Alcoholism treatment: Drug to fight drug addiction appears to prevent relapse
By A. J. Hostetler - AP (11/92)

Philadelphia - A drug used to fight drug addiction also was found to reduce the craving for alcohol in alcoholics, but scientists cautioned more testing is needed before it is prescribed for that purpose.

Naltrexone also apparently helps keep up to 4 in 5 recovering alcoholics from suffering a relapse, according to two reports in today's Archives of General Psychiatry.

"This is very exciting, very promising work," said Dr. Richard Fuller, director of clinical prevention of the NIAAA. "On the other hand, these are just two studies. I'd be careful about immediately applying the medication. The final word isn't in yet."

The studies also emphasized the drug should not be considered the sole treatment for alcoholism.

Naltrexone, used in combination with behavioral treatment, reduced relapse from 54% to 23%, according to one of the reports.

It blocks release of the brain's pleasure-producing chemicals known as endorphins that produce the "high" alcoholics feel.

Dr. Joseph Volpicelli, a University of PA psychiatrist, said his study found the drug also reduces an alcoholic's craving of a drink.

The findings could immediately affect treatment because naltrexone, manufactured by DuPont Pharma as Trexan in the U.S. and Europe, may be prescribed by doctors for uses other than heroin addiction. Industry sources said the drug's annual sales are less than $15 million.

But Volpicelli agreed with Fuller, saying he would need to study the drug for a few more years before prescribing it to treat alcoholics.

Fuller said long-term studies using more patients were needed. The NIAAA already has funded 3 additional studies, 2 of which will extend the work being published today.

Physicians now use the drug Antabuse to treat recovering alcoholics. The drug causes severe nausea and vomiting when alcoholics drink, but does little to stop the craving.

Volpicelli's study followed 70 male patients in a detoxification unit for 3 months. Patients treated with naltrexone slipped and had a drink about as frequently as patients given a placebo.

But those on naltrexone could stop drinking sooner and fewer had a total relapse.

"Ordinarily, in alcoholics, even one or two drinks stimulates the body's craving for more," Volpicelli said. But with the drug, "the cycle of craving was broken."

In the second study, conducted independently at Yale University, 39% of the patients taking naltrexone relapsed, compared with 79% of those who received just counseling. The study followed 97 patients for 3 months.

Both research groups stressed that the drug by itself was not a cure and must be supplemented.

"The medicine works in conjunction with psychosocial treatment," Volpicelli said. "Medication alone doesn't work."

The findings reinforce the notion that alcoholism has a biological basis and is not a character flaw among its 10.5 million Americans victims, Volpicelli said.

"By showing that some people may be at risk for becoming dependent on alcohol because of their biochemical reaction ... perhaps alcoholics will overcome their shame, come out of hiding and get treatment," Volpicelli said.