However, this approach requires a substantial change from the abstinence-only philosophy that goes back at least as far as Prohibition. Naltrexone is most effective, says Volpicelli, in a treatment program "designed to support the notion that while one drink is not great, what you really want to stop is excessive drinking."
While few professionals advise people with alcoholism to abandon the ultimate goal of total abstinence, Volpicelli argues that about 20 million Americans suffer from alcohol abuse disorders, yet only about 2 million are in any kind of treatment program. "We should be flexible enough to get at that 90 percent of people who aren't in treatment," he says.
The U.S. Substance Abuse and Mental Health Services Administration agrees in its naltrexone treatment protocol, saying, "Abstinence should be a desired goal for the patient; however, reductions in drinking may be an acceptable intermediate outcome because there are many other areas of a patient's life that can improve, such as job performance, social relationships, and general physical health."
Although naltrexone (ReVia) has been available for more than 10 years, Volpicelli says it has been poorly marketed, and most patients and primary care doctors remain unaware of its potential. That may change now that the manufacturer of acamprosate (Campral) has embarked on a campaign to promote pharmacological treatment of alcohol addiction.
Review author Srisurapanont notes that the availability of both medicines now gives patients an alternative if one is not effective for them. And, he adds, the possible benefits of using the medications in combination should be studied. The review also notes that other areas ripe for future study include the pos
'"/>
Contact: Manit Srisurapanont
66-53-945-422
Center for the Advancement of Health
17-Feb-2005