Cure for alcoholism pill Cure for alcoholism naltrexone Cure for alcoholism 2014 Cure for alcoholism sinclair Cure for alcoholism in islam Natural cure for alcoholism Vitamin cure for alcoholism Gold cure for alcoholism Best cure for alcoholism Oppenheime. Can you treat alcoholism with pills? - The Portland Phoenix

In an office in Portland, one of the top cities in the world for beer drinkers, Dr. Mark Publicker meets his last patient of the day, let’s call him Mike, a doctor addicted to alcohol who lost both his practice and his marriage as a result. Mike’s there to inquire about a medicine, a drug called Naltrexone which removes the drinking-induced high. Cure for alcoholism.

But can you treat alcoholism with pills? And if so, why haven’t we heard of it?

Publicker is part of an emerging contingency of doctors who question the treatment of alcoholism with Alcoholics Anonymous and abstinence alone. When he headed Mercy Hospital’s Addiction Recovery Center, where 70 percent of the patients were alcoholics, his doctors regularly prescribed drugs like Naltrexone, an opioid blocker, which reduces both the high and the kind of subconscious level impulsivity that causes over-drinking and Topomax, an anti-seizure medication which reduces total of days drinking and drinks per day.

The hardest to treat — homeless people — were given an injectable version of Naltrexone, called Vivitrol. “With the constant stress of life on the streets and access to alcohol, it is almost impossible for a homeless person to stay sober,” Publicker says. Still 50% of his patients stopped drinking while taking them.

But not everyone agrees with the medical approach. Hold-outs we talked to include a local pharmacologist and two criminal attorneys, talking off the record. Plus there’s the $35 billion dollar inpatient addiction treatment industry that’s based on AA alone, an industry that could be radically disrupted (think the impact of Netflix on video stores) if treatment shifts towards outpatient prescriptions plus therapy.

The arguments of those who oppose medication for alcoholism fall along a few basic lines: First, there’s the substitution issue: “Substituting” naltrexone for alcohol is like like methadone for heroin, one drug for another. It’s a somewhat apples to oranges comparison since methadone is an opioid and naltrexone an opioid blocker, but most people don’t understand the difference.

Part of the confusion is that the misuse of addictive medicines like Oxycontin and Vicodin will turn cure seekers into drug abusers.

No one gets high from an opioid blocker like Naltrexone, but it is a chemical and it does alter brain chemistry, kind of like Prozac.

Second, and more heartfelt, is the Underlying Cause issue: Medicine is not really a cure since the underlying emotional causes of addiction are not addressed.

“It will come out in other ways,” a criminal attorney told me, “like pushing in the air from one side of a balloon.” We heard this theory a lot. It makes sense.

An offshoot of the Underly Cause issue is the Moral Catastrophy theory: Drinking, like gluttony, is a moral choice that needs to be confronted consciously, not medically, otherwise, how will the dependent understand how wrong they are?

It’s not easy to decipher who believes what and why. A local pharmacologist, though admitting never having prescribed drugs for alcoholism, said he just does not think opioid blockers like natrexone will work.

Language is usually telltale sign; some people talking about alcoholism talk about dependence, some about addiction. Some refer to opioid blockers as medicine, some refer to them as drugs.

But the pro-medication side of the argument, also has some heavy hitters. The best known national advocate is Dr. Mark Willenbring, t he former Director of Treatment and Research at the National Institute for Alcohol Abuse. According to a recent article in the New York Times, Willenbring was so impressed by the results from research on new treatments that he started an outpatient treatment center in St. Paul called Alltyr, which combines medical treatment with behavioral therapy. Willenbring does not require patients to submit to a higher power, and pledge total abstinence for life.

In Maine, Publicker has taken a relatively moderate approach; he supports AA in addition to medicine. He wants his patients to quit entirely. His credentials are impeccable: Former Director of Mercy Hospital’s Addiction Recovery Center, past president of the Northern New England Society of Addiction Medicine, Editor-in-Chief of the American Society of Addiction Medicine Magazine and the 2009 caregiver of the year by the Maine Medical Association in 2009.

