Drugs to help quit drinking?
But despite such high stakes for alcoholism, alcohol abuse or other alcohol use disorders (AUDs), experts say medications that could help curb drinking are "considerably underused."
"Most people with alcohol use disorders aren't getting any treatment, and only about 10 percent are getting a medication as part of their treatment," said researcher Dr. Daniel Jonas, an assistant professor of medicine at the University of North Carolina at Chapel Hill in a new study that finds that several drugs can help curb the desire to drink alcohol.
The report was published May 14 in the Journal of the American Medical Association. The US Agency for Healthcare Research and Quality funded the research.
Researchers included more than 120 trials assessing the three drugs approved by the US Food and Drug Administration for alcoholism as well as almost two dozen medicines cleared for other illnesses but used "off label" to treat alcoholics. In the studies, patients received counseling along with either the study drug or a placebo. The majority of the studies assessed naltrexone and acamprosate.
Naltrexone, a generic medicine, acamprosate, sold under the brand name Campral by Forest Laboratories Inc., Johnson & Johnson's seizure medicine Topamax and H. Lundbeck A/S's Selincro, helped alcoholics reduce their drinking, an analysis of more than 120 studies found. The oldest US-approved alcoholism drug -disulfiram, also known as Antabuse - didn't prevent a return to drinking, according to the research in the Journal of the American Medical Association.
Acamprosate (Campral ) and naltrexone ( Revia ), along with support from groups such as Alcoholics Anonymous or psychological counseling, can be useful tools to help people stay away from alcohol, the review authors report.
Two other drugs, nalmefene (Selincro) and topiramate ( Topamax ) also can help patients stop drinking, Dr Jonas said. Nalmefene is approved for pain relief and topiramate is approved to prevent seizures, but they are also used "off-label" to treat alcohol abuse.
Naltrexone interrupts the high of drinking, while acamprosate helps reduce the physical and emotional discomfort felt after a patient stops drinking. Doctors wrote 335,000 prescriptions for naltrexone last year, and 132,000 for acamprosate, according to data compiled by Bloomberg.
Disulfiram, the drug the study found to be ineffective, generated the second highest-prescriptions at 178,000 last year. Disulfiram makes people sick when they drink so it is difficult to test against a placebo or in randomized trials, the researchers said.
Selincro, known also as nalmefene, works by blocking brain signals that make activities such as sex and drinking feel good. The medicine isn't sold in the US Topamax, which isn't approved to treat alcoholism, may restore balance in the levels of chemicals released in the brain that are affected by alcoholism.
The research found that Vivitrol, an injectable form of naltrexone by Alkermes Plc,reduced on average a patient's heavy drinking days, but the evidence was insufficient because there weren't enough studies.
For the new review, Jonas' team reviewed 122 studies that evaluated acamprosate, naltrexone or both. The researchers then calculated the number of people who would have to be treated with a drug to see the benefit in a single patient.
The researchers found that 12 patients would have to be given acamprosate to see a benefit from the drug in one patient. For naltrexone, it would be 20 patients.
There haven't been any head-to-head trials to see if one drug is more effective than the other, Jonas said.
Part of the reason these medications aren't used that much is that doctors aren't sure there are drugs that work, Jonas said. "But we do have treatments that work, and we should be using them more than we are," he added.
Jonas noted that these drugs should be used along with other treatments.
"We don't know if they should be used alone. They are always studied in conjunction with a psychological intervention, whether it's AA or cognitive behavioral therapy. The standard of care is that everyone should do one of those things and then you would add medication," he said. "When you add medication, you get added benefit."
Dr. Katharine Bradley, a senior investigator at the Group Health Research Institute in Seattle and co-author of an accompanying journal editorial, said several effective medications are available to treat alcohol use disorders.
However, these medications are often not offered to patients seeking treatment for these disorders, she said.
Unlike the older medications for alcohol abuse, these newer drugs don't make people ill if they drink, Bradley explained.
"Instead, newer effective medications for alcohol use disorders address the underlying biology of addiction to alcohol, and make people less likely to drink or less likely to drink heavily if they do drink," she said.
Patients fighting alcoholism should expect, or ask, for information about medications that could help them in their battle, Bradley said.
"The decision of which alcohol treatment to choose should be the result of discussions between patients and their clinicians that take into account patient values, preferences and goals," she said.
About 18 million Americans suffer from alcohol dependence or alcohol abuse, according to the National Institutes of Health. Yet only about a third of alcoholics receive any treatment for their condition and less than 10 percent get medications, said Daniel Jonas.
The drugs "are not used as much as they potentially could," said Jonas. "Historically, that's because of the uncertainty over whether they work. People with alcohol use disorders have serious problems. They need help and they are often not getting help. One piece of the treatment is these medicines."
Katharine Bradley said the four effective treatments for people with alcohol use disorders should be used along with counseling and other support to aid recovery.
"We have effective medications for alcohol use disorders," Bradley, a senior investigator at Group Health Research Institute in Seattle, said in a telephone interview. "Doctors should start prescribing these medications."
However future studies need to look at how long patients need to stay on these treatments for them to be effective, researchers say.