Painkiller Abuse on the Rise
By Michelle Anselmo, August 20, 2007
(CW11 News-KPLR-TV)

The use of prescription pain killers is at an all time high. While many physicians say its because of better pain management, local substance abuse experts say the trend is leading to alarming addiction rates. Watch

Vicodin, Oxycontin and Morphine are all addictive opiate based narcotics commonly used to manage pain. But when the prescription runs dry, experts say many turn to an illegal drug that can have deadly consequences.

Lynn's addiction to pain killers began innocently. "I had a torn ligament in my hip, and I went to the doctor, and he started prescribing me pain medication,"said Lynn.

Two months later she had hip surgery, but by then she says she was hooked and would do anything to try to control the pain. "Once the Oxycontin wasn't helping anymore, someone offered me heroin and from there it just escalated at that point," said Lynn.

And Lynn isn't alone. Percy Menzies, of Recovery Centers of America, said, "When they cannot get the pain medication, they quite easily turn to heroin and heroin has become an epidemic in the St. Louis area."

An epidemic that Menzies noticed this past year. He says the number of people in treatment for pain pills and heroin abuse is on the rise. This is on and on, we had a woman this morning here, a housewife, who used 90 vicodin in two days time,"said Menzies.

A recent study found that nationwide, the use of pain killers is up 90 percent. Menzies doesn't fault the doctors, but questions the strategy to manage chronic pain. "Physicians often say if I don't offer them the best medications I may get sued," said Menzies.

Lynn has been clean for more than two months. "It's been a uphill battle," she said. She never thought a small pill to alleviate her pain would force her into a world of hurt. "Losing jobs, car accidents, bankruptcy, divorce. There are so many things that remind me of why I need to look forward to the future and that my life is worth more," said Lynn. Lynn's treatment includes two non addictive medications that have helped her regain control of her life.

Suboxone and Naltrexone are newer drugs that work to reduce cravings and withdrawal symptoms. Percy Menzies says treatment for prescription drug and heroin abuse lasts about six months.

manselmo@tribune.com
Copyright (c) 2007, KPLR

This article originally appeared at:
http://cw11tv.trb.com

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St. Louis Woman Alcohol-Free On New Year's For First Time In 30 Years
12/29/2006 8:32:49 PM
Click to watch Leisa Zigman's report. (coming soon)

By Leisa Zigman (KSDK) - The holiday season is notorious for excessive drinking. In fact, addiction experts say alcohol consumption increases 70 percent between Christmas and New Year's Day.

For the first time in 30 years, a St. Louis woman will spend her holiday without a drink.

Chris Parmentar, 45, described her parents as intelligent professionals. She then said her father died at 48 and her mother died at 58. Both were alcoholics.

"You can tell in their eyes and whole face how alcohol has really, really taken over their lives," said Parmentar.

Despite losing both parents at an early age, Parmentar could not stop the disease from consuming her life as well. She started drinking when she was 15 years old. She would consume up to a half-gallon of vodka every two days.

Her drinking continued even after a drunk driver killed her stepdaughter.

"You would think something that hurts so bad would shock you to get some help, but the disease is so overwhelming, I couldn't shake it," Parmentar.

Five months ago, Parmentar started a new treatment that involved monthly injections of the drug Vivitrol combined with counseling. Parmentar said it saved her life.

For the first time in 30 years, Parmentar is sober.

Percy Menzies, president of the Assisted Recovery Centers of America said "(Vivitrol) is an amazing breakthrough in terms of drug delivery."

According to Menzies, the medication eliminates the physical cravings for alcohol.

"It prevents endorphins from activating that part of the brain, by not activating the brain, you don't get high."

According to Menzies, the combination of counseling and medication has profound and encouraging results for patients like Parmentar.

He also said most insurance companies cover the cost of monthly injections and he said there are almost no side effects.

Vivitrol is also being used to help people with opiate addictions such as heroin, Vicodin and Oxycontin.

Alcoholics Anonymous does not take a position on the use of Vivitrol.

