Only 10% of alcoholics get meds to treat addiction
May 14th, 2014
09:39 AM ET

Only 10% of alcoholics get meds to treat addiction

Ask the average person how to treat alcoholism, and they’ll probably describe an AA meeting or maybe a 30-day stint in a fancy rehab center. What won’t leap to mind, even for most experts, is medication.

That’s a missed opportunity, according to an analysis of more than 120 research studies that found that prescription medication helps addicts reduce their drinking and the associated harms.

Taken together, the studies involved 22,803 patients who abused alcohol. The bulk of the papers looked at the medications naltrexone or acamprosate. Both made addicts less likely to drink again and reduced the number of “drinking days” when they did relapse.

Studies involving two other medications, topiramate and nalmefene, also reduced drinking but involved a relatively small number of patients. A handful of the studies looked at disulfiram (sold as Antabuse), perhaps the best-known medication used to treat alcoholics. Researchers did not find evidence of a benefit for that drug.

How naltrexone helped this man quit drinking cold turkey

National statistics show that only about a third of alcoholics receive treatment for their addiction. And despite study results, some of which date to the 1990s, only about a third of the patients being treated are currently prescribed medication, according to the paper, which was published this week in the Journal of the American Medical Association. The result: Just 10% of alcoholics get medications that are proven to help them.

An accompanying editorial in the journal put it starkly: “Patients with AUD (Alcohol Abuse Disorder) receive poorer-quality care than patients with any other common chronic condition. Most patients with AUD do not receive treatment, and medications for AUD are particularly underutilized.”

The drugs work by different mechanisms, according to Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health.

Naltrexone blocks brain receptors that are thought to play a role in the pleasure an addict gets from taking his preferred drug – in this case, alcohol. Acamprosate targets chemicals thought to mediate the addicted brain’s protracted sense of panic or withdrawal in the absence of alcohol. Although both were similarly effective in the larger studies, different patients are likely to respond differently, says Koob, who has studied the neurobiology of addiction.

Do you drink too much? Take this simple test

Some experts have expressed frustration that the drugs are not used more widely. “People just don’t know about it,” said Dr. Raye Litten, associate director of the National Institute on Alcohol Abuse and Alcoholism's Division of Treatment and Recovery Research. “Many primary care physicians just don’t know about this.”

Both naltrexone and acamprosate are generic products, which reduces financial incentives to market them more widely. Koob says his institute is lobbying doctors and pharmaceutical companies to give the drugs a higher profile while backing research on other anti-addiction medications.

There are practical differences as well. Naltrexone treatment requires only one pill per day, but acamprosate requires two pills taken three times a day. Acamprosate can’t be taken by patients with kidney problems, but naltrexone is dangerous for those with liver damage. Since it blocks opiate receptors, naltrexone also can’t be used by patients taking opiate pain medication.

Dr. Daniel Jonas, one of the studies' lead authors and a primary care physician in North Carolina, points out that the improvements credited to medication in the studies are in addition to benefits from other treatment; virtually all patients in the studies received counseling or went to AA meetings in addition to taking prescribed medication.

“The general thinking has been that it wouldn't be appropriate” to simply put people on medication without counseling, but whether that track might work is an unexplored question, Jonas said. If it did, it might make treatment more available to people in areas with few counselors or addiction specialists.

Koob says it’s most important to recognize that effective treatments for addiction do exist.

“In the long term, most people need some kind of behavioral intervention, whether it’s group or individual therapy or mindfulness or religion, if you will,” he said. “But I think medications help you along the way.”

soundoff (51 Responses)
  1. DDW

    OK, so from what I know most alcoholics get there treatment through AA, why is it healthcare wants to push pills on them? It is similar to people who smoke, lets give them drugs to quit, doesn't make sense. I am recovering, I don't need any drugs to help me say clean and sober, I just do it.

