A Miracle Cure for Alcoholism?

CNN.com is reporting new research that shows two medications, naltrexone and topiramate, have a significant impact in the treatment of alcoholism. You can read that article here.

Whenever something positive happens in the mental health world, the critics come out of the woodwork. The sad reality that mental health practitioners aren’t all on the same page rears its ugly head as well. When Cognitive-Behavioral Therapy was demonstrated to successfully treat many cases of depression, the Freud fawners called the treatment superficial and “not getting to the root of the problem.” When medications eliminated many of the symptoms seen in various forms of Schizophrenia, nay-sayers argued that the condition is a permanent one and therefore the patients couldn’t have been schizophrenic in the first place if they weren’t psychotic now. And now the Betty Ford Center is saying that these pills are an overly simplified way of treating addiction and probably want no part of the medication regimen. Are they right? Yes and no.

Let’s be crystal clear about one point: there is not a single form of talk therapy, behavior therapy, medication, or any other intervention that will be successful at treating every person and/or every condition. Lexapro does not work for everyone with depression despite its extensive use and research backing. Psychotherapy doesn’t eliminate Panic Disorder in every patient despite its solid track record. In other words, when you meet a “purist” in the mental health field, run for the fucking hills. These people are an embarrassment to the profession. I once met an acupuncturist who swore that there was nothing she couldn’t treat: headaches, acne, Irritable Bowel Syndrome, AIDS, various tumors, Leprosy, Small Pox, Scurvy or even a broken leg. How pins can eradicate a deadly virus is something she couldn’t explain all that well.


Is alcoholism a complex condition? Of course it is. It’s not solely about abstinence. Those who are addicted have a relationship with alcohol and that needs to be understood and altered. This is where the term “dry drunk” comes into play and it has merit.* Those who simply stop the behavior are at a greater risk of relapse than those who are getting help. Whether that be a 12-Step program or something else, those who are exploring the intricacies of their condition are posturing themselves to be much healthier people over the long haul.

That said, if the medications described in the article are helpful to even a single person whose life is/was being destroyed by alcohol, why not embrace it as part of an overall treatment package? The studies are showing that it works and, while the man in the piece could probably benefit from a support group or other type of intervention as well (especially now that he is sober), he is leading a much happier and productive life. Is this man at risk for relapse? Could he engage in Symptom Substitution (i.e., replacing alcohol with another addiction such as gambling, spending, etc.)? Of course these are all possibilities. This is why the pharmaceutical companies shouldn’t be pushing these medications as the end all, be all of addiction work. But the stark, positive reality is the drug has changed his life and is advancing the field. Any professional who wants to take that away isn’t simply a contrarian, he’s a sadist.

When practitioners attempt to push patients into a specific treatment option because of a “one size fits all philosophy,” they aren’t doing it out of altruism. Such logic is based on ignorance and stubbornness. If you’re one of these purists who foist your single method onto your patients, get out of the field now. You’re not only annoying me, but you’re hindering the people who don’t fit your mold. You’re retarding the field’s progress, and that’s simply unacceptable.

* “Dry Drunk” is a term used in Alcoholics Anonymous to describe an addiction sufferer who isn’t consuming alcohol, but hasn’t addressed his/her relationship with the substance, the inherent powerlessness that comes with addiction, as well as the impact of alcohol on his life and the people around him. In other words, A.A. members view this person as someone who is abstinent but still carries the problems and issues of an addict.

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28 Responses to “A Miracle Cure for Alcoholism?”

  1. Dyson says:

    I hate when medications are abused and used as a crutch. I agree that the various medicines have their places and specific uses, but as you said, they shouldn’t be viewed as a magical panacea.

  2. Ryan says:

    Rob:
    This is a great article. It really points out the vagaries that exist within the mental health field. I feel great subscribing to your blog knowing that you have such an open point of view to new research.

