Friday, April 24th, 2009
One of my most memorable patients was a middle-aged man named Mike who came to treatment for his third drinking and driving offense. At the time, I was a young intern just learning how to connect with patients. He sat down in my office and before I could even begin my customary introduction to the clinic, he proceeded to tell me that I could not possibly have anything to offer him. During the last decade his wealthy parents had invested over 150K in the nations most prestigious alcohol treatment programs, and none of them had helped him. “Nothing against you,” he said dismissively, “but you’re an intern. Just tell me what I need to do to get out of here.”
I may have been an intern, but I was already deeply engrossed in understanding how science and research could inform my clinical work. My internship took place at a community-based treatment program which was part of a large university teaching hospital. On days where my patient load was light, I headed for the library and read the latest addiction journals. The year was 1997 and my curiosity led me to a facinating medication called naltrexone that had been used for a number of years to treat opiate addiction, but was now approved for the treatment of alcohol dependence. The only other drug available at the time was Antabuse (disulfiram) that caused sickness when alcohol was ingested. Most of the studies I read about naltrexone suggested that when combined with psychosocial therapies, outcomes were significantly improved.
As Mike sat there in front of me, half expecting that his deep resevoir of treatment experience would get him off the hook, I said flatly “how did naltrexone work for you?” At first he looked at me quizzically, but then quickly became more serious and said, “Oh yea, that stuff…I tried it but was still able to drink on it.” Calmly I replied, “I think you mean Antabuse. No, I am talking about naltrexone, the medication approved by the FDA a few years ago to treat alcoholism.” Now he really looked confused. “You’re shitting me aren’t you? If there was a new drug that would help me stop drinking don’t you think I would have heard about?” he said with frustration. I too was actually amazed that despite all the treatment episodes this guy had been through, and the fact that he had done time at some of the best in the country, that he would have heard about naltrexone. But he hadn’t. I went to my file cabinet and began pulling out journal articles to make my case. By the end of the session we had arranged an appointment for him to see our psychiatrist for a trial of naltrexone, and I was no longer just an intern in his eyes.
I would like to say that more than ten years later things have dramatically changed and addiction medications are well known and used appropriately in treatment programs across the country. But sadly, many who struggle with addiction still have no clue that a handful of powerful medicines have been approved by the FDA. My doctoral dissertation explored this topic in some detail, but if you want to skip to the chase I have also extracted the section that provides an overview of these medicines. Recently, Dr. Gupta from CNN interviewed a man who experienced success with naltrexone. The interview is short and worth watching.
Although I strongly believe those who struggle with addiction should be made aware of addiction medications and decide for themselves whether to try them, let me be crystal clear that no medication will solve the problem of addiction. As I have discussed in other blog posts, addiction ultimately is about relationships. Medications can help manage cravings and decrease relapse so that therapy can more successfully focus on the developmental catch-up work necessary for long-term success.