NALTREXONE IS ALTERNATIVE TO ALCOHOLISM. WHY IS IT SO LITTLE USED?

PHOENIX—Linda was homeless and wanted to die. Phil, a carver, holds up hands mutilated by his own tools.

They are alcoholics. A few months ago they had hit bottom. Lost everything. Now they say they have focus. Alcohol has lost its buzz. Its taste is often repugnant.

The difference they say is a little known drug called naltrexone. It blocks the pleasurable "high" that alcoholics crave. Some claim results within hours of taking it.

"Sometimes I feel like a midwife because I've witnessed the rebirth of so many people in this program," Lloyd Vacovsky said. Vacovsky runs a pioneer recovery program for alcoholics as a case manager at Central Arizona Social Services. He turned to naltrexone 2{ years ago after he heard about its startling results.

"For 10 years I had referred thousands of people to various programs and I couldn't document one successful recovery from alcoholism. So when I heard about naltrexone I figured, 'What do we have to lose ?' "

Judge Darell W. Stevens of Chico, Calif., discovered naltrexone when he was surfing the Internet, searching for alternative treatments for alcoholism in the wake of increasing repeat drunk driving convictio ns in his jurisdiction. Since 1995, Stevens has mandated in the sentences of more than 100 DWI offenders that they enter naltrexone programs. Like Vacovsky, he reports significant success.

People like Linda and Phil claim remarkable results from taking the $5 tablet once a day for 90 days. But, naltrexone is prescribed by only a few physicians nationwide and few, if any, residential treatment centers use it despite its minor side effects an d testimonials from longtime alcohol abusers.

Chandler physician Dr. Alan Kazan is one of a few doctors nationally who prescribe naltrexone. A specialist in addiction medicine and a member of the Arizona Medical Association, Kazan has ordered naltrexone for about 150 patients over the last three year s. He says naltrexone is not a cure-all, but he would prescribe it to anyone who wanted it because "it's a well-tolerated drug."

In addition, Kazan uses Antabuse, another drug used in the treatment of alcoholism. However, unlike naltrexone, Antabuse does not break the cycle of craving. It causes alcoholics to become violently ill whe n they drink while taking it.

"I probably have used more naltrexone than any other doctor at the beginning," Kazan said. "I think it's a very good medication as an adjunct for other treatment modalities (counseling, support groups), but it's not a magical pill."

Naltrexone, manufactured by Dupont Merck Pharmaceutical Co. in Delaware under the brand name REVIA, is a relative newcomer when it comes to treating alcoholics. The U.S. Food and Drug Administration approved the drug for this use in late 1994.

Naltrexone had been around since the '80s to treat heroin addiction. However, it wasn't considered a treatment for alcoholism until researchers accidentally discovered that alcoholic test rats became teetotalers after they were fed naltrexone.

So why is naltrexone such a secret? Especially in light of statistics from the Institute of Medicine that estimate substance abuse costs $3 billion a year in direct medical expenses, crime and lost productivity. An d approximately 38 percent of adult Americans have experience of alcoholism or alcohol abuse in their families.

"That's the most frustrating part," Vacovsky said. "We have this incredible medicine to help people with alcoholism and no one knows about it. Many of the people in my program first heard about naltrexone not from a doctor but from a local rad io talk show."

Dr. Joseph Volpicelli said that part of the problem is naltrexone represents a new way of thinking about the addiction.

"Alcoholism is not a spiritual disease, it's a medical one," he said.

Volpicelli is credited for recognizing naltrexone's potential to treat alcoholism. He is a psychiatrist and psychologist at the University of Pennsylvania Medical Center in Philadelphia.

He said naltrexone stops the cycle of craving by blocking what are called opioid receptors. Here's how Volpicelli describes it: "Endorphines are released when an individual experiences pain or consumes alcohol. These endorphines bind to opioid recepto rs. This is what kills pain and produces euphoria.

"Naltrexone simply blocks the opioid receptors so the endorphines can't get there. This can in turn stop the vicious cycle of alcohol addiction in which one drink nearly always leads to a full blown relapse."

He estimates that of the 20 million alcoholics in America, only 15,000 have received naltrexone.

Susan Pritchard, a spokesperson for the drug's manufacturer, said only about 2,000 physicians are currently prescribing naltrexone for their patients. Of those, 60 percent are psychologists who specialize in addictions.

Pritchard agrees with Volpicelli. "I think the reason naltrexone has not been embraced is due to a reluctance by the medical community to treat alcoholism as a disease." She also noted that few family physicians treat alcoholism.

In addition to its relative obscurity, another roadblock to naltrexone's more widespread use is insurance companies.

"Insurance companies often don't allow naltrexone to be prescribed by a primary care physician," Tania Graves, spokeswoman for the Arizona Medical Association, said. "Their point of view is that drug or addiction problems should be sent to a s pecialist."

These obstacles frustrate Vacovsky, who said he's had 250 people go through his recovery program. They have come to him either referred by adult probation or the Department of Corrections, or they have walked in themselves, willing to pay $1,000 for the 1 2-month program.

He claims 80 to 90 percent of his clients are no longer alcohol dependent after completing the program, which includes weekly group therapy.

Of the three dozen people attending a recent Tuesday night therapy session, each one praised the drug's effectiveness.

Brian, 43, is nearing the end of the program. He had been a firefighter and then a swimming pool contractor until he lost his contractor's license. He ended up in prison after a DWI conviction.

"After prison I really went on a binge," he said. "There's no way I should be alive. But believe it or not, one hour after my first pill I no longer had the craving to drink."

His sobriety was such a shock to his wife that she couldn't handle his new personality and left, he said.

Volpicelli's most recent research indicates naltrexone can be effective doled out in much the same way as prescription allergy medicine for "people whose alcohol drinking has not irrevocably impaired their social relationships or occupational function ing and who are not profoundly depressed.

"With just the support from a nurse we're finding as good, if not better, outcomes using that approach."

Mac, an alcoholic from Vacovsky's recovery group, is simply grateful the demons from his own world have disappeared. In his words:

"It's like someone reaches into your brain and pushes a reset button. I had nothing before naltrexone, and I have nothing after naltrexone." He grins. "But at least now I know it.

Publication Date : 1998-02-19

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