Effectiveness of medications in treating alcohol dependence

Medications to Treat Alcoholism

This is a guideline and template. Please do NOT use as a final turn-in paper.

Alcohol dependency affects approximately 17.6 million Americans, and many more indirectly through accidents, alcohol-induced crime, and other causes. It is also listed as a causative factor for cancer, liver disease, brain damage, and fetal injuries during pregnancy (Tambour & Quertemont, 2007, p. 9).

The purpose of this paper is to determine if there are any effective medications that aid in treating alcoholism. There are several medications available of varying degrees of effectiveness, but in recent years new drugs, based on the neurobiological functions of the body, have been developed that may show promise. My literature review, using four different sources, will reveal the latest research findings about these newer drugs to determine if any of them show signs of being able to effectively treat alcohol dependence. The standard I will use to determine this is the result of research trials and expert opinion I locate in our literature review.

II. Literature Review

For this review I have researched and read in full, four peer-reviewed, academic medical journals located in medical and health online databases and at the library. All of the resource articles I use are directly related and relevant to our topic.

Willenbring and Gitlow (2008), present an enlightening and interesting four-way debate regarding this subject and whether or not these medications prove of value in fighting alcoholism. A positive argument and rebuttal is presented along with a negative argument and rebuttal.

Tambour and Quertemont (2007), present a study of several of the drugs used to fight alcoholism: Disulfiram, Naltrexone, and acamprosate primarily among them. Richardson, et al., (2008), ran a randomized, double-blind, single-dummy, placebo controlled trial for Naltrexone and acamprosate to determine if one or the other was effective in decreasing or stopping cravings for alcohol. Kranzler (2006), reviews a brief history of alcoholism medications and asks the question whether we shouldn't be doing more to get the drugs out to the public so that more alcoholics can receive treatment.

Affectivity of Current Drugs

.In order to examine the extent to which acamprosate and naltrexone impact on drinking by reducing craving, Richardson, et al., first examined the effect of these medications on daily craving ratings. To make a long story shorter, the results of their study indicated that naltrexone reduced the craving for alcohol at high levels of craving, while acamprosate had no such affect. Their trial also showed that craving was a significant indicator of daily drinking, which supported the theory that craving is a pathway for influencing drinking.

It is interesting to note that Tambour and Quertemont studied the effects of the same two drugs plus Disulfiram, an alcohol-deterrent drug. Their findings, in reviewing other studies, indicated slightly different results from Richardson. Since different drugs target different neuro-inhibitors, the drugs were used both separately and together. Quertemont discovered, in reviewing the results of previous and current studies, that none of the drugs worked particularly well, and that the combination of two of the drugs didn't seem to help. Her review of these studies contradicted the Richardson trial in which acamprosate was found to be ineffective.

Quertemont and Tambour ultimately concluded that the future of curing alcoholism lie in both discovery of new drugs and the refinement of the use of current drugs either singly or in combination.

In Willenbring and Gitlow's debate over the value of drugs to treat alcohol dependence, Dr. Gitlow concludes that until it is proven that the drugs provide a better outcome than the standard therapeutical treatments of today, we cannot be certain whether the drugs are helpful or harmful. They should, thus, be considered experimental.

While Dr. Willenbring concedes that much of the methodology for research trials has been flawed, he points out that a chain of studies that result in the same conclusion might be cause for some belief that a conclusion that the medications work might be in order. He further states that most of the medications have been proven effective in reducing dependence on alcohol.

Kranzler, in his discussion of efficacy of the drugs and getting them to market, indicates that he believes the primary drugs have proven to be effective. But, he says, their efficacy when compared to anti-depressants in limiting the symptoms of depression, is minimal. However, he feels that they are effective enough that, given the enormous scope of the problem of alcoholism, the drugs should be made more available.

III. Conclusion

Disulfiram was discovered, by accident, back in 1947 -- 60 years ago. It has proven its effectiveness, evidently, in deterring alcoholics from drinking, and is known far and wide by doctors and alcoholics as a drug to treat this disease. Naltrexone, the newest of the drugs, has been prescribed over 200,000 times. Given our 18 million alcoholics however, this seems a pittance as far as putting a dent in alcoholism if, indeed, the drugs work. One has to ask also, why the different results from trials for drugs that have been prescribed since the end of WWII?

It seems to me that further research is always important, but we have drugs that evidently work. If we can develop more effective drugs to combat this deadly disease, then we should.

But let's use the ones we have, and, as Kranzler says, get the physicians to prescribe them.

Importance to Nursing

Women are alcoholics too, and their disease can affect their babies, as is well-known. It is important that nurses be aware of the medications available and ongoing research so that they can inform their patients and save babies who might otherwise be victims themselves.