I’m currently separated from my husband who is 55 years old and is a chronic alcoholic. He has undergone detoxification many times, makes an effort not to drink, goes to AA, but then stumbles and starts drinking again, mostly on the weekends. He was on Antabuse but got very sick one time and couldn’t continue it. Is there anything that can be done to help him?
Alcoholism — alcohol abuse and dependence — is a major public health problem. Some 200,000 deaths a year in this country are attributable to alcohol abuse. Alcohol and tobacco are the big killer drugs — far outstripping other drugs of abuse.
Afflicted individuals are often reluctant to recognize that they have a problem and to cooperate in treatment. Although the idea of controlled drinking is propounded by some, most workers in the field insist that complete abstinence from drinking is necessary to combat alcohol abuse.
Treatments are diverse.
The active alcoholic may require supervised detoxification — withdrawal from alcohol with observation and protection against possible severe withdrawal syndromes such as seizures or delirium tremens. Drugs such as benzodiazepines — Valium, Librium, or carbamazapine (Tegretal) make withdrawal safer and easier.
Individual and family psychotherapy, generally of an active, supportive variety, are employed, with drinking behavior being an early focus of the treatment.
AA (Alcoholics Anonymous) is a network of self-help groups which undercuts denial and rationalization in its members and offers ongoing group support.
Pharmacological methods may soon offer more promise.
Antidepressants, especially the newer better-tolerated drugs (such as the SSRIs) help some people, as may lithium. (If an individual’s drinking seems related to a psychiatric illness such as depression, treating that condition makes sense.)
Disulfiram (Antabuse), taken as a pill every day, inhibits the enzyme aldehyde dehydrogenase, so that even one drink will bring about a buildup of acetaldehyde and a toxic, extremely unpleasant reaction: nausea, flushing, hypotension. Reactions can be quite severe, prolonged and even dangerous. Only some individuals can be trusted to try this treatment.
Naltrexone (ReVia) is an opioid antagonist which was approved back in 1994 as a nonaversive drug (Antabuse is “aversive”). Studies show that Naltrexone reduces the risk of relapse to heavy drinking. Naltrexone has certain problems: About 15 percent of patients have intolerable side effects, primarily nausea. Some patients get dose-dependent liver damage (more liver damage with higher doses) — which is especially a problem because alcoholics often have liver disease to begin with.
Now a double-blind, placebo-controlled study shows that a newer opioid antagonist, nalmefene, shows fewer patients relapsing to heavy drinking through twelve weeks on treatment as well as other advantages over Naltrexone (less side effects, no dose-dependent liver damage.)
As more is known about the about brain pathways and mechanisms, we can expect the pharmacological treatment of alcoholism to be increasingly sophisticated and useful.