Treating Alcoholism With a Monthly Shot
Study: Counseling Plus Monthly Shot of Naltrexone Shows Promise
Alcoholism: A Chronic Disease
Alcoholism is the fourth leading cause of disability worldwide. In the U.S., it may contribute to more than 100,000 preventable deaths annually and is present in 4% of the adult population, the researchers, including James Garbutt, MD, of the University of North Carolina at Chapel Hill.
Alcoholism is increasingly viewed as a chronic disease that can be affected by genetics, social, and environmental factors, they note.
Treatment options include addiction counseling, behavioral approaches, self-help groups such as Alcoholics Anonymous, and medications.
"As with other chronic diseases, long-term comprehensive management strategies are necessary to achieve and sustain the benefits of alcohol dependence treatment," the researchers write.
Naltrexone was approved by the FDA in 1994 for treating alcohol dependence. The drug had been shown to reduce drinking frequency and the likelihood that people would relapse back into heavy drinking, say the researchers.
But naltrexone hasn't gotten widespread clinical use. That may be partly due to variations in treatment response -- which could be related to the drug's regimen, say Garbutt and colleagues.
Currently, patients take naltrexone orally every day. Sticking to a daily oral medication routine is a general problem in medicine (not just with alcoholism), write the researchers. They tried a different approach: long-acting monthly shots of naltrexone.
Testing the Shots
The six-month study included more than 600 adults with alcoholism at 24 hospitals, clinics, and Veterans' Administration health facilities across the country.
All had been diagnosed with alcohol dependence and had had at least two heavy drinking episodes per week in the last month. That's at least five drinks at a time for men and four or more for women.
Nearly 200 patients got a monthly injection of 380 milligrams of naltrexone. Around 200 more got 190 milligrams of naltrexone in one monthly shot. The rest received a placebo shot. Everyone also took 12 counseling sessions for alcoholism.