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Using Drugs to Curb Cravings

New Drugs May Prevent Relapses Among Alcoholics, Drug Addicts, Smokers, Even Dieters
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WebMD Health News

May 4, 2004 (New York City) -- Almost everyone knows someone who has successfully quit smoking, drinking, or overeating only to fall back on their old habits. But such scenarios could someday be the stuff of yesteryear if one researcher's vision comes to fruition.

Speaking to a standing-room-only crowd Tuesday at the annual meeting of the American Psychiatric Association, Charles O'Brien, MD, PhD, says a new class of medications can stop or curb cravings for alcohol, drugs, cigarettes -- even food. He is the Kenneth Appel Professor of Psychiatry at the University of Pennsylvania in Philadelphia.

Most of the medications are still in the experimental stage. But one, naltrexone, has been successfully used to prevent relapses among alcoholics and heroin addicts for almost a decade.

Turning Off Natural Opioids

Originally developed to treat dependence on opioid drugs such as heroin, naltrexone works at least as well for alcoholics, says O'Brien, who is also director of mental health research at the VA Medical Center in Philadelphia.

That's because it turns out that alcohol actually acts on the same opiate system in the body. When an alcoholic takes a drink, a blast of endorphins -- the body's natural opioids -- is released into the bloodstream.

And once the endorphins are turned on, the alcoholic desires more and more drinks. "For some people, drinking alcohol is like taking a shot of heroin," O'Brien tells WebMD.

That's where naltrexone comes in. By blocking opiate receptors, it reduces the cravings for both alcohol and heroin.

"We don't really fully understand the neurology of cravings, why people continue to have them after they have quit," O'Brien says. "But some drugs like naltrexone work to reduce them."

Vastly Underused Medication

The problem, according to O'Brien, is that only about 5% of the nation's 20 million-plus alcoholics are offered the once-a-day pill.

"It's a particularly American phenomenon, the feeling that alcoholism is a disease of willpower and you don't give a drug to a person with a drug problem," he says. "But in Europe, Australia and other places, naltrexone has been successfully used to help millions kick their habits."

O'Brien estimates that at least 50% to 60% of alcoholics would benefit if they were given naltrexone in conjunction with counseling, cognitive behavior therapy, or Alcoholics Anonymous.

Most alcoholics say they begin to feel their cravings subside within a few days of starting the medication, he says. By six months later, most are doing well enough that it would appear they could stop taking the drug. But O'Brien says when he tried that with his patients, the cravings returned three months later.

"It could be that, like with blood-pressure-lowering medications, you have to take the drug for life," he says.

Addiction is a Memory

The reason, O'Brien says, is that addiction is a memory. Just as you learn to ride a bike as a child, most alcoholics learn to drink when they're young. And the memory stays with you -- pretty much forever.

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