What if you were a problem drinker or alcoholic, and a medical professional could give you a drug to take away your urge to drink—while you were still permitted to continue drinking? Advocates of this treatment approach, called the Sinclair method, claim you'd likely experience no withdrawal symptoms. According to proponents, after three or four months on the medication, all while still being able to continue to drink, you'd experience diminished cravings or even find that your urge to imbibe goes away.
That's the basic scenario Roy Eskapa, Ph.D., describes in his controversial book, The Cure for Alcoholism: Drink Your Way Sober without Willpower, Abstinence or Discomfort (BenBella Books, 2008). The key, says Eskapa, a clinical psychologist, is a drug called naltrexone, which acts on the brain's opiate receptors.
"Drinking alcohol releases endorphins, the body's own feel-good substances," says Eskapa. These endorphins, he says, head straight for the brain's opiate receptors, which are especially sensitive in people who are genetically predisposed to alcoholism.
Naltrexone, taken before drinking, causes the endorphins to bounce off the opiate receptors, according to Eskapa. If these endorphins don't make contact with the receptors, reinforcement does not occur, the addictive behavior ceases, and the problem drinker therefore loses interest in liquor. "The craving and the drinking go down, and control over drinking is restored," he says.
In his book, Eskapa, who treats alcohol addiction in South Africa, England and India, describes extensive research and dozens of clinical trials on naltrexone's use in treating alcohol dependency. He points out that, most recently, results of the COMBINE study—the largest controlled clinical trial in the field of alcohol dependence, published in the Journal of the American Medical Association in 2006—found naltrexone was effective in treating alcoholism even without intensive counseling.
In 2000, studies conducted in Finland by David Sinclair, Ph.D.—who developed the method that Eskapa recommends—established that a patient has to continue to drink alcohol while taking naltrexone for the treatment to work. "The medication, taken without drinking, won't work and is entirely ineffective," says Eskapa.
Despite that study published in JAMA, Eskapa claims naltrexone is still very much under the radar as a treatment for alcohol in the U.S., mainly because medical professionals here focus on abstinence-based treatments.
So is naltrexone the "cure" for alcohol that Eskapa claims? Many addiction experts disagree.
Does naltrexone work? Experts weigh in
The fundamental issue with naltrexone has nothing to do with acceptance by treatments centers, says David Sack, M.D., an addiction psychiatrist and the CEO of Promises Treatment Centers in Malibu and Los Angeles, famous for its treatment of celebrities. "We use naltrexone, we're not opposed to it, but the problem is it doesn't work that well."
"Naltrexone has an effect, but it's a weak effect," he says, noting that humans are different from the rodents on which much of the research was done. "In animals, the opiate system—the system that naltrexone affects—has a very powerful effect on regulating alcohol consumption," he says. "In humans, the same does not appear to be true."
"Even though naltrexone is my first-line drug in treating alcoholism—it's safe, easy to take and easily prescribed—the fact is naltrexone doesn't work in everyone," says Mark L. Willenbring, M.D., an addiction psychiatrist in private practice, and the director of the division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism. The reason, he says, may be genetic. "It appears that some people with a certain configuration of genes that code for the opiate receptors in the brain are highly responsive to naltrexone," he says. Another issue, adds Willenbring, is that genes associated with a positive response to naltrexone may differ according to ethnicity.
People who work in the alcohol addiction field are aware of naltrexone, adds Daniel Angres, M.D., a psychiatrist and medical director of Resurrection Behavioral Health Addiction Services in Chicago. Angres, who considers naltrexone to be an effective medication, has observed that some people who take it are unable to get a high from drinking alcohol, and that some feel that their cravings for alcohol are reduced. In fact, according to Angres, some people who take naltrexone experience reduced cravings for alcohol whether they're problem drinkers or not.
The downside of naltrexone, says Angres, is poor compliance. Studies have shown that half of the people who take it don't refill their prescription or stop taking it after 30 days, he says. That lack of follow-through was what led to the development of an injectable form of the drug called Vivitrol. Angres, who has spoken on behalf of Alkermes, Inc., the pharmaceutical company that produces Vivitrol, says that because the injectable form stays in your system for a month, it's ideal for people who either forget—or purposely neglect—to take naltrexone orally. Many health insurance plans pay for the injections, which cost around $700 per dose.
Harold C. Urschel III, M.D., chief medical strategist at Enterhealth, a residential addiction treatment program in Dallas, and the author of Healing the Addicted Brain (Sourcebooks, 2009), has been prescribing naltrexone since 1991. He likes that it has very few side effects and that it's easy to take. "But I disagree that you need to drink alcohol in order for the medication to work and decrease cravings," he says. Urschel says that, in his experience, alcoholics taking naltrexone become so frustrated after not getting pleasure from drinking that, after a few weeks, they stop drinking on their own.
He's also a big fan of Vivitrol. "The beauty of it is you can't stop the medication if you're having a weak moment," he says, because it's already being metabolized by the body.
