------- Forwarded message follows ------- > Treatment study offers hope for alcoholics > BU, other sites try combined therapy > The Boston Globe October 9, 2001 > By Raja Mishra > > After fighting for decades to establish alcoholism as a disease, > researchers have begun testing a medical cure for the millions of > alcoholics worldwide, hoping to establish a definitive treatment that would > replace the current mix of teachings, programs, and regimens, many of which > fail to prevent relapses. > > Scientists at Boston University Medical Center and 10 other hospitals are > testing what they believe to be the ''supertreatment,'' a combination of > two addiction-fighting pills and two types of psychotherapy. Within the > next three years, they hope to establish a single approach to treating > alcoholism that could be used equally effectively by the high-priced > celebrity treatment center or the urban clinic. > > ''This is the most important study in a generation,'' said Dr. Domenic A. > Ciraulo, chairman of psychiatry at BU and a lead researcher on the trial. > ''If it's successful, it will tell us what kinds of psychotherapies are > helpful and which combination of drugs are helpful, and the relative costs > of delivering the treatment.'' > > Although the research is just a few months old, some patients say the > treatment already is changing their lives. One of Ciraulo's test patients, > Sandy, explained how a habit of after-work drinks and weekend cocktails > slowly enveloped her life. > > ''It crept up on me. It became real bad, constant drinking,'' said the > 55-year-old medical professional from the Boston suburbs, who asked that > her last name not be used. ''How I got to that point, I don't know.'' > > Sandy's husband watched her decline for years, helpless until reading a > newspaper advertisement seeking volunteers for the study. > > In research circles, the massive 346-patient clinical trial has become > known simply as the Combined Study. It combines two pills that past > researchers found effective in alcoholics with two therapies that garner > high marks with psychiatrists. Some patients get the full combination, > others receive partial treatments. From this, researchers can determine if > the full pill-and-therapy approach truly offers benefits. > > Each day, Sandy gobbles a handful of pills. Once a week, she attends an > intensive therapy session. The pills might be placebos, as part of the > experiment. But Sandy is convinced they are the real thing. > > ''This is working,'' she said. ''This was the right thing at the right > time.'' > > Despite decades of research, there is still remarkably little consensus on > how to treat alcoholism. Currently, doctors and patients pick from a > variety of treatments. Some try the self-help and peer pressure of > Alcoholics Anonymous. Others experiment with psychotherapy. A few opt to > take new, powerful pills designed to kill drink cravings. > > The treatments often fail. Dr. Enoch Gorden, director of the National > Institute of Alcohol Abuse and Alcoholism, estimates that, of those who get > treatment, as many as 50 percent relapse at least once, and only a minority > achieve long-term remission. Identifying and developing effective > treatments is the first priority of alcoholism research, he said. > > Alcoholism researchers view the Combined Study as the pinnacle of modern > medicine's move from viewing alcoholism as a personality defect to treating > it as a medical condition. Top scientists in the often fractious field of > alcoholism studies have come together to run the trial. > > ''I think this study is capable of establishing a treatment that can happen > in a primary-care doctor's office or in a specialized treatment center ... > a standard treatment,'' said Dr. David Gastfriend, director of the > addiction research program at Massachusetts General Hospital, also a site > for the test. > > ''It's a very intricate and far-reaching study,'' he said, adding that, > within three years, he hopes to be treating his patients using the > techniques tested in the study. > > The science of alcoholism has long been hampered by an ethical > complication: Researchers couldn't rigorously test most treatments because > it would mean secretly denying treatment to some alcoholics in a test group > to determine if the others, who got treatment, fared better. > > The Combined Study gives all patients at least basic therapy. Some get both > pills and intensive therapy, some get one fake pill and one actual pill, > and so on. Each variation can then be analyzed. > > The Combined Study ''will tell us how two different medicines and two > different intensities of behavioral intervention mix and can be tailored to > help more alcoholics better than ever before,'' said Gastfriend. > > In the future, designer variations of the two-pronged treatment might be > developed. Researchers hope to examine the patients' genetic makeup, to > determine if particular patients respond better to certain modifications of > the treatment. But that aspect of the trial is far off. > > The talk among researchers is that the approach developed by the Combined > Study might supplant AA, the most popular of all treatments with its 2.2 > million members in 150 countries. But researchers have tremendous respect > for AA's well-known Twelve Steps approach. > > AA did not comment on the Combined Study. ''We have no opinion of the > study. We welcome any work on alcoholism,'' said a spokesman for the > organization, which emerged in 1939 from the theories of a small group of > recovering alcoholics in New York. > > The AA approach emphasizes spirituality. But the Combined Study relies on > two pills, naltrexone and acamprosate. The former stops the high that > alcoholics get from drinking, a euphoria more intense than what the casual > drinker feels. Acamprosate, not yet approved for general use in the United > States, reduces the alcohol craving that makes quitters miserable. > > Earlier tests proved the drug combination safe. Along with the > prescriptions, participants in the Combined Study once a week visit a > psychiatrist who employs cognitive and motivational therapies, two common > approaches usually used separate from one another. Again, these are varied > by patient to test their effectiveness. > > The BU team has enrolled 26 patients, but is still accepting additions, as > are teams at Mass. General and McLean Hospital. > > On a recent day, Sandy sat in a BU medical office, recalling her previous > misery. Her marriage is now on the mend, she is thriving at work, and has a > newfound sense of control over her life, she said. > > ''Life was getting unbearable,'' she said. ''This program saved my life.'' > > Source: > >http://www.boston.com/dailyglobe2/282/metro/Treatment_study_offers_hope_for_alcoholics+.shtml
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