Two medications could help tens of thousands of alcoholics quit drinking, yet the drugs are rarely prescribed to patients, researchers reported on Tuesday.
The medications, naltrexone and acamprosate, reduce cravings for alcohol by fine-tuning the brain’s chemical reward system. They have been approved for treating alcoholism for over a decade. But questions about their efficacy and a lack of awareness among doctors have resulted in the drugs’ being underused, the researchers said.
Less than a third of all people with alcohol problems receive treatment of any kind, and less than 10 percent are prescribed medications. The Affordable Care Act requires that insurers provide coverage for substance abuse treatments and services, and addiction specialists expect to see increases this year in the number of people seeking help for alcoholism.
George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, said the new study should reassure doctors that naltrexone and acamprosate, while not silver bullets, can help many patients.
“This is an important paper,” said Dr. Koob, who was not involved in the study. “There are effective medications for the treatment of alcoholism, and it would be great if the world would use them.”
In the new study, which was published online on Tuesday in JAMA, the journal of the American Medical Association, a team of researchers based mostly at the University of North Carolina at Chapel Hill compiled findings from the most rigorous trials of medications for alcoholism in the past few decades. Ultimately, they analyzed data on roughly 23,000 people from 122 randomized trials.
The researchers focused on a measure known as the “number needed to treat,” an indicator of how many people need to take a pill for one person to be helped. The study found that to prevent one person from returning to drinking, the number needed to treat for acamprosate was 12; for naltrexone, the number was 20.
By comparison, large studies of widely used drugs, like the cholesterol-lowering statins, have found that 25 to more than 100 people need treatment to prevent one cardiovascular event.
According to federal data, roughly 18 million Americans have an alcohol abuse disorder. Excessive drinking kills about 88,000 people a year.
“These drugs are really underused quite a bit, and our findings show that they can help thousands and thousands of people,” said Dr. Daniel E. Jonas, the lead author of the new study and an associate professor of medicine at the University of North Carolina. “They’re not blockbuster. They’re not going to work for everybody. But they can make a difference for a lot of people.”
The new research looked only at the effectiveness of the medications in combination with behavioral interventions like counseling and therapy. Dr. Jonas said it was unknown whether the drugs would be as effective on their own.
“There are so many psychosocial issues that often go along with alcohol use disorders, like depression and anxiety,” r. Jonas said. “Most people don’t think you should just start someone on a medication and turn them loose.”
The research found that acamprosate and naltrexone had side effects like nausea, dizziness and headaches. But they were more effective than a much older, more widely known medication for alcoholism called Antabuse, or disulfiram. That drug works as an aversion therapy that blocks the body’s ability to metabolize alcohol: People who take it become ill if they drink alcohol. As a result, many patients stop taking it.
Historically, treatment for alcoholism and other addictions has been relegated to support groups, rehabilitation centers and similar programs, said Dr. Katharine A. Bradley, a senior investigator at the Group Health Research Institute in Seattle. But that is beginning to change as more doctors view addiction as a chronic illness that should be treated in a health care setting, Dr. Bradley said.
“It’s been a slow transition getting these medications onto the medical agenda,” she said. “But patients need to know that addiction is a biological condition of the brain and that we have treatments to improve it.”
By ANAHAD O’CONNOR
MAY 13, 2014
The Newhawks Crew
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Drugs to Aid Alcoholics See Little Use, Study Finds