Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Wednesday, May 23, 2012
A Pill for Alcoholism?
When I was at APA earlier this month, I heard an excellent talk by Dr. Bankole Johnson on the treatment of alcoholism. I'm currently reading a book called Hooked, by Lonny Shavelson, about an effort by the San Francisco Department of Health to provide drug-treatment-on-demand to all comers in 1998. The book, a great read even if it is a bit out-of-date, talks about how drug treatment gets divided into camps of those who insist on total abstinence versus those who will settle for a decrease in use as part of the "harm reduction" model. Dr. Bankole made the point that if you look at total abstinence for alcohol, the numbers are low and one could get very discouraged trying to treat alcoholics. And he is all in favor of trying medications to reduce craving for alcohol. Which brings me to an article in the NYTimes by Douglas Quenqua called "Drugs Help Tailor Alcoholism Treatment." So Dr. Johnson is quoted in this article, and since I enjoyed his talk, I'll mention the article. It talks about medications that help some people with their cravings-- both on label and off label-- and the question of using a pill to treat an addiction.
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The problem with harm reduction occurs the first time you see a person in their twenties being treated with a harm reduction model. The second problem is when you see a person of any age and they are being treated with a harm reduction model and they are continuing to drink a fifth a day. I think it is a common mistake to think that abstinence based programs stop being helpful if you are not sober. Abstinence and 12 step based programs assume that alcoholism is a progressive disease and they continue to offer hope. They are also compatible with pharmacotherapy that is approved based on both abstinence and a reduced number of days drinking.
I took out my sentence about believing that Bankole Johnson is in the Harm Reduction camp. I don't know that, I just assumed from the either-or nature. He didn't not talk about people drinking a fifth a day as success, but rather as going from drinking a tremendous amount to cutting back to a beer a day. I'm not sure I've seen anyone do that consistently, but I have seen people cut way back, and I've seen people with serious drug addictions go longer between episodes of relapse, and have relapses for much shorter periods of time with many fewer consequences.
There were several people who drank heavily in my family, including my father. He did get sober over 20 years ago (Definitely proud!), it did have an affect on me and my family. If something keeps a person alive, keeps a family together, keeps a kid out of foster care - I am all for it.
People with any other diagnosis, mental or not, have treatment options. Some are more evidenced-based, some are more experimental, and some don't plain work. The wishes of the person with the diagnosis should be taken into extreme consideration when providing a treatment program - some may want a drug-free detox, some may want a medication, some may prefer individual therapy only, some may want a 12 step program, some may prefer Rational Recovery, some want harm reduction, whatever. We are dealing with a human being, and putting control into the hands of the person whenever possible works pretty well in a lot of circumstances.
The brain is pretty complex, as well as the recovery process. I am glad there is research going into this, provided people are strongly encouraged to engage in psychosocial sorts of treatments (and of course make sure insurance companies cough up for therapy bills).
Thanks to Dr. Dawson for mentioning 12-step programs. I'm not up on this literature, but from what I recall from med school, and from my personal experience from family and acquaintances in "The Program", AA has been phenomenally successful. What's wrong with it, not biological enough?
If you're going to argue it has biological underpinnings, then what's the problem with treating it chemically?
seriously. shrinks need to get off their high horses.
Do you have a ladder with lots of rungs? Those horses are jacked up.
coolest book i read recently about alcohol recovery was "lit" by mary karr... i actually used it in my sermon last week. have any of you all read it?
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