Acamprosate Approval in the News

Recent approval by the Food and Drug Adminstration of Acamprosate to treat alcohol dependence is making its way around the media.

The Washington Post runs a short piece by Alicia Ault (free registration required) which includes:

Campral appears to work by restoring the balance between excitation and inhibition in nerve signals, a balance that gets altered by alcohol abuse. An older drug, Antabuse (disulfiram), makes people violently ill if they drink alcohol. Another, naltrexone, works by making people want to drink less, said Litten.

Only 5 to 10 percent of people treated for alcoholism are prescribed naltrexone or Antabuse, which don’t work for everyone and are not widely marketed, said Litten. Forest aims to market Campral broadly to addiction centers and physicians, said company president Ken Goodman, and persuade insurers to pay for the drug.He would not comment on price.

And, from Business Week’s coverage by Amy Tsao:

The U.S. is well behind other nations in using drugs to help battle alcoholism. Including Campral, only three anti-alcoholism drugs have earned FDA approval — and Campral is the first new one in almost a decade. Moreover, fewer than 5% of the nation’s 14 million alcoholics are being treated with drugs, with the vast majority relying on behavioral therapy and support groups like Alcoholics Anonymous to help them quit. Though alcoholism is increasingly viewed in the U.S. as a disease, the predominant belief is that “you don’t treat a sin with medication,” says A. Tom McLellan, professor of psychiatry at the University of Pennsylvania and director of the Treatment Research Institute, a nonprofit group that evaluates addiction therapies.

Many American alcoholics are starting to demand more help in achieving what for most is the greatest challenge: Long-term abstinence.

Tsao notes that Campral has been available in Europe since 1989.

The five percent number doesn’t surprise me. By the time by buddy Brian’s drinking finally killed him in 2002, he had at least a decade of treatment, 12-step support, sponsorship, and one-on-one therapy. His care came mostly from one of the leading hospital-based chemical dependency treatment facilities in Iowa. At age 44, his last year included several close calls laden with all of the standard -itises and -opathies.

A month before his death, he and I talked about alternatives like Naltrexone and harm reduction therapy. Thoughtful, intelligent guy that he was, the value of options struck a chord with him. After all of his years working within that system — and being trained as a peer support group facilitator — he said the only possible outcome of asking about the options would be earning a merit badge for denial, making it out of the question for him.

Maybe his medical condition (such as liver damage at the end) would have precluded the use of Naltrexone at that point. It seemed clear, though, despite being available since 1995, not only was the option not on the table, his caregivers had convinced him that merely asking questions was also strictly verboten. It struck me as a classic case of insanity defined as doing the same thing repeatedly, yet expecting a different result.

Anyway, it’s good to see that more research is in progress:

Researchers are also wrapping up a large, multicenter trial of Campral, Naltrexone, and both drugs combined. That study, for which 1,380 patients took the drugs in conjunction with various behavioral therapies as well as without any additional therapy, should help elucidate what combination of therapies works best.

Hopefully we’re on a path toward treating the truly life-threatening forms of addiction more like cancer and HIV: No single approach is going to work for everyone, but information about any approach which shows promise ought to be in the hands of the folks who could benefit so they can make fully-informed decisions about their preferred course of treatment.

Again, I'm freakin' stunned here...I was thinking, yesterday as I was writing my comment about how cool some of these different approaches are...that I could never, ever, in a million years, talk to my mother about anything less then abstinence. If I ever drink again around her or near her or whatever, it's over. Nothing about controlled, or harm reduction would fly with her or ANYONE who knows me. Those alternatives are closed for me.

And that makes me sad.

Oh, and thanks for the shout-out! *blush*

The important thing, for me, has been that I'm more focused on how I want to live than on whether or not drinking is part of my life.

When I started working on healthier alternatives to the daily drinking patterns that were causing me problems, I didn't know whether the best solution would end up being abstinence- or moderation-based. I just wanted something better, something sustainable, something that demoted drinking and promoted life.

It sounds like you're getting that stuff in your life, Faith -- you're focused on Sydney, you're indulging your creative side with your blog, you're connecting with people, and being there for your mom. I'm happy for you, and encourage you to stick with what's working. Sticking with it now doesn't mean that you're stuck with the current approach forever; twenty years down the road things may be different.

The folks you love believe abstinence is the best way to keep you around and healthy. One of the things you can say to yourself is that "Well, even if this isn't the only option, for now it is my best option."

Is Campral a replacement for antabuse?
Can one consume alcohol in moderation, special situations, etc. without becoming ill?
Thank you. Mike