Current Topics in Chemistry - Bruice

Dr. Glaser's "Chemistry is in the News"
To Accompany Bruice, Organic Chemistry, 3/e.
Chapter 18. More About Oxydation-Reduction Reactions.

For each of the following questions, please refer to the following article:

NALTREXONE IS ALTERNATIVE TO ALCOHOLISM. WHY IS IT SO LITTLE USED?
by Thomas Ropp (The Arizona Republic, February 19, 1998)

Editorial Comments

Take a good long look at the link to alcoholism. Read the facts out loudly and realize just how widespread alcoholisms has become and how severe the consequences are for the physical and mental health of the alcoholic, his/her environment including the workplace, his/her family and his/her children.

Of all the statistical data, the one I find the most critical one is this: "About 43% of US adults--76 million people--have been exposed to alcoholism in the family: they grew up with or married an alcoholic or a problem drinker or had a blood relative who was ever an alcoholic or problem drinker."

Alcoholics Anonymous makes two thing quite clear: "We unequivocally endorse the fact that alcoholism, and other drug addiction, is a primary, progressive, chronic disease and that total abstinence is the cornerstone of recovery." First, alcoholism is a disease. Second, the cure is abstinence.

This leaves only the problem as to how to achieve the cure and that is precisely where the problem lies. Few are capable of breaking the addiction by sheer will power and determination. How can alcoholics be helped to begin the cure and to stay abstinent? "That's the most frustrating part," said a case manager at Central Arizona Social Services. "We have this incredible medicine to help people with alcoholism and no one knows about it." Naltrexone and antabuse are two powerful drugs to help alcoholics achieve the cure. Learn about naltrexone and antabuse by working the following questions.

Pertinent Text References
Chapter 18. More About Oxidation-Reduction Reactions.
Chapter 18.11. Biological Oxidation-Reduction Reactions.
Chapter 18. Box on "Treating Alcoholics with Antabuse".
Chapter 18. Box on "An Unusual Antidote".
Chapter 18. Box on "Fetal Alcohol Syndrome".

Questions

Question 1: Use the ChemFinder to take a look at the structure of naltrexone. Briefly explain the mechanism of action of naltrexone.

Answer 1: Naltrexone curtails the craving for alcohol as it blocks the opioid receptors in the brain.

Question 2: Use the ChemFinder to take a look at the structure of antabuse or disulfiram. Briefly explain the mechanism of action of antabuse.

Answer 2: Antabuse inhibits aldehyde dehydrogenase. The resulting buildup of acetaldehyde causes violently unpleasant effects (effects worse than abstinence). Bruice 3/e, Chapter 18.

Question 3: Describe the role of nicotinamide adenine dinucleotide in the alcohol dehydrogeanse catalyzed oxidation of ethanol to acetaldehyde.

Answer 3: Bruice 3/e, Chapter 18.

Question 4: The Medscape article Naltrexone plus Cognitive Therapy for Alcoholism describes a recent study of naltrexone. Read the article (you might have to sign in with Medscape, which is a free service) and comment on what is said about naltrexone and craving reduction.

Answer 4: Because naltrexone is believed to increase control over alcohol craving, the finding that it had only a modest effect on self-reported craving was of interest. The drug may increase resistance to alcohol-related thoughts and behavior, leading to better control of these aspects of craving.

Chemistry & Society.
Question 5: Alcoholism and AA Recovery is dedicated to recovery from alcoholism & designed to move visitors from their disease into recovery. The recovery is abstinence. The goal of abstinence as the only recovery has been questioned: Is moderation a legitimate outcome in alcohol treatment? In 1996, Audrey Kishline, an alcoholic, published her book "Moderate Drinking : The Moderation Management Guide for People Who Want to Reduce Their Drinking." Does it work? It does not seem to work for Audrey Kishline. On June 27, 2000, CNN reported that, "in March, Audrey Kishline allegedly drove her pickup truck the wrong way down Interstate 90, smashing head-on into a car in an accident that killed a man and his 12-year-old daughter." Might it work for some? How would you know who could succeed with moderation management? Or is the idea of "Moderation Management" just plain stupid?