Medical Treatment of Alcoholism Online Conference Transcript

Written by HealthyPlace.com Staff Writer

Joseph Volpicelli M.D., Ph.D., our guest, pioneered the use of therapy combined with medications to treat alcoholism. In his new book, "Recovery Options:The Complete Guide, Dr. Volpicelli explains all the options to treat alcoholism.
(find here the basics of alcohol abuse treatment)

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Medical Treatment of Alcoholism". Our guest is Joseph Volpicelli M.D., Ph.D. Dr. Volpicelli is an Associate Professor of Psychiatry at the University of Pennsylvania and Senior Scientist at the Pennsylvania VA Center for Research on Addictive Disorders.

During the past quarter century, he has pioneered the integration of medications with psychotherapy support to treat addictions. His research on the use of Naltrexone led to the first new medication to be approved by the FDA for alcohol treatment in nearly 50 years. Dr. Volpicelli is also author of the book: "Recovery Options:The Complete Guide".

Good Evening, Dr. Volpicelli, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Have we arrived at the point yet where there are medications available that will stop, or greatly reduce, the alcoholic's craving for alcohol? (How much is too much alcohol?)

Dr. Volpicelli: Thanks for the introduction, David, and its a pleasure to be here. To answer your question, I believe that we now have effective medications that can greatly aid in recovery from alcoholism. Medications such as Naltrexonecan very effectively reduce craving for alcohol and reduce the chance of a relapse.

David: What medications are available today to help alcoholics and what do they do?

Dr. Volpicelli: The two medications that are approved in the United States are Antabuse, a medication that when combined with alcohol can make you feel ill. And in 1994, a new medication was approved by the FDA, Naltrexone. This is a new class of medication, that can actually reduce the desire to drink and the "high" one gets from drinking. People may have heard of several newer medications that are being tested such as Acamprosate (Campral) and Ondansetron. These medications may be helpful for certain types of alcoholics.

David: Is there any conclusive research out yet, that indicates a physiological reason why a particular person becomes addicted to alcohol?

Dr. Volpicelli: There are several studies that clearly point to a genetic basis for why some people become addicted to alcohol. We have conducted studies that show the release of endogenous opioids (endorphins) is higher in people at risk for becoming an alcoholic. Also, some people may be protected from abusing alcohol because they are very sensitive to the sedative effects of alcohol. They fall asleep before they experience the alcohol "high".

David: What, would you say is the most effective long-term treatment for alcohol addiction?

Dr. Volpicelli: I believe that alcoholism is a biopsychosocial disorder and the best long-term approach to treatment is to combine a biopsychosocial approach. This includes the use of medications such as Naltrexone, and also psychosocial support to help people learn to cope with life without alcohol. Often people have damaged their social relationships from their alcohol addiction, so recovery includes reconnecting with family and friends. For some people, support groups like Alcoholics Anonymous (AA) are helpful, especially in reducing the shame associated with having an alcohol problem. In general, the best approach is individualized to meet the needs of the patient.

David: The relapse rates among alcoholics are very high. Some 50% relapse within three months of starting treatment and 75% within the first year. Can we say that therapy alone, whether it be a 12-step program like Alcoholics Anonymous (AA) or a residential treatment program or individual therapy just isn't that effective for most alcoholics?

Dr. Volpicelli: I would say the glass is half full. Psychosocial treatments are effective for some people, and even among people who relapse, one can often get them back into treatment. Of course, if we can combine medications and reduce the relapse rates further, as appears to be the case, then it is wise to use every available tool to aid in recovery from alcoholism.

David: Here are some audience questions, Dr. Volpicelli:

mwolff: What are the major side-effects of Naltrexone?

Dr. Volpicelli: Most people taking Naltrexone do not report significant side-effects. However, when side-effects are reported, they are often mild and disappear in a few days. These side-effects include nausea in about 10% of people, and for some, tiredness, headaches, or irritability. We can often manage the side-effects by giving Naltrexone at night or with food. On those rare occasions when side-effects persists, Pepto-Bismol can help.

jeffgrzy: How can medication get rid of a craving for alcohol, when cravings are beyond the physical, such as selfishness, resentments, fears, and ego?

Dr. Volpicelli: There are now several studies that show how emotions can affect the brain chemistry. So for example, feelings such as anger or fear, cause biochemical changes in the brain and can increase the craving for alcohol. The use of medications can help block craving for alcohol caused by unpleasant moods or even reminder cues for using alcohol.

aurora23: How do you know if you are an alcoholic or just a social drinker?

Dr. Volpicelli: The best way to decide is to ask yourself: how well can you control your drinking once you start? For alcoholics, it is said in Alcoholics Anonymous (AA) that one drink is too many and 100 drinks not enough. This points out that for the alcoholic, one drink increases the desire to have the next drink creating a vicious cycle of alcohol addiction. This addictive cycle typically leads to problems with physical, psychological, or social health. The social drinker, on the other hand, is able to limit their drinking once they start.