Drinking Problem? Try Drugs

from wired

By Suzanne Leigh| Also by this reporter
02:00 AM Apr, 19, 2006

The story of Irish soccer sensation George Best, who died last November at 59, resonates with many of the 18 million Americans who abuse or are addicted to alcohol.

The Manchester United player had wowed the world in the '60s and '70s with his fancy footwork and Gaelic good looks. But he died heavily in debt after falling off the wagon following an operation to replace his liver, irreparably damaged after decades of hard drinking.

Like many alcoholics, Best's drive to drink transcended his will to survive.

Until recently, physicians had little in their arsenal to help drinkers conquer their cravings. That might explain why so few seek help -- just 1.5 million Americans underwent any kind of treatment for "alcohol problems" in 2002, according to the Substance Abuse and Mental Health Services Administration in the Department of Health and Human Services. Some drugs are available now to treat alcoholism, including ReVia, which has had limited success because it must be taken daily -- an obstacle for some alcoholics. Antabuse is a harsh deterrent that causes flushing, sweating, nausea and rapid heartbeat. A third treatment, Campral, should only be taken after the patient has achieved sobriety.

And last Thursday, the Food and Drug Administration approved Vivitrol, developed by Massachusetts-based Alkermes. Vivitrol is a monthly injection form of ReVia and works by dampening the desire for alcohol. Clinical trials demonstrated that patients who took the drug in tandem with counseling cut their heavy drinking days from 19 a month to just three. Another group that received a placebo and counseling drank six days a month.

What is remarkable about Vivitrol and the drugs currently being studied on alcoholics is that, unlike abstinence programs, their success is not measured exclusively by the duration of a patient's sobriety. There's an unspoken acknowledgment among experts that while lifelong abstinence is the gold standard, reducing intake beats consistent hard drinking.

Dr. Linda Garcia, medical director of the Alaska-based addiction program My Way Out, which combines drugs and dietary supplements with hypnotherapy, diet and exercise modifications, believes that cutting alcohol consumption for a problem drinker is the same as cutting sugars for a diabetic.

"The less an individual binges on harmful sugars or alcohol, the less damage to tissue and injury to other organs. If abstinence cannot be completely achieved, we try to minimize exposure as best we can," she says.

Garcia, an internist, believes there are no miracle cures. But however questionable the efficacy of drugs to treat alcoholism, the fact that more medications are becoming available may mean the medical community is finally moving in the right direction.

Also vying for a spot on physicians' prescription pads is Topamax, an anti-seizure and migraine medication. Although Topamax is not approved for alcoholism, the FDA does not object to so-called off-label use. However, because it has not been extensively studied on alcoholics and doctors don't know how long it should be taken, the National Institute on Alcohol Abuse and Alcoholism does not recommend Topamax in its 2005 clinician's guide for treating patients with drinking problems.

But early research looks optimistic, and some physicians are already quietly prescribing it. A study in 2003 found that alcoholics on Topamax reported drinking three fewer drinks per day than a placebo group. Dr. Bankole Johnson, chairman of the department of psychiatric medicine at the University of Virginia, is currently recruiting patients for a clinical trial of Topamax to treat alcoholism. If the results are good, he predicts the drug will be readily prescribed by family practitioners in a few years' time.

Scientists see promise in other drugs for treating alcoholism, including Abilify, approved for psychosis, Zofran for nausea and Lioresal for muscle spasms. Research also indicates that Acomplia, a weight-loss drug expected to be available later this year, helps alcoholics curb the urge to drink.

Whether these drugs would have worked for hardened drinkers like soccer star Best remains to be seen. Karen Boyce of Cephalon, which has a marketing and distribution agreement with Alkermes, acknowledges the complexity of treating alcoholism due to its "physiological, psychological, sociological and environmental factors." Vivitrol, she says, "will enhance, not replace" treatment approaches like Alcoholics Anonymous.

"I think the effects of drugs like Vivitrol are going to be modest. It will be effective with some people, not with others. We shouldn't anticipate a magic bullet," says Dr. Kirk Wilhelmsen, whose lab at the University of North Carolina at Chapel Hill maps the susceptibility genes of alcoholism. He is leery of medications for conditions like alcoholism that have many different causes.

He also notes that the placebo effect alone can treat conditions like alcoholism, as reflected in Vivitrol's trials.

Others, like Jaren Madden of Alkermes, believe the progress drug developers are making with alcoholism treatments is similar to success they've made over the years with depression. Behavioral intervention was once the only treatment option for patients with depression, she notes. "But now the fact that medication can play an important role in treatment is well-accepted," she says.