Medications for treating alcoholism

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.

Quality of Literature Researched

Important as it is to discuss the literature, it is more important that the literature utilized is of a quality that can yield useful results. So we will briefly explore that subject, with the thought in mind that the combination of sources used may be helpful in giving some constructive results vs., for example, using all double-blind trials as our references.

Willenbring and Gitlow's debate on this subject brings into question their qualifications that allow us to trust their arguments and expertise. Dr. Gitlow is board-certified in addiction and forensic psychiatry, and is the Executive Director of the Annenberg Physician Training Program in addictive diseases. He has taught at Harvard, Brown and Dartmouth, and is currently the chairman of the AMA's Action Team on Alcohol and Health. Dr. Willenbring is Director of the National Institute of Alcohol Abuse and Alcoholism along with several other long-term qualifications in the alcoholism field.

Tambour and Quertemont have utilized over 200 references for their article discussing several of the drugs now available. Dr. Quertemont is a Ph.D. And Professor of Psychopharmacology at the University of Liege in Belgium. She is also a well-respected author and researcher in the areas of alcoholism and other stimulants.

Richardson, et al., ran one of the most respected formats for studies -- the randomized, double-blind, controlled trial -- to explore alcoholism drugs.

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.