April is Alcohol Awareness Month, a time to reflect on the perils of alcohol addiction and the pathways to recovery. As we close out the month, perhaps the occasion has sparked just a little more discussion and determination around seeking treatment.
But one thing is for certain, this month and every month: few people are discussing one of the most effective forms of treating alcoholism.
Why is evidence-based medication treatment for alcoholism such a well-kept secret, something that people suffering from alcohol addiction seldom hear, doctors rarely discuss, and the recovery community usually overlooks?
For those of us in the medication treatment community, it’s an ongoing question.
Alcohol addiction, like opioid addiction, is a chronic brain disease, making it a primary health problem. Two FDA-approved medications, naltrexone and Antabuse, have shown success in helping patients maintain sobriety, whether in concert with counseling or sometimes even on their own. Every patient journey with addiction is different, but medication can have a clear positive effect.
And yet the public consciousness hasn’t been awakened to the medical options for treating alcoholism, because the conversation around treatment has been owned for so many years by traditional counseling alone.
So let’s shift the conversation for a moment.
Medication treatment for opioid vs. alcohol addiction
Evidence-based medication has gained widespread advocacy, if not widespread acceptance, as the standard of care to treat opioid addiction. The Substance Abuse and Mental Health Administration (SAMHSA) recently issued new guidance on treating Opioid Use Disorder (OUD), stating that “It is not sound medical practice to deny people with OUD access to FDA-approved medications for their illness.” Health and Human Services Secretary Alex Azar told the National Governors Association that not offering medication treatment is like "trying to treat an infection without antibiotics."
A recent article in US. News and World Report noted that there’s now rare bipartisan consensus that the use of medication to treat opioid addiction must be expanded. The 2018 spending bill provides $1 billion for opioid crisis grants to states, with requirements that states increase use of treatment supported by clinical evidence, including medications. As Tom Hill, of the National Council for Behavioral Health, put it to U.S. News, "The government is talking about treatment and medication-assisted treatment in a way that the government has never done before.”
But why does the medication conversation stop when it comes to alcohol? This despite the fact that the efficacy of medication to treat alcohol addiction - like opioid addiction - has been long proven.
How medication for alcohol addiction works
My company, CleanSlate, prescribes naltrexone (Vivitrol) to patients suffering from Alcohol Use Disorder (AUD). This medication treats alcohol addiction in three ways:
- It eliminates the “high” that comes with alcohol use and lessens cravings for alcohol.
- It guards against relapse.
- It lessens the number of times that alcohol is consumed and the amount of alcohol consumed in people who take it.
- It helps people have more success in remaining alcohol free.
An alternative medication, Antabuse, is a daily medication that has proven effective to keep people from using alcohol by creating a toxic reaction to alcohol. In short, patients become sick when drinking alcohol.
Both medications can play a significant role in helping patients quit drinking or cut back on their consumption. Public health officials are encouraging physicians to consider medication to treat alcohol addiction. "We want people to understand we think AA is wonderful, but there are other options," George Koob, director of the National Institute of Alcohol Abuse and Alcoholism, told NPR. The NIAAA is a part of the federal National Institutes of Health.
Alcoholism: the bigger epidemic
While we don’t use the term “epidemic” to describe the toll of alcohol addiction, it’s a much costlier addiction for society than opioid addiction.
In 2016, statistics show that 42,000 deaths were attributed to overdoses from opioids. But 88,000 deaths are attributed to alcoholism each year, making it the third leading lifestyle-related cause of death in America, according to the National Institute on Alcohol Abuse and Alcoholism.
The societal impact of alcohol addiction is staggering:
- Alcohol is the most commonly used addictive substance in America
- One in every 12 adults suffers from alcohol abuse or dependence, not counting the many who engage in risky, binge drinking patterns
- More than half of all adults have a family history of alcoholism or problem drinking
- More than 7 million children live in a household where at least one parent is dependent on or has abused alcohol
- Up to 40% of all hospital beds in the U.S. (except for those being used by maternity and intensive care patients) are being used to treat health conditions related to alcohol consumption
According to the 2014 World Cancer Report (WCR), issued by the World Health Organization's International Agency for Research on Cancer (IARC), no amount of alcohol is safe. Increased alcohol consumption directly correlates with an increased cancer risk; one in every 20 cancers is related to alcohol use.
By the time consumption levels reach the stage of heavy drinking or binge drinking, the health and social risks are myriad, both to the individual, their families and the public. This includes unborn children, who are subject to fetal alcohol syndrome disorder. A recent Canadian study found that fetal alcohol syndrome is more prevalent than previously thought, and may even be more common than autism.
It works if you work it
One of the mantras of Alcoholics Anonymous - “It works if you work it” - encourages individuals to honor the path that is most effective for their own recovery and to stay committed. But in order to do this, patients need to understand all of their options.
Medication must become a part of the discussion with patients so that they have the opportunity to choose this pathway of recovery. That means that all of us - health providers, political leaders, insurers, community stakeholders, and friends and family members - need to expand the conversation with those suffering from alcohol addiction to include medication that has been specifically designed to treat their disease.
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