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Detox Expert Won't Take 'No' When 'Yes' Can Save Lives
By Sylvester Brown Jr.
ST. LOUIS POST-DISPATCH
01/04/2007

It's been about three years since I've visited Percy Menzies, president of Assisted Recovery Centers of America, a drug and alcohol treatment center on the south side.

"Come in, come in," Menzies said, escorting me back to his conference room. The huge black and white framed photograph of humanitarian Mohandas Gandhi reminded me of our first encounter. In 2003, Menzies told me why he and his wife, Judealyne, left India 28 years ago: Doctors there advised them that their son Patrick, born with a genetic brain disorder, should be allowed to die.

"That was unacceptable," Menzies said.

Although Patrick, now 30, is mentally impaired, he's healthy. So are the three other sick or abandoned children Menzies and his wife adopted.
We met three years ago to talk about Naltrexone, a non-addictive, FDA-approved drug for the treatment of drug and alcohol abuse. Menzies spent 18 years at DuPont Pharmaceuticals where he worked on poppy-derived substances such as Naltrexone, which prevents addicts from getting a buzz. It would certainly be the new wave of treatment, Menzies thought.

It wasn't. Most government-supported treatment agencies rely on the use of addictive substances, such as methadone, to treat heroin addictions.

Menzies' focus now is on the explosion of Afghanistan's illicit poppy population since the United States invaded the country in 2001. The results are showing up at his agency's doorsteps.

Afghanistan now produces 90 percent of the world's heroin, and St. Louis officials are seeing more cheap, highly pure Afghan heroin use and overdoses. Rep. Russ Carnahan met with Menzies' staff recently to gather more information about turning Afghan poppies into medicine-producing crops. As a member of the House International Relations Committee, Carnahan plans to bring the issue before Congress.

Menzies says St. Louisans are needlessly dying from heroin use. He's been overwhelmed with calls from people, most of them poor, seeking help. Patients pay for services at Assisted Recovery Centers of America, where physicians, nurses and counselors use medication, clinical visits and intense individual and family counseling to combat the illness.

He can't save them all, Menzies said, and would like city officials to help. Neither jails nor city-run clinics offer medical detox for intense withdrawal symptoms, Menzies explained. Therefore most patients, when released from jail or treatment programs, go back to using illegally or to their dependence on methadone clinics.

Dave, 37, an entrepreneur, became addicted to the painkiller Oxycontin in 1992. He was off and on the drug, which is an opiate like heroin, until last year. Of the 12 or so programs he's gone through, Menzies' is the one that's given him the hope of becoming drug-free, Dave told me. Counseling and Naltrexone is the key, he added. The combination helped him cope with withdrawal symptoms — sweats, involuntary muscle spasms, nausea — all associated with withdrawal from heroin and other opiates.

"Right now, I'm a work in progress, but the Naltrexone keeps the craving for drugs pretty much out of my mind."

Menzies contacted Mayor Francis Slay in June asking for a meeting to explore ways the city's health clinics might establish long-term, cost-effective treatment programs. The mayor's office sent his request to City Health Director Dr. William Kincaid. The director showed interest but has yet to schedule a meeting, Menzies told me.

I called Kincaid's office yesterday but was unable to speak with him.

Menzies isn't angry, nor is he pointing fingers. He knows budgets are strained and resources are few. Yet the rise in heroin abuse, especially among young people, and drug-related deaths disturb him. Cost-effective detox programs coupled with counseling actually work and could save thousands of lives. But no one's paying attention.

That, Menzies told me Wednesday, is unacceptable.

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Drug use can damage the brain
and lead to addiction
By Tina Hesman Saey, ST. LOUIS POST-DISPATCH
04/01/2006

Teenagers who drink, smoke and use drugs can derail their brain development and set themselves up for lifelong addiction.

And parents who strictly monitor their teens' behavior are one of the most influential forces preventing kids from using drugs and alcohol.

Now that might not sound like news to you. But truth is, until recently most of what science has known about addiction in teenagers has been extrapolated from research in adults. Now, new brain-imaging studies have shown that the teenage brain is a rapidly-changing organ and doesn't work the way an adult brain does. Researchers now believe that drugs and alcohol can disrupt that massive renovation of the brain during adolescence, making it more vulnerable to drugs and easier for teens to get addicted.

