholism.

Ondansetron

This drug is also a 5-HT antagonist. Both Johnson et al (1993) and Swift et al (1996) have found that ondansetron treatment groups have showed a lowered desire for alcohol than in placebo groups. Again in 1999, Johnson et al (Johnson and Ait-Dauod, 2000) found that ondansetron was significantly more effective than the placebo in decreasing alcohol intake. Although these results have been replicated, others (Doty and deWit, 1994 and Sellers et al, 1994) found no significant results in the decrease of desire of alcohol for ondansetron treated groups versus the placebo groups. Thus, in order to find the true effects of this drug, more studies need to be completed.

Therapy Treatments

There are many available therapeutic treatments for alcoholics. Treatments range from group counseling sessions, support groups (Alcoholics Anonymous), to one-on-one sessions with a therapist.

One study, by Humphreys and Moos (2001), analyzed the long-term effect of a 12-step program versus cognitive-behaviorally (CB) oriented treatment. The 12-step program relied heavily on group activities and focused on methods to obtain self-control. The CB group focused on cognitive skills training and psychotherapy. They found that patients in the 12-step program had significantly greater involvements in self-help groups one year after the study. In addition, it was found that CB patients relied heavily on professional services, and returned for outpatient visits twice as often as persons in the 12-step program. Finally, persons in the 12-step program had higher rates of abstinence. Thus, this study shows that group therapy may be more beneficial, as well as cheaper, than the CB programs in the treatment of alcoholism.

It has been found that patient-treatment matching is important in the rate of compliance (Nielsen et al, 1998). In other words, patients who have high conceptual levels (characterized by independence, tolerance, and self-reflection) should be placed with therapists that have high conceptual levels as well. Likewise, patients with low conceptual levels (easily controlled by external factors) should be placed with therapists that have low conceptual levels. The high-high combination should be in a treatment regime that is not highly controlled. On the other hand, low-low combinations should have a highly controlled regime (all meeting dates and topics previously selected). This patient-therapist-treatment match has been shown to cause significantly (Nmatched=56, Nunmatched=63, p=0.045) higher compliance rates (63%) than non-matched patients (38% compliance). Thus, it is important to ensure that the patient receives the proper treatment, or else compliance levels may be low.

Combined Treatments

Because positive effects are seen in many drug treatments, as well as therapeutic treatments, it is possible that combinations of drugs and therapies produce improvements in alcoholics. Monti et al (2001) analyzed some possible combinations.

Monti et al (2001) analyzed the effects of naltrexone with Cure Exposure with Urge-Specific Coping Skill Training and Communication Skills Training. This study randomly assigned consenting alcoholics to one of four groups (abbreviations explained below):

· CET/CST and placebo

· CET/CST and naltrexone

· ERC and placebo

· ERC and naltrexone

The CET group (Cure Exposure with Coping Skills) consisted of eight minutes of beverage exposure, then completion of urge-rating form and a discussion. Next, the patients were exposed to a personal drinking trigger for eight minutes. Once again, the patients completed an urge-rating form afterwards. The purpose of these sessions was to increase the patient’s urge to drink by learning coping skills.

The CST (Communication Skills Training) sessions focused on interpersonal skills in order to reduce instances of relapse. Patients were taught to give criticism effectively and learned to receive criticism. In addition, the patients learned conversational skills and conflict resolution.

The ERC (Education and Relaxation Control) group included educational discussion and training on how to relax. The meditation/relaxation training (MRT) was used because it was found to have no effect on alcoholics.

The effects of naltrexone were discussed previously.

This study found that naltrexone did not affect the rate of relapse, though it did lower the severity of relapse. In addition, the naltrexone treatment proved to be ineffective after cessation of treatment. Thus, use of naltrexone should be for an extended amount of time. The CET/CST treatment proved to be effective after only four to five sessions. This treatment increased the “alcoholics’ self-efficacy about coping with high-risk situations, and [reduced] urges in high-risk situations.” This combination of therapeutic treatment proved to be useful in regards to alcoholics.

Thus, the combination of naltrexone and CET/CST was found to be most effective in the treatment of alcoholics.

Conclusions

Treatments for alcoholism seem to be most effective when drug treatments are combined with therapeutic treatments.

*** Disclaimer: Though the information presented on this page was found solely in peer-reviewed journals, do not use this information as a treatment guide. If you are looking for treatments for alcoholism, please seek professional help. Thank you. ***

References

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