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Still his new private practice is one of the few places in Maine that alcoholics can go for medical treatment.

One reason is simply the scarcity of medical addiction specialists; there are only 3,500 medically trained addiction specialists like Publicker for 18 million alcoholics in the U.S., that is 5% or so of the population. Less than 1% of alcoholics seeking treatment in the U.S. receive any kind of medicine. After the Mercy Hospital’s Addiction Recovery Center closed last summer, the largest and only outpatient addiction treatment center in the state, there are few options available here.

Primary care doctors could pick up the slack, but they recieve only a day or two of addiction training in medical school. For example, Publicker is on the faculty of Tufts Medical School, but medical students spent just a half a day with him at Mercy’s Center. When it closed, the training program died with it.

Today when Publicker prescribes Vivitrol, to patients, their primary care doctors often refuse to inject it.

And there are deeper belief systems at work.

“Doctors are like everyone else. They have their own beliefs and feelings towards addiction. If they are not interested they don’t go to the conference,” says Publicker.

Here’s the science: About 50% of alcoholism is genetic; one in ten people who over-drink for long periods will develop the disease, which means a change in brain chemistry that causes extreme compulsion, “beyond what anyone without addiction can appreciate” Publicker explained. The compulsions are both neurological - hence the use of medicine - and psychological, responding to “neutral,” triggers like opening the refrigeration after a stressful day at work and thinking about a cold beer. The first beer creates impulsivity that leads to the second, and so on.

In the early 1990’s scientists in the U.S. first gave Naltrexone alcoholic rats. Ordinarily, rats won’t drink alcohol, but when submerged in an alcoholic mist they get hooked; and given a choice of two levers, begin to choose to press the lever for alcohol over food. They found that after injecting rats with Naltrexone they back eating food again. Interestingly enough, stress is also a major trigger; increasing stress by electrifying the cage floor caused the rats to relapse.

Naltrexone was approved for use to treat alcoholism in the U.S. as early as 1994, twenty years ago; two additional major studies at Yale and University of Pennsylvania showed a greater than 40 percent decrease in drinking with humans who took it, Publicker said. There are now 120 clinical studies, including one by a Finnish treatment center with more than 5,000 patients over 18 years and a 78 percent success rate in eliminating or reducing alcohol consumption to normal with the drug plus therapy.

“I began in prescribing it when I read about the rats,” Publicker says.

But are we rat-like or do we, as conscious beings, have something more like free will? Shouldn’t we be self-reliant and willful enough to just stop? Put another way, is it dangerous to expect medicines — or drugs if you will — to do it for us? Publicker says it does not really matter.

“Look, if there was a fat guy with hypertension and I gave him the drug atenolol, I would not be accused of encouraging him, to never get off the couch and to eat all he wants.”

“If I can give someone a 40 to 60 percent increase in their ability to refuse a drink, and encourage treatment and AA meetings and a lot of things, why not? With addiction is rarely going to be just the medicine.”

“There is no conflict between between taking medicine and going to AA” Publicker says. “Bill Wilson the founder of AA always hoped there would be medicine.”

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Not everyone in the pro-medication movement is also pro-AA. In fact, an article by Gabrielle Glazer in Atlantic Magazine last summer, blames the lack of adoption of available medicine squarely on Alcoholics Anonymous, which she describes as kind of a religion-based 19th century snake oil, ie unscientific and unreliable. She claims the only success rates she could find are in the single digits. AA participants responded with thousands of emails, many of them negative, even suggesting “may your children be killed by drunk drivers.”

What everyone does seems to agree on, however, is that the business model for the addiction treatment industry — from alcoholism to opioids — is broken.

“There are inpatient treatment centers charging $20,000 a month whose only treatment is AA,” Publicker contends. “They reject any medical treatment and their patients cycle, cycle, cycle,” he says, back to addiction, and thus more expensive treatment.

