We have been investigating new medications that give patients more of a menu to chose from. If one doesn't work then they try another. Alcoholism is a serious problem. The more weapons you have and the more ways you can treat it, the better. —Dr. Raye Litten
A self-described "chronic relapser," Jared, 25, found that after being in and out of rehab, treatment and meetings dozens of times for the last 10 years, something had to change.
He tried everything, with little success, until he came upon a monthly shot that has kept him sober since the first injection four months ago. Rather than making him sick, the medication simply eliminated, or drastically reduced, his cravings.
"It honestly has been a life saver," he said with a hint of emotion in his voice. "Now I'm to the point where I don't even entertain the thought of using."
Jared's "live saver" is a drug called Vivitrol, used by many doctors today to treat serious addictions, including both alcohol and opioid addiction. Jared suffers from an opioid addiction, but the premise for alcohol addiction treatment is the same. Doctors are finding that drugs such as Vivitrol, when combined with other forms of therapy, can be tremendously successful in treating patients suffering from alcoholism. While these new developments are not intended to be a substitute for traditional rehab or therapy such as Alcoholics Anonymous and are not endorsed by all addicts, doctors say they can be a powerful adjunct to treat individual patients more effectively.
Treatment for alcoholism, as well as other addictions, has evolved dramatically over the last few years and ongoing research makes many doctors optimistic they may be able to substantially reduce the prevalence of alcoholism. Some 30 new clinical trials are aimed at developing more advanced treatment and knowledge. With the combination of traditional and advanced treatment, many patients are finding the path to sobriety and realizing a life free of addiction and constant fear of relapse, although no treatment method can be described as universally effective.
Imagine being placed in a "therapeutic community" where therapists hang shovels around your neck and spit demeaning curse words in your direction in conjunction with aggressive confrontation. Chuck Fenigstein, founder of the athlete addiction facility Healing Warriors and the former clinical director for Sundance Center at Journey Healing Centers, described this as an accepted and common way to treat alcoholics and addicts in society 50 or so years ago.
Dr. Ravi Chandiramani, Journey Healing Centers medical director, described past treatments as being very "punitive" and "judgmental" and said treatment today is vastly different.
"People suffering from chemical dependency are not treated as pariahs or outcasts as they used to be," he said. "The trend has been that chemical dependency is viewed as a chronic relapsing and remitting disease process and treatment requires a comprehensive structured approach with individuals requiring professionals that have specialized skill sets as well."
Fenigstein has been at the center of the changing treatment options over the years and said increased knowledge of alcoholism and addictions in general has fostered better treatment, including a shift in the way addicts and their conditions are viewed.
"Today we have such a wide variety of treatments," Fenigstein said. "In the old days we saw people that were addicts and alcoholics and the underlying precipitants that were driving those addictions were not dealt with as much as they are today with a dual diagnosis model. The research is pretty conclusive that when we deal with what is causing the addiction along with the actual disease we are doing a much better job of minimizing the risk of relapse."
Treatment started to change in the early 1970s when more psychiatrists became involved and the treatment field grew, Fenigstein said.
"It became more professionally oriented and licensed," he said. "Early on there were more addicts and alcoholics doing the treatment and the criteria and standards for professional credentials weren't as high."
Today, 18 million Americans still suffer from alcohol-use disorder and 76 million adults suffer worldwide from the condition, said Dr. Raye Litten, health scientist administrator in the National Institute on Alcohol Abuse and Alcoholism's Division of Treatment and Recovery Research. New research is being conducted daily in order to find more effective treatment options for patients suffering from alcoholism. Patients certainly have more options today, and doctors agree that options are a critical component to battling the disease.
"We have been investigating new medications that give patients more of a menu to chose from," he said. "If one doesn't work then they try another. Alcoholism is a serious problem. The more weapons you have and the more ways you can treat it, the better."
He said in addition to about 30 clinical trials being funded now, unique populations such as young adults and those with psychiatric disorders are being critically studied.
"There is a lot of exciting research and activity going on right now," he said. "No single intervention method works for everybody. Alcoholism is not a simple disease so we need to have a combination of treatment for patients."
Currently, there are several FDA-approved medications to treat alcoholism. Their generic names are: Acamprosate calcium, Disulfiram, Naltrexone and Naltrexone. More drugs, such as Baclofen, are being studied and may appear on the market in the near future. While some of these drugs have been around for a while, many patients do not know about them or fear negative repercussions from taking them.
"None of these are what we would call a cure for alcoholism," Litten said. "We are just trying to find out what works for patients and have all the resources we can to treat various populations."
Jared, who is a patient of Dr. Chandiramani, said the regular schedule on which Vivitrol is administered might be as helpful as the drug itself.
