Treatment for alcoholism by family doctors may be the coming thing as a result of new drugs that claim to reduce the craving for alcohol. But although the new drugs show promise in helping some drinkers stay off the bottle, alcoholics will just be trading one substance for another unless they add some form of therapeutic alcohol rehab into the mix.
According to a recent article in the Journal of the American Medical Association, a growing number of the nation’s 337,000 general-practice physicians are being recruited and trained in the use of the new drugs. What they aren’t being trained in – and would scarcely have the time for anyway – is the in-depth treatment offered by traditional alcohol rehab programs that dig for the source of addiction and a permanent cure. The new drugs, including naltrexone, topiramate and others, aren’t a cure: They would have to continue to be taken to ward off the uncontrollable need for alcohol.
Naltrexone received Food and Drug Administration (FDA) approval as a monthly injectable dose for alcohol addiction nearly a year ago. Named Vivitrol, it’s been around for many years in pill form and already is used as an adjunct to medical Drug and Alcohol Rehab detox. In drug detox settings it’s used only for short periods of time – enough to help addicts through the uncomfortable withdrawal process – after which it is expected that patients seek full recovery in an alcohol rehab program.
The new monthly naltrexone formulation can be started after only four days of abstinence from drinking, and is said to cause less discomfort, such as nausea, than when taken in pill form every day. The long-lasting monthly injection makes it easier to stay on the drug – although having to continually take a drug to stop alcohol cravings is not a replacement for real alcohol rehab that will enable the person to end their addiction.
The anticonvulsive drug topiramate does not have FDA approval for treating alcohol addiction, but it has been widely prescribed off-label to help alcoholics curb their drinking. Like naltrexone, topiramate must continue to be prescribed and taken without fail to help the alcoholic stay on the wagon. And also like naltrexone, this drug offers hope that alcoholics, encouraged by their family doctor, will find their way into alcohol rehab and eventually to a life free of both alcohol and the need for the drug.
Family physicians do offer promise as a conduit towards alcohol rehab programs by convincing alcoholic patients that they need to address their drinking problems. Having a doctor discuss the seriousness of the situation, perhaps pointing out the dangers of permanent brain and liver damage, could help motivate drinkers to seek alcohol rehab more successfully than friends and family members – people for whom most committed drinkers have built up elaborate and often impenetrable excuses and justifications.
But several drawbacks exist that are making doctors a little reluctant to add alcohol addiction treatment to their already busy day. Bringing up the subject of a patient’s drinking and their need for alcohol rehab could be difficult if the patient is in the office for a check-up or some minor illness. Of course if the patient is seeking treatment for a condition related to alcohol addiction the subject is already on the table, so to speak.
Doctors also know that simply handing out a new drug does not replace alcohol rehab and counseling. Hiring counselors and turning a family practice into an alcohol rehab center is not the career path most family physicians have chosen. And until insurance companies decide to cover the somewhat expensive drugs, and pay doctors for treating alcoholism in their offices, the financial drawback remains a major hurdle for both doctors and patients.