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.
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.
Side effects of naltrexone are relatively mild and rare, with about 10% of alcoholics reporting nausea. And with a new injectable form of the drug that is under development, O'Brien thinks that rate can be further reduced. "You give a lower dose that lasts for 30 to 40 days."
Alcoholics aren't the only people being helped by naltrexone. Heroin addicts who take the drug don't relapse, he says.
And naltrexone isn't the only anti-craving medication. Zyban has been successfully helping smokers kick their habit for several years. The experimental agent Rimonabant helped overweight people drop an average of 20 pounds in one study and doubled the chances that smokers would quit in another. Campral, also not yet approved in the U.S., is being successfully used to reduce relapse rates among recovering alcoholics in other countries.
A Promising News Strategy
Eric Collins, MD, assistant professor of psychiatry at Columbia University in New York and co-chairman of the session, says that anti-craving agents represent "a promising new strategy."
"Dr. O'Brien is at the frontier of the field," he tells WebMD. "Eventually we will have agents that help to maintain people off drugs and alcohol after they have quit."
While it's unlikely there will be any global anti-craving drugs, Collins says "we will find specific agents that work for specific individuals."
David Baron, DO, chairman of psychiatry at Temple University at Philadelphia and co-chairman of the session, agrees.
"There will be certain subgroups for which one drug or another will work," Baron says. "Just like aspirin might not work for one person and acetaminophen might not work for another, one anti-craving drug will not work for everyone."
The anti-craving medications "are right on the edge of becoming a standard treatment of choice," he says. "We're not that far away from identifying which patients will respond."