From the NYT:
By ANAHAD O’CONNOR MAY 13, 2014
Two medications could help tens of thousands of alcoholics quit drinking, yet the drugs are rarely prescribed to patients, researchers reported on Tuesday.
The medications, naltrexone and acamprosate, reduce cravings for alcohol by fine-tuning the brain’s chemical reward system. They have been approved for treating alcoholism for over a decade. But questions about their efficacy and a lack of awareness among doctors have resulted in the drugs being underused, the researchers said.
Less than a third of all people with alcohol problems receive treatment of any kind, and fewer than 10 percent are prescribed medications.
In the new study, which was published online on Tuesday in JAMA, the journal of the American Medical Association, a team of researchers based mostly at the University of North Carolina at Chapel Hill compiled findings from the most rigorous trials of medications for alcoholism in the past few decades. Ultimately, they analyzed data on roughly 23,000 people from 122 randomized trials.
The researchers focused on a measure known as the “number needed to treat,” an indicator of how many people need to take a pill for just one person to be helped. The study found that to prevent one person from returning to drinking, the number needed to treat for acamprosate was 12; for naltrexone, the number was 20.
By comparison, large studies of widely used drugs, like the cholesterol-lowering statins, have found that 25 to more than 100 people need treatment to prevent just one cardiovascular event.
According to federal data, roughly 18 million Americans have an alcohol abuse disorder. Excessive drinking kills about 88,000 people a year and costs the health care and criminal justice systems billions of dollars.
“These drugs are really underused quite a bit, and our findings show that they can help thousands and thousands of people,” said Dr. Daniel E. Jonas, the lead author of the new study and an associate professor of medicine at the University of North Carolina. “They’re not blockbuster. They’re not going to work for everybody. But they can make a difference for a lot of people.”
Since there appear to be biochemical routes to help combat alcoholism, I’d like to see a smart philanthropist like Bill Gates put some serious money into a research program to find out the optimal ways to help American Indians fight the alcoholism scourge. Substance abuse is a horrible problem on Indian reservations, and the white man bears a large measure of responsibility for coming here and introducing firewater to a race genetically unprepared for it.
North American Indians presumably haven’t yet evolved the genetic defenses against alcohol that Mediterranean peoples have developed over the last ten thousand years. Notice that in the Book of Genesis, scandalous stuff happens when ancient patriarchs like Noah and Lot get dead drunk, but by the time of the New Testament, people seem to drink responsibly at the Wedding Feast of Cana and the Last Supper: evolution in action.
Native American cultures often put a lot of effort into scrounging up various natural intoxicants (peyote, the peace pipe, etc.), but they were hard to find. That cultural emphasis was disastrous when palefaces showed up offering to trade jugs of distilled corn liquor for pelts.
There are a bunch of stupid laws in the U.S. restricting the genetic research on American Indians that might help figure out exactly what kind of anti-alcoholism drugs could help them most, but Canada, oddly, seems somewhat more open for research and Mexico is another option (although Mexican Indians, who had more technically advanced civilizations, developed their own alcohol before Columbus).