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Alcoholism: How Can it be Treated?

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In observation of Alcohol Awareness Month, Tanicia Haynes, NP with Occupational Health, speaks with Dr. Peter Martin, Professor of Psychiatry & Pharmacology and an Addition Psychiatrist with Vanderbilt University Medical Center, about alcoholism treatment.

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04/20/2017 Wellcast: April is “Alcohol Awareness Month”

Tanicia Haynes: Welcome to this edition of the Vanderbilt Health and Wellness Wellcast. I am Tanicia Haynes with Occupational Health. April is “Alcohol Awareness Month,” and we have the pleasure of speaking with Dr. Peter Martin, Professor of Psychiatry & Pharmacology, who is an addiction psychiatrist, practicing at Vanderbilt University Medical Center. Today, our discussion will focus on the treatment of alcoholism. Hello, Dr. Martin.

Dr. Peter Martin: Hello.

Tanicia Haynes: Thank you for speaking with us.

Dr. Peter Martin: It is my pleasure.

Tanicia Haynes: Great. So, to start, what is the traditional treatment for alcoholism?

Dr. Peter Martin: Well, the traditional treatment, unfortunately, for alcoholism, is to ignore it. You know, I think only about one-tenth of the people who need to be treated are actually getting treatment. People tend to deny it. Their families tend to help them cope with it, and unfortunately, not all of the people who have alcoholism get their appropriate care. It is only when their astute doctor or a family member gets them to the point where they really do need to get help, do we have the opportunity to treat these people, and it is really unfortunate, because there is so much we can do to help them. The traditional approach to alcoholism in the past was the standard AA 12-steps, Alcoholics Anonymous, and in general, it was the alcoholic working within a community of his peers that led them to their recovery. Nowadays, things are different because medical knowledge has developed. There is a lot in psychiatry that can be employed to help patients with alcoholism. In general, I like to think of alcoholism as being a medical illness that can be treated in a word that I have coined. It is called a “pharmaco-psychosocial approach,” an integrated pharmaco-psychosocial approach to treatment, and by that, we mean that we believe the 12 steps is extremely important, because it does help people go down a journey, along with peers who are struggling the way they do. We know they do well with that, but in addition, as psychiatrists, we are very interested in identifying what exactly led to their alcoholism, because a lot of people drink in order to numb feelings or to cover up other psychiatric problems, which can be treated. Then, the next point is that there are, over the last 20 or so years, a lot of medical approaches, pharmacologic approaches, medications, that have been studied and have been demonstrated to be effective in reducing both craving and in relapse.

Tanicia Haynes: To speak on the use of medications, what can you tell us about the use of Naltrexone as treatment?

Dr. Peter Martin: Well, I think we need to go into a little bit of history. To begin with, the first ever medication that was approved for the treatment of alcoholism was Antabuse/disulfiram, and it is a good medicine, but the risk of side effects in using it is a little bit too high for us, although it is a very effective medicine. The first medicine after disulfiram that was approved for treatment of alcoholism was a medicine called Naltrexone, and Naltrexone, interestingly enough, was developed in the 1970s for the treatment of opioid dependence; however, it became approved by the FDA for the treatment of alcoholism because it was shown that Naltrexone actually reduces craving and it reduces relapse to alcoholism, and in fact, there are studies showing that individuals can take Naltrexone quite regularly by mouth and do very well for years and years. There are other ways of taking Naltrexone. Some people advise taking it before you are going to relapse when you know that something is coming up, that it will reduce the amount of drinking that you will partake in, but in general, it is a very effective, and perhaps the most effective and safe medicine that is available.

Tanicia Haynes: You mentioned integrative treatment of alcoholism, including the 12-step program, medication and therapy. Would you ever use Naltrexone exclusively?

Dr. Peter Martin: I think that people like to take care of their illnesses with the least possible effort, and I think it would not be out of question, in my opinion, to try someone who is having trouble with drinking too much and let them try Naltrexone, and maybe that might be sufficient, but in my experience, you can’t just take a medicine and heal alcoholism, because alcoholism isn’t just a bad habit. It is actually a psychiatric illness. I have treated patients who I have put on Naltrexone, but typically, this is a relationship between the doctor and the patient that develops, and you may not want to put someone into a full-court press right from the start. You might just work on getting together and getting to understand what is going on, and go step-by-step until the patient feels their life is improving, and I have seen patients who are shocked about how much better their life can be if they get the proper treatment.

Tanicia Haynes: Thank you so much, Dr. Martin, for speaking with us. We really appreciate the time you’ve taken with us.

Dr. Peter Martin: It’s been my pleasure.

Tanicia Haynes: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu.

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Posted on Friday, April 14, 2017 in Health Plus, Wellcasts and tagged , , ,

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