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Drink-less pill

Part of what makes addiction infuriating is that it is so darned hard to define. Measuring just exactly what addiction is turns out to be very challenging and largely relies on reports from the addict. Most people when it suggested that they have a drinking problem can point to several other friends who drink more than they do. It is a fuzzy line. Not to worry, big Pharma has you covered. They are embracing the murkiness of it all and are preparing a drug called Revex, coming your way in 2012.

Revex does not make you sick if you drink on it like Antabuse does. It does not make you sober and it won’t even remove the desire to drink. Instead the makers of Revex don’t really want you to stop drinking alcohol. What they hope to offer is a reduction in the total number of heavy drinking days. Yep, keep getting bombed. Drink all you want to several days a week, just cut back a couple of drinks on Sunday.

This drug has nothing to do with alcohol or its metabolism but is used for the treatment of excess alcohol consumption. I see a cozy partnership with the alcoholic beverage industry developing soon.  If you have trouble drinking responsibly, take this pill. It also has nothing to do with gambling but it is also in clinical trials for pathologic gambling as well. The theory here is the body’s own opiate system (endorphins) are involved in the good feelings that come from drinking (or apparently from gambling) and that by blocking them the desire to drink is lessened. The casinos might not like the combined effects here.

On the one hand I think it is great the pharmaceutical industry is attempting to make strides in treating addiction and its terrible consequences. On the other hand, a drug whose effect is to get you to drink a little less is ridiculous. By the time a person seeks treatment for alcohol dependence they are already drinking so much that quality of life is severely impaired. Reduction from drinking a quart of vodka to a pint-and-a-half really isn’t much different. There may be a few dollars saved here or there but the damage to the body and brain by the alcohol under the pernicious influence of this drug are essentially identical.

There is already a drug currently on the market designed to reduce the “craving” for alcohol and consequent heavy drinking days. It is called naltrexone. An injectable form is also available that stays in the system for several weeks. No studies have shown complete abstinence or improved control with any of these medications. People in some groups and with the right genes (15-20%) are helped to drink a little less. They act to block the opiate pathway in the brain. They also block naturally occurring opioids: the endorphins. Endorphins are the peptides that make you feel good and which your body produces in response to pain.

A reduction in the total number of heavy drinking days is their goal, and a significant improvement would be a 10% reduction. If a person usually drinks every day and they are the new medication still drink every day but some of those days let’s say one day a week they don’t drink as much, the drug will be considered a success. People who drink and use drugs are excluded from the studies (except for cigarettes and marijuana).

Besides the side effect profile of the drug and its costs, maybe it would be better to offer people a placebo. New data suggest that even when a person knows that the pill they receive is a fake they still feel better. In the meantime, I believe that if you have a problem with alcohol then you shouldn’t drink any of it. If you can control your drinking then you don’t need a pill.

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Category: Current Events, Drugs, Neuroscience

About the Author: Dr. Jason Giles is certified by the American Board of Addiction Medicine and the American Board of Anesthesiology. He is a physician specializing in the treatment of drug, alcohol, and behavioral addictions. He is the founder of Haywire.


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