Pathways to Recovery

for Alcoholics
Drew Pinsky, M.D.
Medical Director
Department of Chemical Dependency Services
Las Encinas Hospital
Los Angeles, CA

March 1, 2006
Criteria to Identify Alcoholism
3 or more criteria (during 1 year)

¾ Tolerance
¾ Alcohol withdrawal signs or symptoms
¾ Drinking more than intended
¾ Unsuccessful efforts to stop or reduce drinking
¾ Use despite physical or psychological
consequences
¾ Excessive time spent drinking or recovering
¾ Impaired social or work activities due to alcohol
 Treatment Goals for Alcoholism are Evolving
Based on Emerging Science
Complete Abstinence Relapse Prevention Emerging Science

According to the APA, “Relapse prevention Normalize imbalanced

the goal for alcoholics is the central concern brain systems
is to stop drinking of alcoholism
altogether treatment”

Enoch Gordis, M.D.

STOP
Former Director
DRINKING
National Institute on
ALTOGETHER Alcohol Abuse and
Alcoholism

Sources: Koob GF, et al. Neuron. 1998;21:467-476. Messing RO. In: Harrisions Principles of Internal Medicine, 15th ed. 2001:2557-2561.
Source: Sass H, Soyka M, Mann K et al. Relapse prevention by acamprosate. Arch Gen Psychiatry 1996;53:673-680.
 Only Three FDA-Approved Treatments for
Alcoholism Over the Past 55 Years

1949 45 years 1994 10 years 2004

Disulfiram Naltrexone Acamprosate

(Antabuse®) (ReVia®) (Campral®)

Aldehyde Opioid receptor Glutamate

dehydrogenase antagonist receptor
inhibitor modulator
Blocks the “high”
Induces vomiting associated with Restores normal
after alcohol alcohol intake brain balance
intake

Antabuse® is a registered trademark of Odyssey Pharmaceuticals, Inc. ReVia® is a registered trademark of the DuPont Merck Pharmaceutical Company; Campral® is a
registered trademark of Merck Santé s.a.s., subsidiary of Merck KGaA, Darmstadt,Germany
Source: O’Connor PG, et al. N Engl J Med. 1998;338:592-602.
Comparative Safety of Disulfiram, Naltrexone, and Acamprosate

Disulfiram Naltrexone Acamprosate

Safe for use during No Yes Yes
relapses?
Safe for use in patients No No Yes
with hepatic impairment?

Drug-drug Interactions • Alcohol or alcohol- • Opioids • None known

containing preparations • Opioid-containing products

Contraindicated in • Hepatic cirrhosis • Opioid dependence • Severe renal

patients with these • Hepatic insufficiency • Opioid analgesic Rx impairment
conditions • Acute liver failure

Possible severe AEs • Optic neuritis • Hepatocellular injury • None known

• Peripheral neuritis
• Polyneuritis
• Peripheral neuropathy

Sources: Antabuse® (Package Insert), ReVia® (Package Insert), Campral® (package insert)
 Case Studies:

Successfully Treating Patients

for Alcohol Dependence
 Barriers to Treatment
¾ Stigma
– 91% of primary care physicians surveyed believe that there is a stigma towards
alcoholics; that figure goes down to 71% once those people enter recovery

– 80% of the general public surveyed agrees that there is a stigma towards alcoholics,
although the number drops to 51% once an alcoholic enters into a recovery program

– 56% think that alcohol is a disease

– Additionally, 34% think it is a disease combined with a personal or moral weakness

¾ Unmet educational needs for primary care physicians and treating alcoholism
– Primary care physicians are the front line
Š Education on available treatments
Š Diagnostic training
Š 51% has prescribed Antabuse® at some point, only 22% are currently doing so
Š Only 26% of primary care physicians have experience with ReVia® and 15% have
experience with Campral® (acamprosate)

Source: Survey conducted by Peter D. Hart Research Associates , August 2005, among 1,000 adults age 20 and over, 300 physicians (in general practice or internal
medicine) and 503 people in recovery from addiction to alcohol.
 General Public is Receptive to Medication and
Welcomes Educational Awareness
¾ 83% of the general public surveyed would encourage a loved one to try a
physician-recommended medication in conjunction with psycho-social
support to their problem with alcoholism, but only 13% are aware of the
newest treatment options

¾ Additionally, 66% of the general public surveyed are not aware that there
are three FDA-approved medications for treating alcoholism (disulfiram,
naltrexone, acamprosate)

¾ 42% of Americans say that their primary care physician has never asked
them about their drinking behavior

¾ And 51% think that health insurance providers should require their
physicians to screen for alcoholism

Source: Survey conducted by Peter D. Hart Research Associates , August 2005, among 1,000 adults age 20 and over, 300 physicians (in general practice or internal
medicine) and 503 people in recovery from addiction to alcohol.
Source: Survey conducted by Opinion Corporation’s Caravan, March 24-26, 2005, among a national probability sample of 1,030 adults comprising 517 men and 513
women 18 years of age and older in the United States
Benefits and Solutions to Treatment and
Pathways to Recovery
¾ Earlier intervention through improved screening and
diagnosis of alcohol dependence
¾ Enhanced treatment effectiveness by supplementing
psycho-social support with medication
– Maintaining abstinence from alcohol
– Reducing risk and severity of alcoholic relapse
¾ Improved quality of life (QOL) and quality of care for
millions of Americans by breaking down the stigma
surrounding alcoholism
¾ Community networks (e.g. CADCA)