Shortcuts to Recovery - Page 2

By Jeanene Swanson 12/01/14

A survey of four medical treatments to aid recovery.

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Vivitrol

Vivitrol is a long-acting (30-day) injectable form of naltrexone that has been approved only recently: in 2006 for treating alcohol addiction, and in 2010 for opioid addiction. Naltrexone, on the other hand, was first approved for treating opioid addiction in 1984—10 years before it was approved to treat alcoholism. Both work by blocking opioid receptors in the brain and preventing the high.

There is little evidence base to prove the efficacy of Vivitrol for alcohol use disorders so far, according to the Cochrane review, and the drug is whoppingly expensive compared to the oral form (try $1100 a month, compared to $11).

Anton, who worked on the multi-site clinical trial that led to its approval, wonders whether it will be an actual improvement over naltrexone. “The main advantage of Vivitrol is compliance,” he says. “An injection means that people have the drug on board,” and they can’t just skip a day when they want to drink. The drawbacks, however, are plentiful: “It’s an injection and a lot of people don’t want to go through that; a lot of people who treat alcoholics are not set up to give injections; some primary care doctors don’t feel comfortable treating alcoholism—it’s a major cultural practice hurdle to get over.” Combine that with its expense, and the “update [to naltrexone] wasn’t all that great,” Anton says.

O’Brien mentioned a study he co-authored treating parolees with long-acting naltrexone as a way to prevent relapse—at least in the first six months. What happens after, especially without any formal treatment as usual, who knows? “That’s a quick fix to opiate overdoses,” O’Brien says. “Unfortunately they can go back and get re-addicted. At least for the first six months, they’re safe.”

Sinclair Method

The Sinclair Method, developed by Dr. David Sinclair in Finland, uses naltrexone in a targeted way: patients don’t have to be sober while on it, and they are instructed to take it only prior to drinking, not continuously. According to two studies he published in 2001, targeted use of naltrexone was much more effective in reducing the amount of drinking than giving alcoholics naltrexone daily and telling them to abstain—which he found was ineffective, even with counseling. In Europe, nalmefene, which is similar to but not exactly the same as naltrexone, is being marketed as a targeted use therapy—meaning, it can be used as needed if the patient thinks there is a risk of drinking.

Most of the clinicians interviewed for this story had mixed opinions on this method. Anton says he doesn’t necessarily believe that you have to drink on naltrexone for it to work. It might work best for people who only drink two or three days a week, or only binge drink on the weekends. “Most of the people that we see presenting for treatment are not those kind of people,” he says. “It doesn’t work for the vast majority of treatment.”

It’s more of a harm reduction tool, and that strikes a bad chord in some people—especially among the abstinence-only crowd. Mooney says she doesn’t use it, but that it can be effective in reducing the risks associated with heavy drinking. It can be an effective tool, if the goal is to cut back or moderate. With nalmefene in Europe, O’Brien says, “They don’t have the goal of total abstinence. If they go from being very heavy drinkers to moderate drinkers, the whole system saves money.”

Rapid/ultra-rapid detox

Most interviewed said this was an expensive and unproven way to get clean, relative to the side effects, cost, and implications for maintaining long-term sobriety. The principle is to induce rapid withdrawal from opioids while the patient is under general anesthesia—essentially eliminating the experience of withdrawal symptoms. The procedure is typically followed by oral naltrexone which may or may not be effective, depending on how prone the patient is to relapsing.

Aside from the questionable safety of this method, as well as the expense—it can be 10 times more expensive than conventional detox methods—its efficacy for preventing relapse in the long-term is nonexistent. “Studies have shown that this method is associated with medical risks and consequences, but not associated with better outcomes,” Mooney says. “I’ve never seen anybody go through it,” Anton says. “Theoretically, it might have some appeal, [but] I would be very doubtful that it would be effective in the long-term.”

Jeanene Swanson is a regular contributor to The Fix. She last wrote about substituting addictions and addiction among Hispanics.

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Jeanene Swanson is a science journalist who specializes in mental health and addiction. As a science writer with a background in biotechnology, she enjoys turning complex subjects into stories that everyone can understand—and apply to their lives. You can find Jeanene on Linkedin.