  3. Sam says:

    I couldn’t agree more. I have to say that any mention of naltrexone gets my hackles raised even before I see what it’s about. Maybe that’s a bit too aggressive. My first reaction is cynicism before interest.
    The reason is that in my local city there is a doctor who is aggressively pushing naltrexone as that magical “one size fits all” miracle cure to heroin addiction. From the long list of its virtues, it can cure alcoholism and fertility problems, and they’ll probably announce it can cure cancer before too long.
    He is continually demanding more money, and enlisting the public to petition the government for more money to fund the treatment, which is very expensive. So far he has gotten by on private donations, and has made a lot of personal sacrifices, but of course more money is always needed. However there are a lot of other addiction services in this country that also need money, and which actually use proven methods.
    I should mention that this form of naltrexone administration is experimental, not formally approved in this country to be used in this method or for this reason. It’s due to a technicality that it can be administered to heroin users, with no real attached responsiblity to provide data on its efficacy or safety…
    If there existed enough randomly-controlled, long-term, replicable, studies, I’m sure that naltrexone would be examined seriously as part of the suite of treatments currently available to addicts in this country. But I guess it’s easier and cheaper to write into the local paper and accuse the government of dehumanising heroin addicts and letting them die.
    Nevermind that it would be much more respectful and humanising to the heroin users to give them the reassurance that they are using a treatment which has been proven, and is supported as best practice by the majority of scientific (and health!) community.

  4. Anonymous says:

    Doc Rob, want the typos or no?

  5. Anonymous says:

    Doc Rob,
    Yes, do you want them to be pointed out to you or not?
    Dr. Rob: Yes, but why don’t you send them to me directly through the Contact tab, rather than using the Comments thread?

  6. Nadia says:

    Doc Rob,
    Do you want my damn typo finding services or not? I do not think you appreciate my typo finding skills. I would like more attention.
    Okay had to do that. Now I think people generally look down their noses at any type of addicts; they act like they want to help them but deep down they believe these filthy things don’t really deserve help because they brought whatever unto themselves. Then people say stupid things about addicts and their true opinion shines through; you can tell they don’t think of them as actual people.
    Like you said, as long as the pharmaceutical companies don’t get their way with the drug, why shouldn’t alcoholics get all the help possible?

  7. Anonymous says:

    “All criticism and advice is welcome!”
    I got this off Nadia’s blog with regard to her writing.
    Now I can’t remember if it was here or where I first found Rob on “This is by us” that he exclaimed the same desire in order to sharpen his writing skills.
    Clearly Rob has an editing problem, this is all part of the process of becoming a published writer.
    I also don’t understand why Doc Rob deleted his comment off of my first post, making it seem like I was asking twice rather than answering his reply.
    At any rate, if I needed some cyber attention, I’d get my own blog like the both of you.
    Dr. Rob: I deleted it because after a re-read it didn’t make all that much sense.

  8. Great points about the initial reactions to cognitive-behavioral treatments for depression and about schizophrenia. Addiction is a complex phenomenon in my experience – not so simple as to be curable with a pill or even simple abstinence. However, just like abstaining from alcohol can be very helpful part of overcoming addiction, pills may prove to have their place in the recovery process too someday. Maybe that day will be very soon —

  9. Cassandra says:

    With a husband fresh out of a 28-day program in a rehab facility (that was located smack in the middle of the Napa wine country of all places), I find these potential new treatment options incredibly intriguing.
    Having been raised by religious zealots for a time, I long rejected the disease modality of alcoholism and felt it was simple lack of will or compromised morals. Until I lived with an alcoholic, I never understood the deep psychic pain and despair the alcoholic feels about his powerlessness over his addiction. Over the last couple of years, I’ve been reading about the incredible strides in neuroscience research into addictions. Time magazine had a great article about the science of addiction in 2007. While I think there is a spiritual and behaviorial component to alcohol abuse, the new research is showing how the brains of chemical abusers are wired differently than non-abusers. Beyond the Influence (2000) discusses this in depth.
    The chemical abuser is still responsible for their recovery and maintaining sobriety. However, the sooner we can eliminate the stigma of addiction and stop castigating chemically dependent individuals as sinners or weaklings, the better our ability will be to prevent future dependency and treat current dependency. If not abused, I find the use of naltrexone and topiramate as potential tools for long-term recovery very, very exciting.

  10. Tracie says:

    “That being said, if the medications described in the article are helpful to even a single person whose life is/was being destroyed by alcohol, why not embrace it as part of an overall treatment package?”
    This reminds me of another point: I think even the placebo effect is useful if it results in some kind of benefit.
    Everyone reacts to treatment differently, and speaking from experience (my mother is an addict), it can take several tries to find something that works. These medications are just one more tool in the toolbox, and as you said, if it helps one person overcome their addiction, I have hope for it becoming useful in the field.

