The Complexities of Treating Alcoholism
Newer medications -- Revia (naltrezone) and acamprosate -- act on neurotransmitters that control reward pathways in the brain.
"Naltrexone blocks the opioid receptors; it's a deterrent and a little less frightening than Antabuse. Acamprosate acts on a completely different brain system, acting to normalize the system rather than blocking it," says Mason. "It's the irritability of that system that triggers the relapse. Alcohol quiets the system; it's the absence of alcohol that triggers the irritability and hyperactivity, the unpleasant sensations [that occur during withdrawal] and lead to relapse."
"However, both naltrexone and acamprosate are not panaceas, they're not silver bullets, they don't work for everyone," Mason says.
Alcoholism can be compared to other chronic illnesses like diabetes, which has a strong behavioral component in its development -- and which demands serious lifestyle changes. "In some ways, we're a little more pessimistic than we should be, when we think about what we're asking [alcoholics] to do for treatment of their alcoholism," says Drexler. "It's very similar, the rates of compliance in diabetes with diet and foot care, things that take a fair amount of discipline and continuing motivation. It's about the same as with staying completely abstinent from alcohol."
Behavioral therapy, including the Alcoholics Anonymous 12-step program, helps people to get past denial, understand their behavior patterns, and develop new ways to stay sober. And while behavioral therapists have tried to develop different treatment methods, Mason says one large study showed that the type of therapy made no difference. "As long as you just delivered good-quality intervention, it didn't matter whether it was 12-step or cognitive behavioral therapy. Treatment works!"
With few inpatient detoxification programs available anymore, drinkers are exposed to alcohol all the time -- a hard battle for many, says Mason. "The fact that we're identifying medications that make a difference, even a modest difference, and we're developing behavioral therapies very specific to alcohol ? there's a combination giving us a lot of hope for outpatient management of a real public health problem."
Newer drugs, and better combinations of drugs, are being developed, Mason tells WebMD. "I think we'll move even further forward to find better drugs? that involve a lot more pathways in the brain. In this disorder, which is so lethal, any advantage is a true advantage, and especially if there is no downside in terms of adverse events or interactions with other substances."