    May 14, 2014 at 11:11 | Report abuse | Reply
    • TooClose2DC

      AA alone is not effective. Their success rate over the past 70+ years show that those that are no longer drinking would have been able to do it even without AA. What is needed is a more holistic approach of AA fellowship, psychiatric counseling, diet and nutrition, and medicine. Even short term inpatient facilities (less than 90 days) have horrible relapse rates despite group and individual counseling offered. These facilities rarely give anti-addiction medicine and their poor success rates show them to be nothing more than providers of false hope.

      May 14, 2014 at 12:36 | Report abuse |
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      May 18, 2014 at 11:32 | Report abuse |
  2. Jordi Heguilor

    AA's success rate is only 5%, but they believe that their 12 Steps are the ONLY way to recover, so they oppose the use of medicines to cure alcoholism.

    May 14, 2014 at 11:27 | Report abuse | Reply
    • tom johnston

      I sat in an AA meeting yesterday with 30 people at 10 am for a one hour meeting.
      On one side of me sat two people who have been sober for 85 years combined. On the other side were two more people
      who have been sober a combined 83 years.
      If a person has any sense of well being left, AA is the good choice. You can't force anyone to quit drinking or doing drugs if they don't want to. By the way, they don't oppose the use of medicine to quit, google the AA big book and read it . Just believe in a higher power, not necessarily God, just a higher power and do the step work. It works.

      May 14, 2014 at 15:11 | Report abuse |
    • Kathy Crozier

      AA doesn't support anything other than the 12 steps.
      "Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy."
      I'm 27 years sober by the grace of God and AA helped me to see that.

      May 14, 2014 at 15:21 | Report abuse |
    • eric

      5% isnt that much... no wonder there are so many failures... goto a AA meeting and when asked if you're a newcomer, watch as they blow you off... that happened to me back when i was 27 at a meeting... ill never bow down to that bull-oney ever again...

      May 14, 2014 at 19:05 | Report abuse |
  3. Ken

    I am an alcoholic and drug addict, in recovery, that means at the current stage of my life I am NOT using any drugs and\or alcohol. I AM under medical supervision, taking Antibuse daily as a preventative to drinking. It has been almost 2 years since I had a drink. I can probably get by without the Antibuse....it is my Safety Net, my Crutch......if I need to be on this the rest of my life.....so be it. I would rather take one pill daily and be safe\sure, than to wake up in jail for something foolish I did. I am also an Opiod addict, and I daily take one strip of Suboxone, also as a preventative, it is only a 2MG Strip.....the normal dose is 8MG.........AA and NA never worked for me. Hope this helps someone out there.

    May 14, 2014 at 12:51 | Report abuse | Reply
    • wjshelton

      Ken, see my reply to PJ McGhee. It was meant for you. LOL! I clicked reply on the wrong post, although what I meant to say to you also goes for him. He's doing what works for him too.

      May 14, 2014 at 14:23 | Report abuse |
    • JB

      What if you smoked and/or ate cannabis, Ken, instead of the meds? It's natural and the drugs you take for alcoholism are man made and are causing damage to other areas of your body. Unless its not medically available or legalized in your state, then I get your perdictament. It's amazing all the benefits that are starting to be discovered and all the negative press has been inconclusive. Best of luck to you.

      May 14, 2014 at 17:03 | Report abuse |
    • Eeyore

      @ JB, you DO realize that whether a substance is "man-made" or not has nothing to do with anything, don't you? Chemicals are chemicals.

      May 14, 2014 at 19:20 | Report abuse |
    • Pravas

      I was alcoholic for 6 years. I reached to a point where I started loosing control over my sense and body. It was one moring that my body couldnt took it further and two days I was vomiting blood. No one was around and. I was bed sick. It was that time I felt I am going to die and literaly I was on bed for waiting to die... I went into deep sleep and some how At mid night I woke up. I started feeling better and that was the moment I felt how precious the life is. It was the most astounding experience that I opened my backyard windows and had fresh air... Today its my year and I never touched that poison. Even someone drink infront of me I feel nothing about it... It took 3-4 months for my body to energize and I didnt took any medicine or special care. Today I run 5k, spend more time with my kids and first time I worked in my backyard to create a beautiful a summer garden..

