Alexander DeLuca, M.D.
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Why is There so Little Research on Naltrexone as an Aid to Problem Drinkers Trying to Moderate?

 
by Alexander DeLuca, M.D., FASAM; Addiction, Pain & Public Health website - doctordeluca.com; Issued: 2001-06-13; Posted: 2002-12-12; Modified: 2004-06-09
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Right now, the overwhelming percentage of funds spent on alcohol research focus only on "alcohol dependent" people. Hardly any funds are spent on how we might help the much larger, far more costly to society, group of people, called "problem drinkers," the people you might find at a Moderation Management (MM) meeting or participating in MM online forums and listservs.

It is important to realize that it is the problem drinkers who ARE THE MAJORITY, yet the 'Treatment Industry' offers very little or nothing in the way of engagement and treatment, telling them instead to "come back when you hit bottom" and other such odious nonsense. Anyone presenting for help is labeled "alcoholic, either in or not in denial." One little thing we can and are doing is collecting the experiences of people who are working with their physicians and using naltrexone to help themselves achieve their moderation goals. You can see our growing collection of experience at: "Members of Moderation Management share their experiences using naltrexone as an aid to controlled drinking."

When (then Dupont, now Merck) re-introduced naltrexone as ReVia for the treatment of alcoholism, sales went nowhere. The treatment industry and the addiction medicine doctors and counselors, were almost unanimous in ignoring the very excellent research that this drug might help, just as they had ignored decades of research that Antabuse, when supervised, can help greatly in early recovery.

The treatment industry somehow feels that the use of ANY medication somehow threatens their 'abstinence-uber-alles' world view. That is, if we were all just good little addicts and alcoholics we would (after paying for inpatient detoxification and rehabilitation) simply "not drink and go to meetings." Unfortunately, while paying lip service to the high co-morbidities of trauma, depression, anxiety, insomnia, homelessness, and vocational problems, generic treatment does not bring to bear the tools of modern psychology and psychopharmacology on these co-morbidities which are highly associated with relapse. Hence the oft-noted "revolving door" phenomena.

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What we are seeing now is a grassroots resurgence in interest in naltrexone; it is the people who suffer with alcohol related problems who are bringing this drug into the mainstream. Problem drinkers are the majority, both numerically and in the amount of harm they cause to themselves, their families, and to society in general. Yet precious little research being done on naltrexone as an aid to moderation or controlled drinking in those who do not, yet, meet American Society for Addiction Medicine criteria for alcohol dependence.

The forces of abstinence-uber-alles, are very powerful. They have money, and they crush people and institutions that don't "hew to the philosophy of complete abstinence." Take if from me, I know. See [Abstinence vs. Harm Reduction - A False Dichotomy] and [The Harm Reduction vs. Abstinence follies of Summer 2000 - or, addiction medicine shoots itself in the foot, again"] So researchers and academic institutions are very, very wary of terms like "controlled drinking" and "moderation" and "harm reduction;" very little money flows that way.

Let's name names, shall we? The National Council on Alcoholism and Drug Dependencies and the Smithers Foundation.

Check out what these people did to the alcohol research center at Rutgers approximately 30 years ago. See: "The Controlled Drinking Debates: A Review of Four Decades of Acrimony" by Brook Hersey, Psy.D., 2001].  and in 2000 to the Smithers Addiction Treatment and Research Center in July 2000 when we merely suggested that we might be able to help people earlier on the continuum of severity of alcohol-related problems if we stopped demanding they swear allegiance to abstinence on the first visit. The Smithers Foundation took out a full page ad in the New York Times (that's about $90,000) in order to purposefully mislead and confuse the public about our efforts to modernize addiction treatment at the Smithers Center. Finally, read about how these organizations, supposedly representing the "12-Step approach" and the "Minnesota Model," misinformed and dis-informed the public regarding the Audrey Kishline tragedy. 

The only correct AA response to the Audrey Kishline's fatal MVA is, by the way, "There but for the Grace of God, go I."

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Here's a link to a web page that will tell you more than you ever wanted to know about how the Treatment Industry, the Corporate Cowards, and the Tyrannical Philanthropies went about intimidating and crushing new ideas, in the Summer of 2000; read it and weep: [Abstinence vs. Harm Reduction Wars of Summer 2000]
 

..alex…

Addendum 12/11/01:

If alcohol abuse is not just an early stage of alcoholism, then why is our entire assessment and treatment system rigidly abstinence-oriented? Why do we continue to try to force the person with 1-4 alcohol - related problems into the box we have constructed for the person with 4-12 alcohol-related problems? 

Consider the following recent articles from peer-reviewed journals:
1) "Five Year Clinical Course Associated with DSM IV Alcohol Abuse or Dependence in a Large Group of Men and Women."  by Schuckit et. al.  "...[A]lcohol abuse ... does not usually progress to dependence,"  and,

2) "Evidence About the Use of Naltrexone and for the Different Ways of Using It in the Treatment of Alcoholism." by Sinclair, "Naltrexone is most effective when paired with drinking but ineffective when given during abstinence..."

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