“At some of these we balked. We thought we could find an easier softer way. But we could not.”
Alcoholics Anonymous, Chapter 5: “How It Works”.
Familiar words to most in recovery. But that experience hasn’t stopped science from a continuing search for an easier softer way, mostly in pill form. Here’s the latest candidate: nalmefene.
It’s an opioid antagonist (a relative of naltrexone) publicized as helping to reduce craving in persons who are dependent on alcohol. Other drugs, including naltrexone, have been used for the same purpose. But where those drugs are taken daily, nalmefene isn’t. Instead, the alcoholic takes it shortly before he commences drinking.
Why? Because it lowers the risk he’ll ‘overdrink’ (translation: get drunk). That’s what happened in a 1999 study of a hundred outpatients in an alcohol clinic.
Now it’s not entirely reliable — 33% of the folks who got the medication went ahead and ‘overdrank’ anyway — but, still, that’s a lot better than placebo. This is getting some controlled drinking advocates very excited.
I should note that where the emphasis to date has been on developing meds to help alcoholics quit drinking, this one is intended to help them continue to drink. Now that’s what I call a paradigm shift.
One thing’s for sure: it’ll be popular, because your typical alcoholic would rather not quit if he could think of an alternative.
Such drinkers are often described as deficient in ‘readiness’, as in “Bob really should quit, but I guess he’s just not ready yet.” Some would interpret that as evidence that Bob’s a candidate for nalmefene. Now I’ve got nothing against client choice, but if we offer Bob the option of going through treatment and the dramatic changes required for recovery, versus, say, popping this pill before he starts in drinking — which one do you think he goes for?
Of course the study was only a few months long, and the participants got cognitive-behavioral therapy throughout, and were monitored by breath tests and report from others. That suggests that real life results might not be quite as good in the absence of those controls.
I can imagine Bob making some subtle alterations in the treatment plan. “Last three times I drank I did OK,” Bob might think to himself, “but I miss that buzz I used to get right before I started in heavy. So what if I have a couple drinks first, THEN take the pill? Have my cake and eat it too?”
Alcoholics are very creative people, particularly in finding ways to screw up the best laid plans of research scientists.
Nonetheless I bet they sell a ton of this stuff. And AA members will likely say the same thing they’ve always said to newcomers: “Good luck to you. Come see us if it doesn’t work out.”
— September 7, 2013 @ 