And scientists say that an addiction that starts early in life is harder to kick than one that starts later. Nearly half of kids who are regular drinkers before age 14 will become alcoholics, said Dr. Danielle Dick, a clinical psychologist and geneticist at Washington University. That puts early drinkers at three times greater risk of alcohol addiction than people who wait until age 21 to start drinking, she said.

Percy Menzies, director of the Assisted Recovery Centers of America, an addiction treatment center in St. Louis, says that "When people come to us and say they started drinking as teenagers, we know we have our work cut out."

Epidemiological studies have shown that most addictions start in adolescence, said Dr. Nora Volkow, director of the National Institute on Drug Abuse. And when a teenager's pleasure-chemical systems aren't fully developed and then get wired to depend on substances for feeling good, the normal flow of brain chemicals that aid in learning, decision making and other key processes are often blocked, Volkow said.

Parents are the key: In adults, genetics are more than 50 percent responsible for addiction to alcohol. So people have long assumed that genes are the biggest reason kids drink, too.

But new studies of twins in Finland and Missouri showed no evidence that genetics contributed to alcohol-dependence in 14-year-olds, Dick said.

Instead, Dick said, parental monitoring is one of the most consistent predictors of whether teens start using alcohol and other drugs.

And that means more than just having a good relationship with your kids. A good, warm relationship doesn't mean kids are going to tell parents what they are doing, or with whom.

"Parents might say, 'Oh, if they were doing that, they'd tell me,' but the reality is, they probably won't," Dick said. What works is knowing where children are, who they are with and what they are doing. Children with the highest level of parental monitoring were less likely to start drinking or using drugs, Dick said.

For an addiction to take hold, kids must be exposed to addictive substances. So young adolescents who never have a chance to smoke or drink avoid stirring up a genetic predisposition to addiction. In a more permissive environment, genes may rear their heads.

Once teens start to drink or use drugs, the consequences turn severe. Recent studies show that teens who start using marijuana before they turn 17 are at higher risk of developing schizophrenia than people who didn't use or started smoking marijuana later in adolescence or young adulthood.

Marijuana has often been called a gateway drug, a substance that can lead to use of more harmful drugs. Most researchers agree that marijuana doesn't necessarily set up the brain for further addictions, but does give kids practice in obtaining illicit substances and access to a subculture where harder drugs are available.

The real gateway drug may be nicotine, experts say. Most kids try cigarettes before other drugs.

Researchers compared sets of identical twins in which one twin started smoking before age 17 and the other twin smoked later. Twins who started smoking before age 17 became addicted to other substances, such as alcohol or other drugs, more readily than their twins who waited, Volkow said. Because identical twins have the same genetic make-up, the addiction of early-smoking twins can't be chalked up to genetic susceptibility alone, she said.

Cigarette smoking also can disrupt memory and attention, said Dr. Leslie Jacobsen, a psychiatrist at Yale University. But withdrawal from cigarettes is also bad, she said.

"Once you're dependent, you're always confronted with a certain amount of nicotine withdrawal," she said.

"Children get addicted to smoking more quickly than they expect, and many aren't even aware that they are dependent," she said.

Brain is at risk: Even teens who just binge drink on weekends can hurt their brains, said Susan F. Tapert, an associate professor of psychiatry at the University of California San Diego. Her measurements of a seahorse-shaped part of the brain, called the hippocampus, revealed that drinkers had shrunken hippocampuses compared with teens who don't drink. That is important because the hippocampus is one of the regions of the brain most responsible for learning and memory.

Tapert doesn't see the same dramatic change in the hippocampus of marijuana smokers.

But that may not matter, Jacobsen said.

"It's not just how the brain looks, but how it works that's important," she said.

Teens who smoke marijuana - even those who have stopped using for a month - need to expend much more mental energy to do simple tasks, Tapert said.

For instance, marijuana smokers retain 5 percent to 10 percent less information when listening to a story. That difference may not seem big, but could make the difference between passing or failing a test in school.

