SATURDAY REWIND: Meds boost outcomes, but no silver bullet for alcoholism

Recent news about the effective use of anti-seizure drug Gabapentin in the treatment of the symptoms of alcoholism and the growing list of approvals for the new drug Selincro (see article) draw attention to science's search for the elusive cure for the disease of alcoholism.  This article from the alcohol research news archive looks at two pharmaceutical solutions for early recovery woes, but notes there is no pill today to cure alcoholism. Period.


New research released by the Society for the Study of Addiction produced positive news about two prescription drugs used to help prevent lapse in alcoholics in treatment trying to stay sober. The drugs, acamprosate (marketing name: Campral) and naltrexone (ReVia) were found to help those struggling in different phases of recovery. Acamprosate helped manage emotional triggers in people who had already stopped drinking, naltrexone helped manage cravings in heavy drinkers who are trying to stop drinking or recently quit.

The study findings are encouraging but the medications still fall short of being a silver bullet. There is no alcoholism pill.

The slight increase in abstinence in the 2012 treatment study shows progress is being made as science looks for that alcoholism pill. Emphasis in treating alcoholism and alcohol use disorders instead remains focused on therapies such as group or one-on-one counseling and 12-step meetings or their alternatives.

The course of recovery, even for those taking the medications, centers more on talk and less on pills because while drugs like acamprosate and naltrexone help change brain chemistry, they don’t change minds. Once you take away the alcohol, sometimes with the successful use of prescribed medicine, the minds still need work. Alcoholics who slip in recovery and non-alcoholics drink for essentially the same reason: It relieves social/physical/emotional tension. With alcoholics however, their bodies are programmed differently genetically and respond to drinking with more drinking. So counseling or a 12-step meeting helps those abstinent keep from taking the first drink. Recovery has very little to do with stopping the drinking and those successful in recovery admit they’re success is based on learning or relearning how to manage life’s tensions.

Generics of both pills can be found at most pharmacies when doctor and patient agree that medication can help maintain abstinence as part of, not instead of, a sobriety plan. The generics are not currently on the lists of deeply discounted prescriptions at the three largest retail pharmacies.
-- from examiner.com (see full article)
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Details on the third literary award for Every Silver Lining Has a Cloud, plus the new radio interview replay is available at alcohologist.com... and please read the new interview with Scott Stevens at Christoph Fisher Books.  Mr. Fisher is an acclaimed international historical fiction novelist from the UK. 

SUNDAY SNIPPET, May 5

This week's excerpt goes back to 2010's What The Early Worm Gets, a book in which the genetic and biochemical roots of the disease of alcoholism are probed. A significant body of research in the field of alcohology revolves around neurochemicals serotonin and dopamine, a.k.a. The Big Two brain chemicals.  They control the oldest part of the brain, the part that regulates what we need to survive based on primitive requirements – eat, don't get eaten, procreate. Dopamine tells the body we need something to survive. Serotonin alerts the body that the need has been met. Non-alcoholics have The Big Two in proportion to one another. In alcoholics, the dopamine is overproduced and serotonin never quite overcomes the dopamine to signal that we've had enough of something alcoholics are genetically wired to believe is a survival necessity: Alcohol.

“Alcohol is a central nervous system depressant. Use of alcohol in an Alcoholic will continue on a binge until the central nervous system becomes so depressed you pass out. There is not enough serotonin to tell the body it is okay. The dopamine keeps telling the body it needs more and is unopposed. It is for this reason that an Alcoholic doesn’t know that other people do not feel the way they do when they drink and that non-alcoholics (“normies”) don’t feel the same way an Alcoholic does when he drinks.

 

Non-alcoholics have no idea what it is like, how it feels, to drink alcoholically.

 

To complicate matters even further, some researchers theorize the alcohol molecule itself triggers release of more dopamine. The chemical composition of alcohol is so close to many neurochemicals that it could mimic or interfere with them, especially because alcohol is absorbed directly into the bloodstream at the small intestine without digestion or metabolization.

 

Treating the imbalance balance between dopamine and serotonin is not new ground. It was originally discovered in 1992 that obesity could be managed by combining Fenfluramine (which blocks the brain’s ability to reabsorb serotonin) with Phenteramine (which increases serotonin and decreases dopamine). The Fen-Phen combination also proved effective in treating Alcoholics in 1993. The Fen-Phen combination however proved also to be saddled with side-effects and fatalities and Fenfluramine was pulled off the market.

 

Rats have the same primitive structures in their brains and the same Big Two. Rats who have had serotonin removed from their brains have compulsive sexual activity and eating (Eat, Don’t Get Eaten, Breed) because there is nothing to counter the dopamine surges telling the body a survival need isn’t being met. If you have hunger, fear or an unconsummated sex drive, that represents Big Two imbalance. The imbalance stems from nothing you do or eat. A neurotransmitter responsible for the balance called Gamma Amino Butyric Acid (GABA) is controlled by your genes.

 

The physiological disease has its foundation in the genetic deficiency of the low or missing alcohol metabolism enzyme [discussed earlier in the chapter] PLUS the imbalance between the Big Two. What’s morality or character or behavior got to do with that? Where does willpower begin to fix that? An Alcoholic is no more capable of willing that physiological picture to correction than a starving person can will himself to a full stomach.”

– from What the Early Worm Gets, pages 60-61

Where willpower does come into play is resisting the first drink once sobriety is reached. A practicing alcoholic has no defense against this neurotransmitter imbalance once the alcohol is consumed. Once sober for awhile and the body's tissues have adjusted to not having the alcohol, then a dose of will is needed to keep it that way. An alcoholic has to will something other than the first drink. Once the first drink goes down, those neurotransmitters are still out of whack and there is no way an alcoholic can resist the second drink. Dopamine is running wild, and running the show at that point.  In fact, the low serotonin will make the body crave the second drink or the tenth as much or more than the first one.

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