Friday, October 12, 2007
Fighting addiction
I once worked with an alcoholic. Let's call him Jarred. A bright man, energetic, lots of fun. But he could never make it to work on time. He didn't keep appointments. Sometimes he would just disappear for days. Eventually we had to part ways. We just couldn't get any work done. I never saw him drink, but I knew he had an alcohol problem and there was nothing I could do to stop him. He had to do it himself.

So about six months ago, it was with great relief that I learned Jarred was now in therapy and taking a drug to curb his alcoholism. I had heard of therapy but not the drug. So as I did more research I found that there are drugs on the market being prescribed to alcoholics every day, helping them to curb or fight their cravings for a drink. Addiction experts say it's a baby step towards solving a big problem, but at least pharmaceutical companies are headed in the right direction.

Now a new study in the Journal of the American Medical Association has found that a drug usually prescribed to severe migraine sufferers or epileptics can actually help alcoholics curb their consumption within 14 weeks. (Link to story)

The drug is Topamax. The study found that alcohol-dependent patients who received the medication had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received a placebo. In many cases patients on Topamax had a significantly higher rate of achieving 28 or more days of continuous non-heavy drinking and 28 or more days of continuous abstinence. But there were side effects.

Many patients had problems with concentration: They were very confused while taking the medication. Others complained of tingling, dizziness, itching. But a positive side effect was weight loss. Unlike the other drugs designed to treat alcoholism, Topamax actually caused the patients to lose weight. And that's important. Dr. Peter Martin, director of the Addiction Psychiatry Training Program and the Vanderbilt Addiction Center in Nashville, Tennessee, finds many of his alcohol-dependent patients are either overweight or diabetic because alcohol has a lot of calories. He feels any drug that can help them fight their addiction while keeping their weight down is a plus.

For now, Topamax has not been approved by the FDA for use in alcoholism, but that approval may be just around the corner. The manufacturer hopes the drug will help those heavy drinkers who would rather see their doctors to help them with their addiction, instead of going into expensive rehab centers. Physicians say these drugs bring new hope of fighting an addiction that at one time seemed hopeless.

I haven't heard how Jarred is doing since he acknowledged that he is an alcoholic. I can only wish that with therapy and the help of these new medications, he will be able to find peace and a new direction in his life.

Know of someone who's using therapy and prescribed drugs to help them fight their alcoholism? Tell us about it.
Topamax's effectiveness at treating alcohol dependence has been known for awhile. The research articles I know of, including randomized trials, go back to 2003. Other drugs for treating alcoholism have been around a lot longer than that, but are mainly known by people in the medical community or people who have gone through addiction treatment. I'm guessing this latest Topamax study got a big press release because it was funded by the manufacturers of Topamax, who want the public to know about it so they'll go request it from their doctors.

What I worry about is that people will go to their primary care physicians (who are not qualified to form an addiction treatment plan), request Topamax, and receive it without a full evaluation or being required to attend addiction therapy in addition to taking the medication. The same thing happened with medications for depression and anxiety, which has lead to problems with misdiagnosis, inappropriate prescribing patterns and limited treatment effectiveness, as well as created a health insurance environment where people with mental illnesses are expected to be treated by drugs or else they'll be "carved-out" into a different plan that discriminates against them for having a mental illness that can't be treated by a primary care physician. I predict that once the FDA approves Topamax for alcohol dependence, insurance companies will start covering it and limiting coverage even more for people who want to attend addiction therapy.
I am thrilled to see dialogue about choices for addiction treatment being discussed in this forum. Topiramate, trade name Topamax, is but one of many medication that have been studied for the treatment of alcoholism. There are three FDA approved medications approved for the treatment of alcoholism: antabuse which causes a violent reaction flu-like reaction if the person drinks while using it, acamprosate which helps to treat the difficult post-acute withdrawal symptoms in early recovery and naltrexone (both oral and injection for long-term use) which helps to reduce cravings. It is extremely important that any individual who is prescribed medication by a knowlegable prescriber also receive one of the many evidence-based therapies for addiction. Unfortunately in the U.S. many lack health insurance for these treatments. Despite the fact that more than 50% of all emergency room admissions are drug or alcohol related our legislators and health insurers have yet to add the pieces together that treatment will save dollars in the long run. Treat addiction, save health in individuals overall. Best example is nicotine addiction and lung cancer. No brainer. Someday the U.S. will figure it out. Until then, only the wealthy will be healthy!
Dr. Gupta,

I am a recovering alcoholic that is in AA. I was once on Topamax for bi-polar disorder (common in alcoholics) but was told after 2-3 years that it was no longer effective. I did take it when my life became very stressful and it took cravings away, but, Topamax eventually was replaced by another drug to treat my bi-polar disorder. And, I remain sober today.

I am concerned that the advertisement of Topamax as a craving deterrent may mislead people into thinking that this will "cure" alcoholism. According to the NIAAA and Alcoholics Anonymous, total abstinence is the true cure, not a drug. The drug can get you through the initial cravings and behaviors, but for long-term sobriety, programs such as Alcoholics Anonymous are far more effective. This must be made clear.
Topamax MAY cause weight loss.

That's not always a side effect. I've been taking it for migraines, and I must be the only person on the planet who has gained weight on this drug. I was seeing a nutritionist and a personal trainer at the time I started and still I picked up 20 pounds. Don't try this as a way to lose weight!