A University of Missouri study of college-age students showed that chronic binge drinkers make bad decisions in other parts of life. Researchers at the Midwest Alcoholism Research Center in Columbia tested 19 and 20-year-olds on a decision-making task involving gambling risks. People who were chronic binge drinkers more often made decisions that would put them at high risk for losing money, said Kenneth J. Sher, director of the center.

The binge drinkers weren't more impulsive or thrill-seeking than their non-drinking counterparts and they scored similarly on the ACT college entrance exam. But bad decision making on the gambling test was also associated with making unwise decisions about drinking in life. The heaviest drinkers had their first full drink at age 13, and were bingeing on almost 18 drinks per week by the fall of the their freshman year in college.

The researchers don't know whether the students are heavy binge drinkers because they are bad at decision-making or if the alcohol impairs their ability to make good decisions, Sher said.

Either way, students get set in their ways earlier than many parents realize, he said.

"Most drinking patterns are set before they get to college," Sher said.

Parents unwittingly give young teens access to alcohol. Few parents think to lock up their liquor cabinets, Sher said.

"I think parents are clueless," he said. And many have a strong case of denial. "They don't think their kids would ever drink."

The concern that some parents have about being hypocritical when telling their kids not to smoke, drink or use marijuana is misplaced in light of the data on how drugs affect young brains, Volkow said.

Parents often don't realize that the weed their children are smoking is far more powerful than the herb kids smoked a decade ago, Volkow said. The concentration of THC (delta-9-tetrahydrocannabinol) the main active chemical in marijuana, has risen from 2 percent of the active ingredients to 14 percent, she said.

As grim as the picture is for teens who use drugs, tobacco or alcohol, there is some good news. Because the teen brain is still developing, it may be able to recover from the harm of substance use if teens clean up their acts.

"I feel a lot better," said Duffie, 24, who has stayed drug-free. "I feel better about myself and the life I'm living now."

Naltrexone has been around for 20 years, but few people know about it.

Experts say a major shift in thinking about how alcohol and drugs affect the brain is producing more and better medications to treat addiction to drugs and alcohol.

About 22 million people abuse or are addicted to drugs, according to government statistics. That figure includes alcohol and prescription drugs.

"We have a serious drug-abuse problem in this country, including with alcohol, even if we don't recognize it," said Dan Duncan, director of community services at the National Council on Alcoholism and Drug Abuse, St. Louis area.

"We have a lot of stereotyping going on; people want to think it's an inner-city problem. That's not true. Go to West County. They're doing drugs and have the means and resources to buy whatever they want. It costs all of us, and we're affected directly or indirectly by this problem."

Research into medications to treat addiction has taken off. Twelve years ago, the federal government was funding just a half-dozen clinical trials of drugs for alcoholism, and no pharmaceutical company was conducting research. Today, the government is financing studies of 51 drugs and nine companies are doing clinical trials.

Like antidepressant medication, some of the newer drugs are designed to repair chemical imbalances and abnormalities in the brain that occur as a result of chronic abuse, Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism said.

FORUM IN ST. LOUIS: Federal health officials held a forum July 29 at St. Louis University, part of a four-city stop, to raise awareness among doctors and the public about one medication, buprenorphine. Marketed under the trade names Suboxone and Subutex, it went on the market in 2003 to treat heroin, prescription painkiller and other opiate addictions.

Like naltrexone, it can be prescribed by private-practice physicians, so "hopefully it will allow addiction treatment to be incorporated into mainstream medical practice," said Nick Reuter, senior public-health adviser at the U.S. Substance Abuse and Mental Health Services Administration.

Finding new medications for alcoholism has been challenging because different regions of the brain are involved. That complexity also "opens up many strategies for treatment," said Dr. Raye Litten, associate director of the division of clinical and recovery research at National Institute on Alcohol Abuse and Alcoholism.

Naltrexone was approved by the FDA in 1984 to treat opiate addiction and in 1994 to treat alcoholism. It also is being studied for use in combination with acamprosate, the latest anti-addiction drug to gain FDA clearance. Sold under the trade name Campral, acamprosate went on the market in January.

