A little-known drug called naltrexone provides a “meaningful benefit” in helping
alcoholics moderate their drinking, according to the latest review of evidence
from 29 studies on four continents.
The findings, along with the recent FDA approval of a similar drug called
acamprosate, open the door to new treatment options for drinkers who aren't yet
ready to face total abstinence.
Naltrexone, which is not addictive, “should be accepted as a short-term
treatment for alcoholism,” say authors Dr. Manit Srisurapanont and Dr. Ngamwong
Jarusuraisin of Thailand's Chiang Mai University. Almost all of the studies
tested naltrexone, or NTX, in combination with psychosocial treatments such as
counseling or self-help groups, and the authors recommend using this approach in
The review's conclusions are based on “high-quality evidence” that naltrexone
reduces by 36 percent the risk of an alcoholic relapsing to heavy drinking in
the first three months of recovery. “Short-term treatment of NTX for alcoholism
gives a meaningful benefit in preventing a relapse,” the review said, citing an
18 percent lower likelihood that patients will abandon their treatment program.
The review appears in the most recent issue of The Cochrane Library, a
publication of The Cochrane Collaboration, an international organization that
evaluates medical research. Systematic reviews draw evidence-based conclusions
about medical practice after considering both the content and quality of
existing medical trials on a topic.
Dr. Joseph Volpicelli, of the University of Pennsylvania School of Medicine, has
been conducting research on naltrexone use for alcohol dependence since the
early 1980s. Naltrexone blocks the brain's receptors for natural painkillers,
known as opioids, which normally create the feeling of wellbeing associated with
He explains that the benefits of naltrexone lie not so much in preventing a
patient from having one drink, but rather in breaking the cycle where one drink
leads to many more. “Naltrexone helps people have more control over the use of
alcohol. For me, that's the fundamental issue of what addiction is: impaired
However, this approach requires a substantial change from the abstinence-only
philosophy that goes back at least as far as Prohibition. Naltrexone is most
effective, says Volpicelli, in a treatment program “designed to support the
notion that while one drink is not great, what you really want to stop is
While few professionals advise people with alcoholism to abandon the ultimate
goal of total abstinence, Volpicelli argues that about 20 million Americans
suffer from alcohol abuse disorders, yet only about 2 million are in any kind of
treatment program. “We should be flexible enough to get at that 90 percent of
people who aren't in treatment,” he says.
The U.S. Substance Abuse and Mental Health Services Administration agrees in its
naltrexone treatment protocol, saying, “Abstinence should be a desired goal for
the patient; however, reductions in drinking may be an acceptable intermediate
outcome … because there are many other areas of a patient's life that can
improve, such as job performance, social relationships, and general physical
Although naltrexone (ReVia) has been available for more than 10 years,
Volpicelli says it has been poorly marketed, and most patients and primary care
doctors remain unaware of its potential. That may change now that the
manufacturer of acamprosate (Campral) has embarked on a campaign to promote
pharmacological treatment of alcohol addiction.
Review author Srisurapanont notes that the availability of both medicines now
gives patients an alternative if one is not effective for them. And, he adds,
the possible benefits of using the medications in combination should be studied.
The review also notes that other areas ripe for future study include the
possible benefit of continuing naltrexone treatment beyond the first three
months of recovery and strategies to further increase treatment completion.
Volpicelli believes psychiatry is on the brink of recognizing a new standard of
care for alcohol abuse disorders: allowing patients to choose from a variety of
treatments, which may or many not focus on total abstinence. It is, he believes,
a time of great hope. To those who suffer with alcoholism, he says, “Be aware of
all the options available and find the best one for you. See someone, stay in
treatment, and over time you're going to get better.”
FOR MORE INFORMATION:
Health Behavior News Service: http://www.hbns.org.
Center for the Advancement of Health
Contact: Ira R. Allen
Vice President of Public Affairs
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