The side effects are real; it can also exacerbate seizures. Go to a doctor who has experience with this medication, and stay monitored.
I have taken Topamax in the past, and from my personal experience with the drug, I could easily understand why alcoholics would take fewer drinks per day, simply because they are too busy staring at a wall.
Does this work w/other kinds of addiction like gambling? Just wondering.
I can't believe this! I'm on Topamax for migraine and it says right on the bottle not to use alcohol. Topamax is a central nervous system depressant and so is alcohol. Put them together and you can stop breathing!

Also, the side effects are indeed terrible. I wouldn't take it except its better than migraine every day. Oh, its also 10 dollars a pill. Stop it suddenly and you'll get convulsions. I suggest alcoholics try AA, which is free and has no life-threatening side effects.
Drugs to cure alcoholism could be a great thing! I would like to point out that Topamax is no picnic. I took it for migraines a couple years ago. I'm alreay on the thin side, and I lost 10 pounds. I had constant tingling in my fingers and terrible dry mouth. I knew I had to go off the medication though, when I couldn't remember my own home address.
That being said, not everyone will experience the same symptoms. And if it works to cure an alocoholic from drinking, that can only be a good thing!
This is an interesting blog, but not even touching the surface. I watched this story on America Morining last week. It struck me as very simplistic. CNN needs to consider doing and investigative report to help the American people understand that chemical addiction is a brain disease and not a moral choice. That stigma continues to plague the recovering community and prevent both the addict and treatment providers from gaining the support they need to beat this terrible disease. I have been providing services to drug addicted individuals for 22 years and have watched many families destroyed by their family members addiction, and in too many cases the death of the addict. There are several medications now on the market that are blocking the highs from these killer drugs. Topomax, Naltrexone, Vivitrol IM, Bupenorphrine just to name a few. These medications would not have any positve affect unless the addict or abusers brain were not chemiclly altered. Please consider investigating further and helping us to address the stigma.
Hello readers,
Let me tell you a little about me I am an alcoholic and addict. I am also a firm believer in medicine. While I believe this drug to be a wonderful step in progess towards fighting addiction, from experiences in life I know it is not a lasting fix. I am in the program of Alcoholics Anonymous, I see people come in daily. Men, woman, and teens who have a common problem. Alcohol is a sympton of alcoholism once you stop drinking there is more to it. Therapy is a wonderful tool, not just any thearpy, but working with other alcoholics and addicts. I myself could not believe in such nonsense until I experienced the alluring power other alcoholics carry. They carry the power to understand my reasons for drinking, they share similar experiences (many frowned upon by society), and show me how to overcome myself. In AA one is not just recovering from Alcoholism, but in fact life it self.
"Better to understand than be understood"
If you think you may have a problem with drinking try 30 days of AA meetings and see how you feel, after you get involved and work the 12 steps. I have yet to finish them still in my fist year of sobriety, yet already my life has had amazing changes... love
I suffer from migraines and had to take two three month courses of Flunarizine (a calcium blocker). A great drug but the major side effect is weight gain. I may ask for Topamax next time.
AA is a cult and destroys more families than it helps. God forbid anyone come up with a cure for this "disease" that doesnt involved daily brainwashing sessions with coffee guzzling chain smoking old farts reciting their glorious tales of falling down drunk.

Drunks in AA are just addicted to meetings instead of booze.
I think it's so interesting that we as a society permit the FDA to tell us about various drugs and medications. Did you know that doctors have around 1 hour of education on the disease of alcoholism? Alcohol is the most socially acceptable drug in the world that takes more lives that half the medications the FDA and the US goverment take off the shelves. Does this take a rocket scientist? Why do we tax cigarettes and the goverment paqys billions for advertising, "not to smoke? I guess the tobaco industry isn't paying the politicians enough. Do you think it's possible that the beverage industry is?
I feel excited knowing that there is a drug, called Topamax to help alcohol addiction. Topamax is usually prescribed for severe migraine sufferers or epileptics. I think that therapists should use this drug to help their patients. Negative side effects of this drug are tingling, dizziness, itching. But the positive effect is that you loose weight. People who have alcoholic problems should start using this drug and plus go to therapy.
The use of Topamax to aid in alcohol abstinence is wonderful. However, alcoholism is a disease that is progressive in nature and has a predictable outcome. At the present time, and over the past 70plus years, nothing has worked more effectively for alcohol abstinence than Alcoholics Anonymous. This program addresses alcoholism at its root causes and provides solutions which help people remain alcohol free and live happy, productive and healthy lives. Perhaps drugs like Topamax will help individuals bridge the gap. With alcoholism, drinking alcohol is just one small component to the disease. Excessive drinking is a symptom of the larger disease. This is not speculative, there is much sound medical research to support this. While drugs like Topamax are encouraging, they do not address the disease of alcoholism other than to help reduce drinking. Once drinking is eliminated, you are left with the disease and are in need of help to learn how to live life with the absence of alcohol. Again, I think the development of drugs like Topamax are encouraging and life changing, but people need to be properly educated about the disease of alcoholism, and to understand that excessive drinking is only a part of this deadly disease.
I am a 24 year old recovering meth addict. I used for 6 years and tried many ways to quit including attending narcotics anonymous meetings. Finally I was prescribed topamax by an addiction medicine specialist. After struggling over and over to get even 2 weeks clean, I have now been clean for over 9 months with no relapses.
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