More Effective Alcoholism Treatment

New research is fundamentally changing our understanding of both addiction and recovery. Dozens of new alcoholism medications are in preclinical or clinical testing; many of them target novel pathways, such as the exaggerated stress response that both humans and animals develop under the influence of alcohol addiction, an amped up version of the typical release of adrenaline and other chemicals when we perceive a threat.

But neither new treatments nor existing drugs are making their way to enough patients, says Mark Willenbring, director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism. An antirelapse drug called naltrexone, for example, was approved in the 1990s but is prescribed for only about four percent of those with alcohol dependence. It blocks the brain's reward mechanisms, which are often triggered by drinking.

Willenbring is promoting a new system, in which patients are treated by their primary-care doctors in office visits. He says this model will appeal to people who either don't want or don't need lengthy counseling or inpatient programs. Willenbring spoke with Technology Review about what works in treating alcohol addiction.

TR: What's the biggest problem with the treatments for alcohol dependence available today?

MW: The number-one problem is that so few people with alcohol dependence actually get treatment. Over the lifetime, it's probably fewer than 10 percent.

TR: Why so few?

MW: Most people say they don't need treatment, or that they can handle it on their own.

Part of the reason for that is the interaction between the treatment system and the perceived need for treatment. For example, if the only treatment for depression is to be hospitalized when seriously depressed and to undergo electroconvulsive therapy, that's a high threshold. Most of us would have to be really badly off to go get that. But if treatment meant getting a prescription from your family doctor, that's a much lower threshold. Before that [became available], very few people with depression got treatment, because the treatment was so draconian.

The treatment system we currently have [for alcohol dependence] is separated from mainstream health care and mainstream mental-health care. It was devised in 1975, when all we had for treatment was basically group counseling and AA. So when people think about getting treatment for drinking, they envision going somewhere like the Betty Ford Center.

That system has three main problems: First, most people don't want it; they have to be forced into it. The second problem is that patients within the general health and mental-health system are not getting located or treated. Third, because the programs are built around counseling, they are not staffed by medical personnel. So there's no one there to talk about medications available for treating alcohol dependence. And a lot of counselors don't really believe in [medication].

Consequently, the new treatments we're developing are not being implemented. Try finding a doctor who knows how to prescribe naltrexone for alcohol dependence. They're very hard to find.