An injectable form of naltrexone, Vivitrex, is currently undergoing review by the FDA as a monthly shot.

Down the road, people might take two or three medications that act on specific parts of the brain, experts say. The drug combinations would work much like those designed for people with AIDS, cancer, diabetes, depression, heart disease and high blood pressure.

"Just getting them out on the market would give patients a menu of medications to choose from," Litten said. "Like antidepressants, if one doesn't work, you could try another one."

Researchers are learning that many alcoholics and drug addicts need ongoing or intermittent care much like people with other chronic conditions. "Treatment should not be a one-time thing," said Willenbring, a psychiatrist who directs the division of treatment and recovery research at the federal health agency.

Treatment professionals caution that a commitment to abstinence is essential.

"You can't put this into somebody's coffee every day and expect them to be transformed," said Barbara Mason, a consultant to Forest Laboratories Inc., the company that makes Campral. "It's another tool in the toolbox of recovery."

TREATMENTS UNDERUSED? Yet, for all the excitement about pharmaceutical treatments, naltrexone and acamprosate are largely going unused.

Only about 5 percent of people dependent on alcohol have ever been prescribed medication, Willenbring said.

Fewer than 3 percent of the nation's 1.1 million opiate addicts have tried naltrexone, even though it's been around for 20 years.

The reasons vary — from low awareness of the medications to lack of drug coverage and a bias against taking a drug to beat an addiction.

"Most people think addicts just need to learn how to change their behavior," said Dr. David Gastfriend, an associate professor of psychiatry at Harvard Medical School. "That's like fighting this disease with one hand tied behind your back."

HOW IT WORKS: Naltrexone works by occupying the opiate receptors in the brain. As a result, the feel-good chemicals triggered by alcohol and opiate drugs are blocked, eliminating the high. The brain chemicals are endorphin, dopamine, serotonin and gamma-amino butyric acid, or GABA. The active ingredient of naltrexone is made in St. Louis by Tyco Healthcare/Mallinckrodt, the biggest U.S. manufacturer of the drug.

Studies have found that people who are genetically predisposed to addiction have lower levels of endorphin in their brains but experience an excessive release of the chemicals when they drink or do drugs, well beyond what the average person experiences. Repeated heavy drinkers and drug users build up a tolerance and require more and more to get high.

Eventually, alcohol or drugs are taken to relieve the unpleasant effects of not using, such as irritability, anxiety and craving. "You're drinking to feel normal," said Barbara Mason, co-director of the Pearson Center for Alcoholism and Addiction Research at the Scripps Research Institute in California.

Since naltrexone blocks the release of endorphins, if an alcoholic drinks, speech might become slurred or walking might get wobbly, but there's no buzz. If the person relapses on the medication, he or she is more likely to stop after two or three drinks because the reward of feeling good has been taken away.

After using naltrexone for several months, some alcoholics are able to abstain from alcohol forever. Some treatment professionals describe the drug as a "chemical chastity belt."

The aim of researchers is to design newer drugs that don't make people sick and are not habit-forming or mood-altering. The side-effects of naltrexone and acamprosate are generally mild, if any. They are not addictive and don't produce a high. The drugs usually are prescribed from three months to a year.

Steve Duffie's mother, Cathy Duffie, is convinced he would have died without the medications.

"It's amazing what addiction can do to you," she said, glancing at the son she never gave up on. "It's a horrible life."

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Readers Promote Cold-Turkey Alternatives
Bangor Daily News, February 23, 2006

In a recent column, "Anonymous" - a soon-to-be-released inmate at the Mountain View Youth Development Center in Charleston - described her path to addiction and her fears about re-entering society from a drug-free environment. Bangor psychologist Jack Keefe responded to her letter in the same issue. We received several responses, most of which assumed Anonymous was a young man.

The poignant appeal for help occurs thousands of times a year from people leaving jails and prisons and going back to an environment filled with cues that can trigger drug cravings and lead to relapse. This young man is going to experience cravings triggered by the sights, sounds, places and people associated with past drug use.

