Many Docs Treating Alcohol Problems Overlook Successful Drugs

Naltrexone and acamprosate should be used more often, panel says

Officials at the National Institute of Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, have suggested that two often-overlooked medications might offer some relief to the millions of Americans with alcohol-abuse problems, according to a report from Kaiser Health News.

More than 18 million people in the U.S. abuse or are dependent on alcohol, and yet a study funded by the federal government reported last year that only 20% will receive treatment. In fact, the study showed that only about one million people with alcohol problems will seek any kind of help, ranging from a meeting with a counselor or a doctor to entering a specialized treatment program.

The NIAAA has formed a branch dedicated to the development of medications and is supporting trials of drugs to give patients and doctors more options. The NIAAA and the Substance Abuse and Mental Health Services Administration also asked a panel of outside experts to report last summer on drug options.

“Current evidence shows that medications are underused in the treatment of alcohol use disorder, including alcohol abuse and dependence,” the panel reported. It noted that although public health officials and the American Medical Association say dependence on alcohol is a medical problem, there continues to be “considerable resistance” among doctors to a medical approach.

Naltrexone and acamprosate are the two drugs on the market for patients with alcohol cravings. A 2014 analysis in the Journal of the American Medical Association of past studies found that both drugs “were associated with [a] reduction in return to drinking.”

Naltrexone, which is also used to help treat opiate addiction, comes in both an oral form (Revia, Duramed Pharmaceuticals) and an injectable form (Vivitrol, Alkermes, Inc.), and has few adverse effects. It was approved for use in patients with alcohol addiction in 1994. Patients who drink while taking naltrexone get drunk without the opioid-induced reward to reinforce the behavior. The absence of this reward makes drinking less appealing in the future.

Acamprosate (Campral, Allergan) was approved in 2004 to maintain abstinence from alcohol and is available as a tablet.

A third drug is also available, but it doesn’t work against alcohol cravings. Disulfiram (Antabuse, Odyssey Pharmaceuticals) makes people violently ill when they consume alcohol. It was found to be less effective than naltrexone or acamprosate in helping stem alcohol abuse.

When naltrexone came on the market, sales teams had trouble explaining how the drug worked differently than disulfiram to the nonphysician administrators who made treatment decisions in addiction clinics.

Source: Kaiser Health News; October 3, 2016.