Addiction Treatment Articles

Treating Alcoholism: Can Abstinence Be Replaced with a Pill?

Time magazine poses an important question this week regarding alcoholism treatment: Can a pill replace abstinence? Maia Szalavitz writes that alcoholics who take an anticraving medication called baclofen say the drug allows them to resist powerful relapse triggers such as a favorite bar, former drinking buddies, the sight of alcohol, and even having a single drink

She tells the story of Bob, 62, who battled alcohol dependency for several decades, regularly drinking at least 35 beers per week. Two years ago, after taking baclofen for two weeks, he found himself drinking soda water at a dinner party and, for the first time, not thinking about needing a drink.

“I realized I wasn’t having that nagging feeling in my head, ‘I should really get a drink,'” said Bob. “It never appeared during the dinner either so that was the eureka moment.” He continues to take baclofen and now drinks about two or three times per week, no more than a beer or two at a time.

Dr. Olivier Ameisen had a similar experience, which prompted him to write his memoir The End of My Addiction. A longtime alcoholic, Ameisen had been to rehab at least eight times and had attended nearly 5,000 Alcoholics Anonymous meetings without being able to maintain sobriety.

He began taking baclofen more than five years ago, and has since been able to abstain from drinking altogether. He occasionally drinks moderately in social situations but doesn’t have cravings or other addiction-related problems.

“I never understood how people could leave liquor in a glass,” said Ameisen. “Now you could give me a sip of champagne and I could leave it. That was impossible in my wildest dreams. And it’s effortless. Complete suppression, not reduction of cravings. I’m indifferent to it.”

But despite some anecdotal success, there is little scientific data to support the efficacy of baclofen. Previous animal studies have suggested that it does have a powerful anticraving effect, however, and two large studies are under way. But even if the apparent anti-addiction benefits of the drug—which is currently approved by the government to treat muscle spasms—are proven in human trials, it might do little to persuade most American addiction-treatment providers to use it.

For many people, successful treatment of addiction involves complete abstinence; for some, this includes abstaining from drugs that would help fight cravings. For decades, experts have debated whether drug addicts who cannot or will not quit should even be offered ongoing treatments that would reduce harm related to their drug abuse.

Baclofen might also be able to reduce cravings for nicotine, binge eating, or even heroin or cocaine, because it seems to intercept the drugs at their roots. Researchers think that by binding to the GABA-B receptors in the brain, the brain’s reward system is modulated, preventing the release of excess dopamine (the chemical that creates a sense of euphoria).

But not all research has been conclusive. A recently published multisite trial of the drug in cocaine addicts did not produce significant results, which could be due to the dose, according to Teri Franklin, a professor of neuroscience at the University of Pennsylvania. Franklin noted that most alcoholics who have reported success with the drug tend to take at least 80 mg per day, whereas the cocaine trial used 60 mg.

However, at high doses, baclofen can cause drowsiness and muscle spasms—though Franklin suggests that these side effects can be prevented with gradual exposure. Patients must also be gradually weaned off the medication to avoid muscle problems and anxiety. In addition, it seems that baclofen must be taken indefinitely, since cravings can return once the drug is stopped.

Regardless of the potential success of baclofen, most addiction experts would continue to encourage abstinence. “There are always some patients who can [cut down] to drink small amounts, but they are the exception,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse, which is funding several ongoing trials of baclofen.

Although Volkow thinks baclofen shows promise in helping patients quit drinking altogether, she says the idea of controlled drinking is unwise: “My advice to patients is, don’t risk it.”

Moral Reconation Therapy Helps Inmates with Drug Addiction

When Jeff Smith was 17, he was already an alcoholic and tried heroin for the first time. “It used to take me three hours to get high when I drank. I could do the heroin and be there in three minutes,” he said. When his drug addiction eventually lead him to forgery and he was sentenced to the Shelby County Correction Center in Memphis, TN in 1987, he took part in a new program called MRT, or moral reconation therapy.

At the time, the program wasn’t successful in treating Jeff’s drug problems. When he was released on parole and returned to his old habits, his parents changed their locks to keep him out of their lives. But while Jeff relapsed, the MRT program grew from a pilot program in Shelby County to one that is now used in 47 states and eight countries.

MRT was developed by Memphis psychologists Dr. Greg Little and Dr. Kenneth Robinson, and was first used in 1985 as part of the Shelby County Correction Center’s drug abuse program. Robinson says it is now the most widely used inmate rehab program in the world.

The program was refined into a formal treatment method in 1987, and involves theories from psycholgists Carl Jung, Jean Piaget, and Lawrence Kohlberg. Little and Robinson formed a company called Correctional Counseling, Inc., and states on their website that MRT “seeks to move clients from hedonistic (pleasure vs. pain) reasoning levels to levels where concern for social results and others becomes important.” Put simply, MRT seeks  to make inmates think about the way they make decisions. The term “reconation” comes from the archaic term “conation” and means getting offenders to re-evaluate their choices.

Robinson says most people who experiment with drugs and alcohol are like Jeff Smith, starting in adolescence. “You see those people making poor decisions,” he said. “It changes your ability to live.”

Little says that logic doesn’t apply to offenders. “The bulk of offenders, 60 to 90 percent, have diagnosable antisocial personality disorders, and most people with antisocial personality disorders abuse drugs or alcohol.”

Smith, now 53, says he was a good example of this. When he was on parole, he worked, but mainly to support his drug habit. “I made decisions to do what I wanted to do regardless of consequences. I lost several jobs because of alcohol and drugs,” he said.

After violating parole, Smith was sentenced to another 13 years in prison and was released after 6-and-a-half years. He then enrolled in the Salvation Army Adult Rehabilitation Center and entered MRT group therapy.

“I missed out on 35 years of my life with my family. I had always known the difference in right and wrong, but I didn’t always do right. MRT helps you realize those things are conscious decisions,” Smith said.

When he completed therapy, Smith became an MRT trainer. He now works as a carpenter, furniture refinisher, and antique pricer for the Salvation Army and is living with and helping care for his aging parents.

“MRT is very easy in the beginning,” said Little. “We ask them to buy into the program. Soon, they are slowly swimming upstream. We ask them to stand up and tell what they know is the absolute truth. … It’s that they are liars. We try to have them clear the air by telling us they’re liars.”

After admitting their weaknesses, inmates are then confronted with choices, which grow more and more complex. For example, they may be asked whether it’s right to steal if you can’t afford a prescription for your sick wife who might die without the medication. As they consider their answers, they have to think about the way they make decisions.

Shelby County Sheriff Mark Luttrell says that the MRT program works, but that it doesn’t perform miracles. Standard rates for repeat offenders in the United States are 65-85 percent, and the recidivism rate in Shelby County is about 85 percent. But Little says MRT fares better nationally, with a recidivism rate of 60 percent in the short term and going down to 20 percent after 10 years.