Drug for alcoholism wins praise tempered with skepticism

January 22, 1995|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

The unveiling last week of a drug that blunts the effects of alcohol qualified as a rare strike against the nation's greatest addiction. But the reception among alcoholics and the people who treat them was decidedly sober.

Many in the Baltimore area said there is more to defeating alcoholism than blocking the "buzz" that temporarily calms the nerves and chases bad memories. No pill, they said, can repair the broken egos and personal crises that drive many people to drink in the first place.

"The drug is an available tool, part of a treatment program," said Dr. James P. McGee, director of psychology and addictions programs at Sheppard and Enoch Pratt Hospital in Towson.

"By itself, it isn't going to get people a job, get their spouses back or fix their livers. People may not have the craving to use, but they might make the decision: 'What's the point of staying sober? My life is not improved.' You've got to attack addictions from 50 angles."

The government announced Tuesday that it has given market approval to naltrexone, the first drug in 47 years for the treatment of alcoholism. The Food and Drug Administration endorsed the drug after researchers showed that it significantly cut the relapse rate among alcoholics who had entered experimental treatment programs.

The drug is not new. A decade ago, it was offered to heroin users because of its ability to tie up the brain receptors that ordinarily get stimulated when someone shoots up that drug.

Addicts who used heroin felt nothing as long as they were taking the pill. Most, however, desperately missed the high, so they quit naltrexone and returned to their drug of choice -- heroin.

Despite naltrexone's spotty history with heroin users, researchers noticed a curious thing. Some of the addicts who were also alcoholics seemed to be drinking less.

That chance observation ignited a wave of research into naltrexone's potential against alcoholism.

In separate tests, researchers at Yale University and University of Pennsylvania said alcoholics who had taken naltrexone after going through detoxification stayed sober at much higher rates than did patients given placebos. Both groups took part in therapeutic programs while taking their pills.

The studies lasted three months.

At Penn, 23 percent of the alcoholics treated with naltrexone relapsed into drink, compared with 54 percent of those given placebos. The Yale results also were encouraging: a 39 percent relapse rate among people taking naltrexone, compared with 54 percent among those taking placebos.

For reasons that are not well understood, naltrexone seemed to blunt the craving for alcohol. Also, some people who strayed once or twice while taking naltrexone were able to get sober again because they didn't feel as high when they drank.

A big unknown is whether brief relapses in a short trial are harbingers of heavier drinking later.

One man, a Baltimore lawyer who has been sober for 17 years, said he fears that the treatment carries the dangerous message that alcoholics can afford to get drunk a time or two without risking repercussions.

"They may think, 'Maybe now that I'm taking this, I can take a few drinks and I won't get drunk.' Then, whammo, they're off the wagon and on the whiskey trail again."

Veterans Affairs hospitals also are testing naltrexone on alcoholics. Those results won't be known for many months.

pTC Harry Beckman, an alcoholic for 30 years, said he has been trying to get sober for the last 10. During that time, he failed in at least eight treatment programs at a succession of veterans hospitals.

He managed to stay sober for a few days or weeks but ultimately succumbed to the knotted stomach, the clenched muscles and overwhelming desire that came with abstinence.

Mr. Beckman even tried the drug Anabuse, which induces nausea when combined with alcohol. But he outwitted the therapy by simply waiting for the medication to wear off. Then he drank.

An Air Force veteran who served in Vietnam, Mr. Beckman had spent a decade sleeping in homeless shelters and panhandling for enough change to buy liquor. Nothing worked until he entered a naltrexone study at the Baltimore VA Medical Center last fall. That hospital, like other testing centers, administers the drug in conjunction with therapy and participation in self-help groups.

This time, Mr. Beckman said, the craving for alcohol never surfaced, and he has gone five months without a drink.

"That's just me," said Mr. Beckman, 51, conceding that the drug might not work for others. "I just pray to God for that pill."

In keeping with the methods of the study, he wasn't told whether he was taking naltrexone or a placebo during the three months he participated. He won't be told until researchers treat a total of 50 patients and compute the results.

But the transformation was so clear that his VA physician, Dr. Joseph Liberto, decided to give him the labeled drug, naltrexone, indefinitely.

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