In a finding that promises to revolutionize the treatment of alcoholism, two groups of researchers have independently found drug that reduces an alcoholic's craving for liquor.
Use of the medication, called naltrexone, in combination with conventional behavioral treatments, reduced relapses into alcoholism from the normal 50 percent of patients to only 20 percent, according to reports that will appear tomorrow in the Archives of General Psychiatry.
The medication also made it easier for alcoholics who relapsed into drinking while on the program to return to abstinence, according to Dr. Joseph Volpicelli, a psychiatrist at the University of Pennsylvania Medical Center.
"These are very important observations and we will be issuing new grants to reproduce and extend them," said Dr. Enoch Gordis, director of the National Institute on Alcohol and Alcoholism in Bethesda, Md.
"But more important," he added, "this is the beginning of a new era in which both pharmacotherapy and verbal therapy will be incorporated into alcoholism treatment. Naltrexone is promising, but others will come down the road in the next decade."
The discovery could have an immediate impact on alcoholism treatment because naltrexone is already widely available for use in treating narcotics addiction. Any physician is thus able to prescribe the drug for other purposes, such as treatment of alcohol abuse.
Alcoholism is the most significant drug abuse problem in the United States. Government studies have shown that a minimum of 10.5 million Americans are victims of alcoholism, and many researchers believe that number significantly underestimates the problem.
At least 100,000 deaths are associated with alcohol abuse each year, either from cirrhosis of the liver or from accidents caused by intoxication.
But perhaps even more important are the social costs. Nearly half of all Americans have been exposed to alcoholism in their own families, according to a 1991 government report, and alcoholism is a major cause of divorce.
But few alcoholics -- no more than one in 10, according to Dr.
Volpicelli -- seek treatment for their addiction.
And many who do seek treatment quickly drop out of programs, perhaps because the craving for liquor is so strong that they are unable to resist the temptation.
Current medical treatment -- as opposed to the traditional 12-step counseling programs exemplified by Alcoholics Anonymous -- relies on a medication called Antabuse. Patients who drink alcohol after taking Antabuse suffer severe nausea and vomiting. The drug serves as "a threat to the patient not to drink, but does nothing to reduce craving," Dr. Gordis said.
Antabuse is a valuable medication for patients who are committed to stopping their drinking, he added, but is of little value for those who are not strongly motivated.
Naltrexone is likely to be viewed as much more desirable by alcoholics because its effects are positive, reducing the craving, rather than negative.
Naltrexone was developed for treating heroin abuse. It targets the same receptors in the brain that produce feelings of pleasure when heroin or other opiates bind to them. Naltrexone also binds to those sites, but does not produce a pleasurable "high." Its action is thus similar to that of methadone, but it is not as potent.
Alcohol does not bind to those receptors in the brain. But recent research suggest that alcohol causes the release of the brain's own endorphins that do bind to those receptors and produce a pleasurable sensation, Dr. Volpicelli said.
He thus reasoned that naltrexone might help in treating alcohol abuse.
Preliminary studies in 1991 hinted that might be the case, but controlled studies in which neither the patient nor the physician knew the medication was being given were necessary to prove it. The new studies to be reported tomorrow appear to accomplish that.
Dr. Volpicelli emphasized that naltrexone is not a cure for alcoholism and that it is not a substitute for 12-step or other recovery programs.
Naltrexone can help tremendously, Dr. Volpicelli said, "but it is essen
tial that recovering alcoholics also undergo a comprehensive treatment program which helps them cope with the social, legal, family, physical and psychological problems that occur as a result of their drinking behavior."