Hi

as requested a thread about the Heinala paper 2001

Title: Targeted use of Naltrexone without prior detoxification in the treatment of Alcohol dependence: A factorial double blind, placebo-controlled trial.

Authors Pekka Heinala et al. Senior author John D Sinclair

Journal: J Clin Psychopharmacol 2001; 21: 287-292

Study aim: To replicate other studies and test new strategies for increasing the efficacy of naltrexone in the treatment of alcohol dependence. The study design was of the highest 'quality' in that it was a prospective, single centre, double-blind,32 week trial comparing naltrexone to placebo. All subjects included had not been detoxified of alcohol prior to starting the trial. Other bahavioural methods were included - counselling to enhance coping skills etc. The first 12 weeks were seen as an 'induction period' and the final 20 weeks with targeted medication (taken only when craving was high) was considered the test period.

Conclusions: The study confirmed the original findings regarding the efficacy of naltrexone in conjunction with coping skills therapy (those figures of 75% upwards). In addition, their data show that detoxification is not necessary and that targeted medication taken only when craving occurs is effective in maintaining the reduction in heavy drinking.

My comment

The key thing for me from this paper was the length of time of the trial and the fact that the first 12 weeks were seen as the induction period and the following 20 weeks considered the trial period proper. That really does mean we are still all in very early days. Although the original rats did not need counselling etc to achieve success, it is probably true also that their behaviour - although they are clever little things - is more instinctively driven than 'intention' driven. I don't think they consult the financial times before investing in the stock market if you know what I mean. If they become alcoholic in a laboratory situation I suspect they just respond automatically to the increased 'drive' they have developed for alcohol. Similarly when the naltrexone kicks in and does it's job they probably don't even notice it. They have relatively simple brains and relatively simple neural pathways which can be 'pruned' quickly. We, by our very human nature, philosophise about everything - including our attachment and detachment to alcohol. Our brains are much more complex and the neural pathways more numerous. Those involved with alcohol reinforcement have probably also been strongly 'hooked into' other systems and therefore not only do the primary addiction pathways need pruning - but also the connections between those and other brain systems may also need to be cut in some individuals. This may explain why some of us may have to practice 'seeing it to be it', in the case of changing addictive behaviour and attitudes.

Have you all seen Dr Escappas recommendation to look at a link on his The Cure For Alcohol site? It has a link to an audio interview with a girl who has successfully beaten a very hard core alcohol addiction. It is interesting that she has had a dramatic and rapid response to her very serious drinking problem. I am only speculating but, it is possible that there is a stong correllation between severity of addiction and speed of success. This has yet to be tested. Search through Dr Escappas questions if you cannot find the link - you will find it there.

Lets all keep our eye on the goal

Camelia

Thank you for this, Camelia - and for your comments. I also am encouraged to see that these clinical trials considered the first twelve weeks as only an induction period. Has anyone here completed a full 32 weeks, as yet? Maybe potato, who considers herself cured. Most of us are still in the very early stages. LaBear? You're only 1/3 of the way into the induction period!

Another thing I've been thinking about. Does being cured of alcoholism necessarily mean we will never again drink to excess? I know many people who are definitely not alcoholics who still over-indulge on occasion.

The point I'm trying to make is that we need to set realistic expectations. This is a process that's going to take several months. The entire process may take a year or more. We may not get the exact results we want and expect. What we will get is a measurable decline in our consumption of a potentially life-threatening product. We will drink within safe and reasonable limits - or perhaps, not at all. The more I get into this, the more I'm considering abstinence as a goal.