I have been so eagerly anticipating getting a prescription for Naltrexone. I lost my insurance, and have been in an uphill battle to get more insurance through COBRA (I got laid off). Now, I finally got the insurance, made an appointment, and asked the doctor for Naltrexone.

He scrunched his face and said, "I think that drug is for narcotics." I tried to explain The Sinclair Method to him, and I told him about the book "The Cure for Alcoholism." I even told him about this website. I would have walked him down a path, holding his hand, if he would have let me.

But he said... "There are FDA approved drugs for alcoholism. I'll write you a prescription for this drug called Campral. It is designed to actually eliminate cravings for alcohol." I had not heard of Campral, but I persisted anyway. I told him that I'd really prefer to go ahead and start Naltrexone. He said that prescribing Naltrexone for alcohol treatment is using a narcotic medication for something other than what the FDA has approved its use for. He said that he isn't 100% opposed to the idea, but he'd prefer to start me out on Campral and see if that works.

I am so disappointed. I have an appointment with him in 2 weeks for a re-check. I am not a doctor, and can't talk to him on that level. What can I say to him in order to make him see that this isn't some lofty, weird fad of a few fringe weirdos?

Inform him that he is a fugging idiot and that Naltrexone was approved by the FDA for the treatment of alcoholism in 1994, then ask for your money back.

[Acamprosate is Campral - E]

"Evidence-Based Treatments for Alcohol Dependence

New Results and New Questions

Henry R. Kranzler, MD

JAMA. 2006;295:2075-2076.

An estimated 8 million adults in the United States have alcohol dependence.1 Of this number, only a minority ever receive treatment for the disorder, even when treatment is defined broadly to include participation in Alcoholics Anonymous. Of the alcohol-dependent individuals who receive treatment, only a small fraction ever receive a medication specifically approved by the US Food and Drug Administration (FDA) to treat the disorder.

In 1994, the FDA approved naltrexone for the treatment of alcohol dependence.2-3 This followed by nearly 50 years the approval of disulfiram, which was approved prior to the modern era of efficacy review. Meta-analytic studies of naltrexone have shown that the drug reduces the risk of relapse to heavy drinking and, to a lesser extent, the frequency of drinking.4-5 In 2004, following use of acamprosate in Europe for more than a decade, the FDA approved this drug for treatment of alcohol dependence. Meta-analysis of the European acamprosate studies indicated that the drug helped alcohol-dependent individuals maintain abstinence once they had stopped drinking.4 In contrast to disulfiram, which produces an aversive reaction when combined with alcohol, both naltrexone and acamprosate appear to exert their effects directly on the individual's motivation to drink alcohol.

In this issue of JAMA, the report by Anton and colleagues6 of the results of the COMBINE Study provides evidence that an FDA-approved medication can be of benefit when used to treat alcohol dependence in routine medical practice. These authors describe the results of a randomized, placebo-controlled trial of naltrexone, acamprosate, and the 2 drugs combined, conducted at 11 sites in the United States. To accomplish the aims of the study, a complex study design was required. In addition to study medication, 8 of the 9 study groups received low-intensity medical management and 4 of these groups also received combined behavioral intervention, a high-intensity psychosocial treatment. In a design feature unique among trials of medications to treat alcohol dependence, the study also included a group that received only the behavioral intervention with no active or placebo medication, making it possible to analyze the comparative effect of a placebo on drinking outcomes.

This study of nearly 1400 abstinent participants was well designed and well executed. Nearly complete data on participant drinking behavior during the 4-month treatment period lends confidence to the findings. Overall, alcohol consumption decreased by 80% during the treatment period, and all treatments were well tolerated. Compared with placebo, naltrexone significantly decreased the likelihood of heavy drinking and increased the number of abstinent days, even in the absence of intensive behavioral treatment. Surprisingly, however, acamprosate, either alone or in combination with naltrexone, showed no advantage over placebo on any of the drinking outcome measures. When combined with placebo, the high-intensity behavioral treatment also increased the number of abstinent days. Participants who received the combined behavioral intervention, but neither an active nor a placebo medication, showed significantly less improvement than those who were treated with placebo, underscoring the substantial placebo response among these alcohol-dependent individuals. At 1-year posttreatment follow-up, although treatment effects were diminished and between-group differences no longer statistically significant, the direction of the findings was the same. This suggests that treatment may be required for longer than 4 months to produce sustained benefits.

While this important study provides evidence of the efficacy of some treatments for alcohol dependence, it also raises a number of questions. In view of studies from Europe providing consistent evidence that acamprosate helps to maintain abstinence,4 the lack of efficacy of this medication in the COMBINE Study is perplexing. Although population differences must be considered, differences in study design may have contributed to the lack of replication of the European acamprosate studies. The modest effects of the specific treatments and a lack of additive or synergistic benefits of combining treatments suggest that other compounds and therapeutic approaches should be explored to yield further improvements in the treatment of alcohol dependence.

The findings from the COMBINE Study should be of great interest to primary care physicians treating patients with alcohol dependence. Patients who decline an offer of pharmacological treatment to reduce their drinking can be referred for intensive behavioral treatment. Notably, however, the beneficial effects of naltrexone were seen in the context of medical management similar to what is routinely available in primary care practice. This offers the prospect that an efficacious treatment for alcohol dependence can be made as widely available as are current treatments for smoking cessation and major depression."

If it were me I'd sympathize and tell him that I could see how he missed the headline because it was 15 years ago. Then I'd complain that listening to him is giving me a headache and would ask if he's heard about a new drug called Tylenol that might be able to help with that.

Naltrexone IS FDA approved for use in the treatment of alcoholism.

First, the single largest study of alcohol treatments to date is called Project COMBINE and was published in 2006 in the Journal of American the Medical Association.

http://www.cscc.unc.edu/combine/#
That study showed Campral (acamprosate)to have low efficacy in alcoholism treatment. (Campral also has a nasty side-effect profile: Bad digestive tract upset; unlike naltrexone, these side effects do not dissipate after a few days). The same study showed naltrexone to be very effective in the reduction of consumption. A major finding of the COMBINE study is that it is appropriate for primary-care physicians to prescribe naltrexone as a primary treatment for alcohol problems, because it works without If you have Eskapa's book, bring it with you. If not, print out the relevant chapters found on this link:
viewtopic.php?f=3&t=6

Chapter 3 discusses the COMBINE study and Ch. 17 is directed at medical professionals. Both chapters contain the information I've set out here.

Hope this helps.

My doc sent me home with Campral just like yours. I later dropped off a packet that included a photocopy of the article Lo0p quoted, the chapter for medical professionals that lena linked to, a copy of the relevant wikipedia page on TSM, and a short letter asking for reconsideration of my request for support to evaluate this proven protocol.

I got a voicemail back from my doctor within two hours *thanking me for the additional information* and agreeing to give it a whirl. At my one-month follow-up she was very supportive and appeared genuinely interested. I am her first exposure to this in her practice. My experience has been practically text-book - it is working for me pretty much as advertised.

I think maybe docs just can't keep up with all the possibilities and the good ones welcome a rational pointer to credible sources.

I had a hand-pain doctor tell me one time that the reason they send almost everyone home after the first visit with the equivalent of a "take two aspirin and call me in the morning" is because a significant number never come back. From their perspective, that "treatment" works! Once someone comes back, only then do they really start to dig in to the problem. I think it's a form of triage, honestly.

While I'm being honest, it also CHAPS MY HIDE that TSM is so unknown in the medical community and folks have to dig so hard to get some support.