      May 14, 2014 at 20:32 | Report abuse |
    • Ms. Romero

      Congratulations on your sobriety. You give me hope that someday maybe my father and my husband can achieve what you have. Thank you for giving me some hope.

      May 15, 2014 at 10:37 | Report abuse |
  4. PJ McGhee

    I'm in recovery too. meds have helped me in the past although i don't take anything now. but if someone tries AA and can't "get it" try the meds. TRY ANYTHING. go to church, go to a therapist. go to rehab. get meds. alcoholism is an incredibly hard thing to battle by the time most people HAVE to fix it or die. do whatever it takes. and get used to one idea. most non-alcoholics are simply never going to understand what you are going though. stick with AA too. it may not be enough in the beginning but long term it's wonderful. it's just group therapy to me although some AA folks don't like that idea.

    May 14, 2014 at 13:21 | Report abuse | Reply
    • wjshelton

      What works for you works for you and that is all you need to know. I did AA and NA 28 years ago and have been clean and sober since. I also haven't been to a meeting in 24 years. Okay, that's actually a lie. I went to a meeting when I hit 25 years, just to celebrate. Keep doing what you know works for you, just as I have done. As my daddy used to tell me, "If the truck ain't broke, don't fix it!"

      Have a good one!

      May 14, 2014 at 14:20 | Report abuse |
  5. amanda

    Very informative article.

    May 14, 2014 at 13:40 | Report abuse | Reply
  6. NFLisnotreality

    Oh sure, now they tell us. All that rehab, counseling, and support groups when I could have been taking some pills.lol! Oh well, still sober after 15 years- a non-smoker for 7 and that was being prescribed a pill to quit smoking much easier quitting smoking with the pill than with support to kick the booze habit. Or maybe I just learned how to quit better after all that rehab support and counseling hmmm.

    May 14, 2014 at 13:43 | Report abuse | Reply
  7. Tim

    The medications are an adjunct to other therapy/treatment, not a replacement for it. Nobody's suggesting that this magic pill will make you stop drinking forever; if that's your understanding of the article or the nature of addiction, that's your own issue. They're saying that these medications, in conjunction with other things (groups, meetings, peer support, education, religion, etc.) can help people stop and stay stopped. That's all. I don't see why anybody who knows what addiction is like wouldn't support another tool that could help save lives.

    May 14, 2014 at 15:48 | Report abuse | Reply
  8. ms.pierce

    My son has been AA sober 2yrs 5mo. He tributes his success to daily connection with sponsor, meetings and becoming a sponsor. He rejects any rx meds, including his ADHD meds. This works for HIM. Do what works for YOU.

    May 14, 2014 at 16:42 | Report abuse | Reply
  9. JB

    If pot was legal, there would be less drunks.

    May 14, 2014 at 16:57 | Report abuse | Reply
    • CarlTests

      That seems unlikely. Addiction is addiction, and alcoholics tend to crave the booze. They would likely just be drunken pot smokers.

      May 14, 2014 at 18:50 | Report abuse |
    • Eeyore

      @JB, where do you come by this "information"? Pulledoutovyerazz dot com?

      May 14, 2014 at 19:19 | Report abuse |
    • Eyesore is part of the Medical Cartel problem.

      No Eyesore. He got it from PalinVotersAreMorons dot com.

      May 14, 2014 at 22:27 | Report abuse |
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      May 14, 2014 at 23:08 | Report abuse |
  10. CarlTests

    I'm glad to hear that there may be medications that will actually help alcoholics. If you are rational and have to deal with alcoholics, you quickly learn the need to practice tough love and also that addiction is hard kick. I've known people who had antabuse and they would just hide it or throw it out, so it didn't work for them. I note that this article says that studies have not shown antabuse to be effective. I hope the other drugs are effective. If you aren't an alcoholic, you will have trouble understanding addiction and you will need to try to understand more. You will need to mentally protect yourself if you are dealing with an alcoholic and you really can't cut them any slack when they are drinking, but perhaps things like the drugs mentioned in this article can help the alcoholic, and therefore, help those who must deal with them.