Vivitrol is administered by injection once every month. Chandiramani said this type of treatment takes the onus off the patient to comply with taking pills daily.
"The patient is less likely to take a tablet," he said. "This option takes the willpower out of the equation away and makes them more likely to stay in recovery."
Despite the seemingly utopian effects these medications can have for patients like Jared, it should be noted that doctors are not recommending or advertising them as a "cure all."
"These medications are not intended to be a substitute for counseling or rehab," Chandiramani said. "We are looking for medical tools that give us a fighting chance against the disease and that can be used as adjuncts to traditional therapy."
Chandiramani said he does not hesitate to introduce his patients to them, however, because the positive effects seem to overshadow any negative side effects.
"I don't see any reason not to use them," he said. "Anything that I can use to gain an advantage on the disease I will."
While experts strongly recommend addicts work through therapy or 12-step programs like Alcoholics Anonymous, for people like Jared, new treatment options make all the difference.
"I tried everything else including AA meetings but they just weren't for me," Jared recalled. "Those treatments work for a while but they just masked the issue."
What works for you
Committed. Disciplined. Spiritual. Action. Fenigstein, a former alcoholic, used these four words to describe his own recovery process from alcoholism and addictions that have been permeating his life for decades.
As he described growing up in an family of alcoholics at an early age, his voice exuded confidence, passion and an aged wisdom.
"I didn't know it was the alcohol, I thought it was me," he said of his terrible childhood environment. "You think you're doing something wrong or there is something wrong with you. That's where shame develops."
He described being abused by his rabbi, getting involved with alcohol and drugs and even denouncing God. Now, however, those four words have allowed him to stay on a path of sobriety and spiritually and have turned his life around. He said AA meetings were the most helpful in overcoming his addiction.
"I love AA," he said. "It's one of the tools I would never take out of my toolbox. I really committed to that because it was one of the things that worked for me. It's all about what you're looking for."
He said he has tried "every treatment option known to man," but that the AA meetings were clearly most effective. Although he is not closed-minded about the potential benefits of new drug treatments for some patients, the concept was not suited for him.
"AA is not the only way, but statistics have shown that all the therapies combined don't have nearly the success rate that AA has," he said.
Sometimes going through hardships is the best way to fully commit to change, he said.
"I wanted to remember the pain of my own detox so I'd never have to go through it again," he said. "I didn't want a substitute drug to deal with another drug. That doesn't make any sense to me."
For the last eight years or so Fenigstein has spent hours each day practicing prayer meditation and teaching therapeutic practices such as yoga and mindfulness meditation. He now works in a private practice treating professional athletes, including baseball players from the Cincinnati Reds, because he feels a strong connection with them due to his own athletic ability at a young age. The treatment avenues he pursued, through organizations such as Alcoholics Anonymous, have allowed him to create and enjoy his new life of abstinence.
Chandiramani said that while treatment and research have come a long way with new technologies, traditional treatment options such as AA should not be overlooked or devalued.
"The value of organizations like Alcoholics Anonymous is still very much a part of treatment," he said. "But now we have other tools that serve to round out treatments for people. The goal is to expose these patients to as many tools as possible because you never know what is going to stick for somebody."
Future of treatment
As new drugs and treatment options emerge, it may be possible to substantially reduce the number of people suffering from alcoholism worldwide.
"We are optimistic that will happen," Litten said. "But it takes time for these things to happen. We are always looking for something more effective in the future."
One of the potential roadblocks is simply spreading the word that these new types of treatments do exist for patients. Litten said this is one challenge that needs to be met.
"We need to identify why people aren't using this state-of-the-art treatment," he said. "It seems like a lot of people don't know about it, so one of our goals is to get these newer interventions out to the public over the next 10 years."
Two new cocaine vaccines are also in the developmental stage and proved effective when tested on animals. These vaccines could be available to humans within the next few years.
Litten said in the upcoming years even more will be learned about addiction and alcoholism and that the situation should not be looked at as medications versus therapy, but rather as a combined and team effort.
There is definitely a risk-benefit factor when considering these treatment options, Litten said, and some people may suffer side effects more than others. He said researchers are working on providing more individual options for patients, as well as identifying which individuals can tolerate certain medications.
"What we hope to do over the next 10 years is be able to predict what patients will respond to certain types of interventions," he said. "This will allow patients to be treated more effectively."
Every patient is different, but Jared believes if he hadn't been introduced to Vivitrol as an option, he may still be in the cycle of addiction and substance abuse today.
"Vivitrol is the most success I've had by far," Jared said. "It literally removes the option of using."
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