There is a medication specifically for detoxed opioid patients returning to a cue-rich environment. The medication is called naltrexone. Naltrexone was approved by the FDA in 1984 to treat heroin addiction. It is an ideal medication for people returning home from jails, prisons and inpatient treatment programs.

Naltrexone is nonhabit-forming and nonaddicting. It protects the patient from accidentally or impulsively using any opioid like heroin, OxyContin, Vicodin etc. If the patient uses any of these drugs, he will not experience a "high" and is therefore less likely to relapse. The patient needs to take two tablets every other day to be fully protected.

The key to successful naltrexone therapy is taking it under supervision. Somebody must watch the patient ingest the medication. This can be done at a local pharmacy, a health center, a probation office etc.

We have treated hundreds of opioid addicts with naltrexone and the results are amazing. This young man should ask the prison infirmary to start him on naltrexone one to two weeks before release and continue the medication for a minimum period of six months. He should also attend self-help groups one to two times a week. If he goes back home on naltrexone, the Pavlovian "bell" of craving can ring but the drug-taking response will not occur because he knows that the naltrexone will not allow the heroin to act in his brain.

- Percy Menzies, pharmacist, Assisted Recovery Centers of America, St. Louis, Mo.

Don't dismiss methadone

After reading last week's letter from the young man who is soon to be released from prison and feeling nervous, I know I would be nervous also. But I was disappointed that [psychologist Jack Keefe] did not provide a more favorable discussion of methadone.

He was right on the mark about how we destroy our endorphin system, which is so important to leading a fulfilling life. He is right that there is no medication on the market to replenish our endorphins except another opiate. Methadone is one such medication.

After nine months of white-knuckling it, my endorphin system had not replenished itself. Plain and simple, methadone saved my life whereas Alcoholics Anonymous and Narcotic Anonymous, inpatient care or outpatient treatments did not work. I am not addicted to methadone, but I am dependent on methadone. I do not experience any euphoria from using methadone.

Sure, the new drug buprenorphine is a godsend, but it is often only good for those in the earlier stages of addiction.

I wish the stigma and all the negativity about methadone would go away and it would just be accepted as an effective medication for the treatment of opiate addiction.

- Skip, Ocala, Fla.

This letter came in response to last week's column by Barbara Royal, director of the Open Door Recovery Center in Ellsworth.

Long-term methadone treatment best for many addicts

Buprenorphine (i.e. Subutex or Suboxone) is an alternative treatment for opiate addiction; however, it is not as effective in treating some opiate addictions as methadone. There are significant differences in the way each medication works in the brain's opioid receptor site.

Research on cost versus benefit for society when a patient is in methadone treatment shows that there is an average of $38 saved in social and health costs for every dollar spent on methadone maintenance therapy. This is based on a lifetime of maintenance therapy rather than temporary dosing for purpose of detoxification. With detoxification, the benefit decreases to an average of $7 for every dollar spent.

Some people argue that methadone maintenance is nothing but a crutch. Dr. Vincent Dole, the pioneer of methadone maintenance treatment, said in an interview that if a man lost his leg, the best case scenario would be to re-grow the leg. But that is not feasible, so the next best thing would be to give him a crutch (or an artificial leg), so he may be able to manage and have a more fruitful life.

To say that all patients in addiction treatment should aim for total abstinence is naive at best. It is an opinion that has detrimental consequences to patients, their families and society at large.

- Ericka R. Lear, Acting Director, Pennsylvania chapter of the National Alliance of Methadone Advocates.

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Combination Treatments Help
Alcoholics Stay Sober
05.02.06, 12:00 AM ET

TUESDAY, May 2 (HealthDay News) -- New research suggests that combining medical management with the drug naltrexone, using specialized alcohol therapy, or even trying both strategies at once helps alcoholics stay abstinent about 80 percent of the time.

Surprisingly, the study found the medication acamprosate, which has been used in Europe and was recently approved by the U.S. Food and Drug Administration for the treatment of alcoholism, wasn't effective. At least one expert from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) contends that acamprosate has been shown effective in other studies, and it's likely that it works for some, but not all, people.