  11. Amber says:

    This is too close to home, don’t really know how to respond to it.
    It was well written and I agree with you Rob, there are benefits to some meds, but they aren’t going to save you in the end. Some of them just mask the addiction. What happens when you’re weaned off the meds then?
    Dr. Rob: I’m guessing it’s too early to say, but perhaps you don’t ever get weaned off of them.

  12. Frank says:

    Alcoholism is the new death wish…..thats all I have to say. we need to offer a hand to those in need of help. Help by helping others, not by ignoring the pain…
    http://www.recoveryconnection.org /?utm_source=blog&utm_medium=pv&utm_content=zs&utm_campaign=home

  13. Anonymous says:

    My dad is an alcoholic who has been on all variety of medications for depression, sleep aids, and some alcohol specific injected drug I don’t know the name of that was specifically intended to treat the addiction. None of it worked, mostly because I’m pretty sure he just wants a magic pill to fix it and doesn’t get the non-chemical help he needs. Basically he wants to trade one dependency for another.
    So basically, my point here is that I agree with your assertion that this is and never will be a fix-all solution for alcoholism (or anything else, for that matter).
    I do wish there were more alternative support groups to AA, because the spiritual approach doesn’t really appeal to everyone. I don’t go to Al-Anon meetings because, as a staunch atheist I can’t conform to the “higher power” parts. I know you can define it however you choose, but it’s pretty obvious it means “god,” no matter what you name it, and it offers me no comfort.

  14. JM says:

    http://www.youtube.com/watch?v=mNwj_n7ElQw – Really funny but not accurate. Feel free to post in your blog though. 🙂

  15. The Edge says:

    If it helps just one person overcome his addiction, it is definitely *not* worth it. Not only does it waste time and money for all the other people who try it, but it also adds to their sense of frustration and hopelessness as they find themselves paying yet more money to yet another professional for another treatment that doesn’t work. Honestly, after a man tries two or three different methods it’s enough to make him want to give up.

  16. Jack says:

    agreed completely. you can’t denounce tools, they all have their use for something.

  17. David says:

    yup I agree

  18. Medication can be good as an adjunct, but most people don’t understand that substance abuse is as much about lifestyle as it is about NTs. The appearance of the “dry drunk” and “addiction swapping” are two very salient things that need to be addressed.
    There is something to be said about “not getting to the root”. While a CBT approach can be helpful for symptom management, you end up focusing on the Smoke and not the Fire.

  19. […] of unilaterally bashing (or praising) a singular approach to complex animals was first delineated here for the treatment of alcoholism, and the same holds true for depression. The sheer number of possible symptom clusters, the […]

  20. […] I pointed out here, the Shrink World can never accept something that benefits people if it doesn’t suit its […]

  21. Interesting. Learned something new. Very nice.

  22. I like Ones style man

  23. BL1Y says:

    Can you discuss what the drugs actually do? Are they interfering with whatever part of the brain craves alcohol? Helping with detox? Antidepressants so you don’t have as much cause to drink? A job so that you have less time to drink during the afternoon?

  24. Rob Dobrenski says:

    Just like a lot of other drugs in the realm of mental health, no one really knows.

  25. Joanna says:

    Totally agree with your take on purists, one size fits all especially doesn’t apply to these very complex issues.

    Anyone who is a zealot is dangerous!

  26. I do not even know the way I stopped up here, but I thought this put up used to be good. I don’t recognize who you’re but certainly you are going to a famous blogger when you aren’t already 😉 Cheers!

  27. Alcohol will rip appart any chance of good health in your resources. If you dont end your addictive ways you will se your body and mind decay.

  28. Seviah says:

    Moderation management seems really to have helped my friend Keith, who, hospitalized for three days has characteristically counted the site’s month’s recommendation. It might help me too. I’ve never “quit” anything, only stopped, which seems more or less in keeping with AA’s day -to-day philosophy. If I were to go out, date, leave the sofa, I’d enjoy the Basil Hayden or Cab mix no doubt, and my history with drink involves you know how I toured Europe with my mother, Cali (think SIDEWAYS) but my use of alcohol now remains medicinal, secondary. My interest in resuming a life that I actively control, one that I don’t have constantly to apologize to you about, remains primary. Almost within grasp, still elusive.

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