Meds a good 'first step' for treating alcoholism

Two drugs commonly used to treat alcoholism may be appropriate
for people in different stages of recovery, a new analysis confirms -
likely because they work differently in the brain.

The drugs, acamprosate (marketed as Campral) and naltrexone (ReVia),
are both non-addictive themselves and don't make users sick when mixed
with alcohol. So they're a good first option for people struggling with
alcohol dependence who are motivated to stop drinking but would like to
avoid an inpatient program, researchers said.

In a new analysis of 64 trials evaluating the two medications,
researchers from California found acamprosate was more effective at
helping people who were not currently drinking stay sober. Naltrexone
had the advantage when it came to cutting back on heavy drinking and
helping recovering alcoholics avoid cravings.

All of the trials randomly assigned participants to take one of the
drugs or a placebo pill, with drinkers typically also attending therapy
sessions. They included about 11,000 people in total.

Both acamprosate and naltrexone tended to work better when study
subjects had stayed away from alcohol for at least a few days before
starting the drug trials, or had been through a detox program.

Natalya Maisel from the VA Palo Alto Health Care System in Menlo
Park, California, and her colleagues calculated that eight people
dependent on alcohol would need to be treated with acamprosate for one
additional person to quit drinking. Nine would need to take naltrexone
to keep one from returning to heavy drinking, the researchers reported
in the journal Addiction.

The findings make sense to addiction specialists given how each drug
acts on the brain, according to Dr. Raymond Anton, head of the Center
for Drug & Alcohol Programs at the Medical University of South
Carolina in Charleston.

Acamprosate is known to calm brain activity in general, so it can
stabilize a brain that gets out of sorts when an alcoholic stops
drinking. But if people start drinking again while on acamprosate, it
probably won't help keep their cravings down, he added.

Naltrexone, Anton said, works on the brain's reward and reinforcement
system - so if people were to drink while on the drug, it would block
some of the positive feelings produced by alcohol and keep them from
overdoing it.

"It stops a slip from becoming a relapse," he said. Naltrexone can
also help alcoholics in recovery avoid giving in to cues, like when they
drive past a liquor store, according to Anton, who wasn't involved in
the new study.

Maisel's team noted that most of the trials of both acamprosate and
naltrexone used in the analysis were only a few months long - and there
is "a paucity of information in the literature regarding how long the
benefits of these medications last after treatment," the researchers
said.

Anton said both drugs could be a useful "first step" in addressing
problem drinking when paired with therapy - especially for people who
are hesitant to seek care because of the time and money involved in
intensive treatment. They should talk with their doctors about
medication options, he said.

Generic acamprosate costs $40 to $90 for a one-month supply. Naltrexone runs closer to $100 per month.

"People should realize that there are alternative treatments that are
useful for them while they continue in their normal work and family,
that they don't necessarily have to go into a 30-day treatment center to
get treatment for alcohol," Anton told Reuters Health.

"If it doesn't work, you can always think about rehab or inpatient treatment later on."

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