"The number one finding is one of optimism. With treatment, people got better. The average across the group went from 12 drinks a day to under two drinks a day," said Dr. Mark Willenbring, director of the NIAAA's Division of Treatment and Recovery Research, said at a press conference Monday. And, he added that many people in the study completely abstained from alcohol.

"If you have a problem, or know someone with a problem, treatment works. Some treatments work better than others, and now we have more choice. People can go to their family doctor [for treatment]," he said.

Results of the study appear in the May 3 issue of the Journal of the American Medical Association.

It's estimated that about 8 million Americans are dependent on alcohol, according to the study. According to Willenbring, only about one-quarter of alcoholics ever try to quit drinking. "This is a serious disorder that is not getting adequately treated," he said.

The current study included nearly 1,400 people who were diagnosed as alcohol-dependent and had already stopped drinking for between four and 21 days.

The study participants were randomized into one of nine treatment groups: medical management and placebo; medical management and acamprosate; medical management and naltrexone; medical management and acamprosate and naltrexone; medical management, specialized therapy and placebo; medical management, specialized therapy and acamprosate; medical management, specialized therapy and naltrexone; medical management; specialized therapy and naltrexone and acamprosate; or specialized therapy alone.

Medical management was delivered by a health-care professional, such as a doctor, nurse or physician's assistant. It included a discussion of the consequences of heavy alcohol intake and advice on stopping drinking. Medical management also included encouragement for attending self-help groups, such as Alcoholics Anonymous. Follow-up visits, lasting an average of 20 minutes each, reviewed drinking history and provided additional encouragement.

Specialized therapy, dubbed Combined Behavioral Intervention (CBI), was provided by a mental health-care specialist, such as a psychologist or social worker. This therapy included aspects of cognitive behavioral therapy, motivation, parts of the 12-step program and a support system. Study participants who received CBI had as many as 20 sessions.

The study participants were assessed for drinking behavior at 16 weeks, and then again a year later.

During the treatment phase of the study, the researchers found that medical management combined with naltrexone alone, CBI plus placebo, or CBI alone were the most effective treatments, allowing alcoholics to stay abstinent about 80 percent of the time.

Acamprosate didn't perform better than placebo, even when it was combined with naltrexone.

"We found no evidence of efficacy for acamprosate, and also no evidence of incremental efficacy for combinations of naltrexone, acamprosate and CBI. Somewhat unexpectedly, we observed a positive effect of receiving placebo medication and medical management," wrote the study's authors.

Willenbring said that past studies on acamprosate done in Europe have found a benefit from this medication, and he suspects there is probably a subgroup of people that benefit from this drug. The researchers will be reviewing the acamprosate data to see if there is a group of people who were helped by acamprosate. Like antidepressant medications, Willenbring said that people with alcohol dependence may need to try more than one drug to find the one that works.

"I was surprised that there was no effect greater than placebo for acamprosate, and I was also surprised at the magnitude of the placebo affect," said Dr. Henry Kranzler, a professor of psychiatry at the University of Connecticut School of Medicine and author of an accompanying editorial.

He said the strong placebo effect may have something to do with the way the study volunteers are recruited. These people were already abstinent, and likely highly motivated to succeed.

He said there's definitely still a place for acamprosate in alcoholism treatment because it has been effective in other trials. "Clinical trials aren't perfect. Not too long ago, a major study from the VA showed that naltrexone had no effect," he pointed out.

With any of these treatments, he said, "the effects aren't huge effects." But, they can help people who are motivated to stop drinking.

"Naltrexone is not the alcoholism pill. It's a medication that helps people reduce their risk of drinking. It's not a magic bullet," said Kranzler.

After a year, there wasn't a significant difference between the groups. On average, the groups had between 75 and 80 days completely abstinent. The CBI group only managed 67 abstinent days. Willenbring said findings may suggest the need for maintenance treatment, similar to that of other chronic diseases.

Call Assisted Recovery's 24-Hour
Help Line (314) 645-6840 for a free, confidential consultation.

Call Assisted Recovery’s 24-Hour Help Line (314) 645-6840
for a free, confidential consultation