Addictions & Answers: Controlled drinking meds for alcoholics -- miracle drug or denial in a bottle?

BILL: Dave, you heard about this new drug, Nalmefene? Supposed to block brain signals that makes drinking feel good? The promise is that it can curb a drunk's urge to order another after s/he's had that barrier-breaking first shot?

DR. DAVE: "Nalmefene is aimed at reducing consumption without the abstinence that Alcoholics Anonymous and other treatment programs say is necessary," says Adron Harris, director of the University of Texas at Austin's Waggoner Center for Alcohol & Addiction Research . "This less-strict approach may drive more abusers to seek treatment for the first time."

BILL: Drunks like to say booze fills the hole in your belly. I think it's a hole in your heart and soul. How does a chemical fill that?

DR. DAVE: The actual hole that Nalmafene research does fill is the craving among a small group of scientists to develop a path to controlled drinking for alcoholics.

BILL: Where I agree with Adron Harris is that the notion of complete abstinence is so scary it does keep many a drunk from seeking treatment. Why are you so dead set against that?

DR. DAVE: Experience tells me a return to controlled drinking is the holy grail of virtually every alcoholic. The unstated promise behind Nalmafene is maybe you don't have to stop drinking at all. Listen, Bill, are you having a bit of longing yourself for some pill that would allow you to have that "occasional drink or two?"

BILL: Doc, is that what you hear in my interest in Nalmefene? The siren call of relapse? To dance once more with three martinis on the other side of the moon?

DR. DAVE: What I don't like is that Nalmefene's false promise undermines work on medications that actually do support a more comfortable abstinence.

BILL: Such as Naltrexone and Acomprosate?

DR.DAVE: Both already approved by the FDA to alleviate cravings.

BILL: I remember going through bouts of depression in rehab – a feeling I had to have a drink right now or die. One of those proven suppressants would have made it a lot easier to pay attention to aftercare group counseling sessions.

DR. DAVE: And that's where the new advances in medication are at their best! In fact, even in good Minnesota Model treatment programs we see rates of recovery in depressed alcoholics hovering around 30%. Add Naltrexone and a common non-abusable anti-depressant, Zoloft, to the treatment and those research rates jump up above 50%.

BILL: Whoa Doc—aren't you back to pushing pills rather than treatment? Instead of weeks in rehab, wouldn't the temptation be to just go get a prescription from your family doc?

DR. DAVE: The statistics are that doctors who mistakenly prescribe just anti-depressant medication to improve the symptoms of alcoholism are actually choosing the least effective course of treatment.

BILL: We've certainly seen a lot of celebs who actually died trying to find a chemical way out of their alcoholism or addiction—Corey Haim, Anna Nicole Smith, Judy Garland and the pinnacles of old time rock and roll—Janis Joplin and Jimi Hendrix.

DR. DAVE: Its called Combined Drug Intoxication, or CDI, and it comes from trying to mix drugs to "get a better high" without so many negative side effects...

BILL: What you are saying is that drugs like Nalmafene could actually be called "Denial in a Bottle?"

DR. DAVE: If family physicians reading us want to see the different medications that can be legitimately used to support an abstinence-based alcoholism recovery, they can go to this medication web site.

BILL: Run by the American Academy of Family Physicians, right? Dave, I have to tell you though, that with the holidays coming to an end, the research I'd like to see would be for those infomercial favorites--Fat Burner pills, followed by two tablets of Exercise-in-a-Bottle. Now, if there had been one to evaporate the contents of a full bladder, I would never have to leave the couch!

DR. DAVE: Well Bill, we've run out of space today; but I'll be glad to reserve next week's column for medication and eating disorders—just in time for your New Years' Resolutions.

Dr. David Moore is a licensed psychologist and chemical dependency professional who is a graduate school faculty member at Argosy University's Seattle Campus. Bill Manville is a Book of the Month novelist; his most recent work of non-fiction, "Cool, Hip & Sober," is available at online bookstores. Bill also teaches "Writing To Get Published" for Temple University