    May 14, 2014 at 18:49 | Report abuse | Reply
  11. me

    My sister takes one of these medications and has been for about 3 years. It has helped her immensely to lead a more productive life. She does not do AA. I'm amazed she was even willing to do the pills. AA is just not something she would do; she has a great deal of denial and she still drinks but the pills keep her from drinking to excess now, she is able to stop. I think the part of the reason she won't do AA is she doesn't want to quit drinking. So the pills enable her to drink and be able to stop after a few. I've long given up on her ever quitting and as long as this keeps her under control, it's a win. I have a brother who did AA for years and was able to quit drinking over 20j years ago successfully. Neither of my parents were big drinkers and I have never had any problem with alcohol and drink very little.

    May 14, 2014 at 19:16 | Report abuse | Reply
  12. JM

    I had a major drinking problem and needed professional help at the age of 38. My general doctor recommended an adult psychiatrist to meet with. The consultation with the psychiatrist was very productive and it was decided I would begin taking Naltrexone once a day. I attended AA meetings in the beginning along with taking the Naltrexone. I have been sober 18 months. Naltrexone helped with my cravings and still take it. Alcoholism runs in my family and I was determined to break the cycle. Medication can help with recovery..... I am proof.

    May 14, 2014 at 22:00 | Report abuse | Reply
  13. Coreen

    I know a man who is 71 and drinks when he is awake – No amount of coaxing from anyone has made him stop. I realize he is an alcoholic, which he acknowledges, but he does nothing about it. His 44 yr old daughter and 41 yr old son do nothing about it – in fact they give him a bottle at Christmas or gift card at a liquor store. I have never seen such disregard for a deadly problem. He will drink a glass of white wine, then a beer and during the day, he will have a martini or manhattan and then go back to wine and beer. Total disaster.

    May 15, 2014 at 01:08 | Report abuse | Reply

    I drank most of my life and when i sober AA was there help me get my life back on track. Im comming up on 3 years. You have to have willingness if you can't be yourself who can you be.And there's no such thing as a normy,it's just you being who you are YOU!!!!

    May 15, 2014 at 01:27 | Report abuse | Reply
  15. KieranH

    Yes, drugs do a great job of abating alcoholism. Try heroin!

    May 15, 2014 at 07:23 | Report abuse | Reply
  16. Mike

    There is no cure-all treatment for substance use disorders. 12-Step meetings will work for some, and not others . Medication-assisted treatment is the same. An addict has to find what will work for them, but first-and-foremost they NEED TO WANT IT. Whatever their reason is, staying alive, keeping their kids, staying out of jail, they need to want it for themselves. Where there is a will, there is a way.

    **Also for anyone reading currently struggling with addiction issues and wants support but doesn't want to attend 12-step meetings, check out SMART Recovery (google it for their website and to find meetings). It's a self-help / support group based on cognitive-behavioral therapy.

    May 15, 2014 at 07:35 | Report abuse | Reply
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  18. Leigh

    It amazes me that these meds are not known or used by more docs. Addiction is so difficult to beat. The more support an alcolholic/addict has (no matter what form that support is in) the better chance they are going to be successful. I have used both Vivitrol and Topamax. Both have been very helpful. But, neither are magic pills. The underlying cause of addiction doesn't go away with the med. However, my cravings have. In the perfect world, do I want to take a med? Of course not. But in a perfect world, I wouldn't be an alcoholic.

    May 23, 2014 at 06:40 | Report abuse | Reply
  19. Chuck

    VIVITROL is the once a month injection of Naltrexone which works very well for me as an alcoholic. You do not get a buzz from drinking at all.

    August 15, 2014 at 12:38 | Report abuse | Reply
  20. Megan Lauren

    We cannot deny the fact alcohol and drug addiction rate increase every year. And most of theses addiction cases are not address properly. There is only a low chance where family sends them to a rehabilitation center, their own family are in denial stage that family member have addiction problem. There are many causes of addiction it can be from depression, grieving, guilt, and fear. I hope we can eradicate or at least lessen the growing number addition cases in the world with the help of different drug treatment center who helps them get back to their life.

    October 28, 2014 at 23:30 | Report abuse | Reply
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