Publicker has voiced this same criticism of Gov. Paul LePage’s bipartisan plan to invest $2.4 million in treatment for opioid abuse, including a 10-bed detox center, with no money for medicines like methadone plus suboxone he has found to be the only workable, shall we put it, fix. The highly publicized debate over how to treat opioid abuse often spills over into any question quietly raised, about how to treat alcoholism, a more widespread problem.

Publicker’s interest in addiction started early on; as a young family doctor working for a nonprofit HMO in Western Pennsylvania in 1980 most of his patients were steel workers. He noticed something odd.

“These guys had elevated liver enzymes, uncontrolled blood pressure and gout. I figured they must have been poisoned in the steel industry; it was the only explanation.”

Then someone gave him a book on addiction, “I woke up the next morning slapped my forehead and said Oh My God all my patients are alcoholics.”

Back then there were no medical text books or conferences on alcoholism, so he set out to figure it out, going to AA meetings which “is very weird if you are not an alcoholic” and talking to his patients. About six months in, he says, “I started to get God Bless you letters from patients and family and I got hooked,” he pulls at the imaginary hook in his cheek.

He joined the American Society of Addiction Medicine and became a conference junkie just as the science began to uncover the biological mechanisms of addiction to both alcohol and opioids.

Since then he has treated addiction in homeless alcoholics from Deering Park to “feral” street boys huffing paint thinner in Gaziantep, Turkey. His patients include Portland business owners and retired investors, the functional and the desperate.

In a hallway photograph, surrounded by a group of smiling Chinese people, Publicker looks like he sponsored a soccer team. The photo is actually of the first AA group in mainland China, who trained to become lay addiction counsellors at a time when there were no addiction treatment centers in China, a culture with 300 million alcoholics.

Today, Publicker believes it is the U.S. that has fallen behind Europe in the treatment of alcoholism and other addictions. He speaks to doctors on the subject about ten times a year. With a grant from the Lunder Foundation, he is currently developing a set of neutral questions to allow doctors to identify alcohol abuse in patients, a tricky conversation.

But the journey has not been easy. Along the way, the Gaziantep, Turkey, where Publicker treated homeless boys in a center 30 miles from the Syrian border, has been overrun by ISIS.

Mercy Hospital’s Addiction Recovery Center, the largest treatment center and only outpatient center, fell victim to LePage’s cuts to MaineCare and closed last summer.

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After all these years is there one patient that stands out his mind?

There was a homeless woman, Susan, he says, that he still thinks about. She was about five foot four, 100 pounds with a great smile. She grew up like many of the homeless addicts in Portland enduring sexual and physical abuse, and winding up living on the streets of Portland, an alcholic, for about 20 years. During that time she was readmitted ten times a year or so to Mercy for detox.

He told her that “With Vivitrol injections (that last a month) she would not have to do anything.”

“She got it. She started on it, and lo’ and behold, she stopped drinking. She would call us and say ‘I’m due for the was a sweetie.”

This story also does not have a happy ending. After four shots and four months sober, Susan went missing. Publicker does not know whole story, he just knows that homeless people often pool their money, hole up in a hotel room and drink. In 2006, Susan was found dead in a hotel room. She was 47.

Out the window of Publicker’s new, smaller private practice office the view is peaceful; sometimes the Fore River rises, crawling up the banks to the ground floor of the building, but on a rainy day in February, the water pools, restfully reflecting the trunks of barren trees.

If you walk up the trail and go toward the waterfall, Publicker says, you will find the homeless encampments.

“Here’s a medicine that frees homeless people. About 50% of them were able to totally abstain or cut down their drinking while taking it.”

Do you have a soft spot for the homeless? I ask.

“I have a soft spot for everyone,” he says. “Listen, there is famous old quote, by Philo of Alexandria, in around 25 B.C. ‘Be kind, because everyone you meet is fighting a great battle.’”

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