Abstinence vs Medication Assisted Treatment for AUD

Posted , 8 users are following.

I thought this would be a good topic to start, as there's been some discussion about it as of late.

Let's keep it on topic.

The classic approach of Abstinence only to address Alcohol Use Disorder has a 4 year success rate of 10%, per NIAAA stats. Worldwide, people continue to die at the rate of 1 every ten seconds from alcohol related causes, yet those with AUD are told to "just quit drinking". While 10% is a lot of people that won't be drinking themselves to death and causing massive collateral damage along the way, it seems there is considerable room for improvement. 

Medication Assisted Treatment seeks to end the compulsion and craving experiened by the remaining 90% that cannot seem to adhere to a life of abstinence through willpower and social support alone. 

While I think that abstinence is a good answer for that 10% of the poplulation, if that answer does not adequately serve the remaining 90%, we will have to ask a different question.

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16 Replies

  • Posted

    I fully support medical intervention to alcohol addition.  I am prescribed Revia, and it most certainly saved my life.  My cravings are manageable, I often don't even think too much about drinking anymore, so I just quit cold turkey 2 days ago.  Dealing witht he physical addiction - but without the medical intervention of Revia, I don't think either abstinence, nor moderation could work for me.  

    The AA abstience only system has been said to only be objectively able to boast a 5-7% success rate (and that is only if they continue coming to group).  Dr.Sinclair who experimented with Revia (Naltrexone) believed it can cure alcoholism, though what he called "neuropathway extinction".  The Revia prevents your brain from being able to get pleasure from alcohol, so you cravings diminsh.  (Anyway, sorry to digress!) smile

     

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  • Posted

    Ah, a subject that interests me and hopefully won't digenerate into arguing!  Thanks ADEfree, this subject matter has much merit.

    Here is my take on it.....

    Traditional treatment success estimates (as you say) are approx 10%.

    Even if medically assisted treatment has another 10% success rate that means that 20% of the people with alcohol related issues are being helped.  That has to be good, right?  Any improvement is an improvement.

    However, medically assisted treatments have a much better success rate than 10%!  Take TSM, for instance, which show results of 78% in clinical testing. 

    Therefore, the 10% using traditional treatment should be proud of themselves. Add another 78% onto that and suddenly we are reaching 88% of those that need help.

    Add in the success rates from the other medically assisted treatment such as Campral, Baclofen etc (which I do not know the success rates exactly but I know that these treatments all have their positives) and we are reaching close as close to 100% of the people as we can possibly hope to.

    Therefore, our issues are brought on by our own refusal to accept that 'one way is NOT the only way'.  We put off those seeking help by our disputes and place barriers of beliefs in their way of treatment.  If someone needed help and internet searches find us all in dispute with each other, then they will likely turn away because they can find that closed-minded and 'I am always right' behaviour in the pub! 

    I am sure I can speak for all of us when I say that we ALL want the best possible outcome for anyone who asks for help.  If someone tries a method and it doesn't work, that is fine - move onto the next one that looks appropriate.  With an open mind and an open community (both medical and non-medical) we can achieve so much more sucess than we can in our own individual 'groups' of people recovering.

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    • Posted

      I dont think I could have stopped without taking something - OK I know what I take is a bit extreme, but while it works I'm taking it.

      AUD is complex because it does appear to be possible to go for ages without wanting to drink, and even when I do - SOMETIMES - managing to drink just a few units, then stop.

      The trouble is that getting really stressed about something seems to put turning to alcohol at the top of the list of solutions at the time. Its mainly a build up of stress which is the trigger for me. 

      Since thats not the behaviour of a 'classic' alcoholic I sometimes have fooled myself into actually believing that I'm not one - an alcoholic. I know people who drink everyday, some an amount which they can function with and still go to work, and some who drink so much their lives have done or are falling apart.

      I have to somehow hold on to the feeling I have now - that I know my weakness, and its not going to change, and no matter how long I manage to be dry for - it will always be there. 

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    • Posted

      Yes, there seems to be this idea that there's one type of alcoholic, where there are at least three. The Daily Drinker who generally has a "start time" and won't drink before that. The Maintenence Drinker, who drinks all day (frequently "topping up" throught the day to stop withdrawal symptoms), then drinks more heavily after the work day is done. The Binge Drinker, who can go days, weeks or even months without a drink, but then has heavy drinking episodes that often culminate in blackouts. 

      It appears that there is at least one common mechanism driving all three types that involves the opioid pathways in the brain. These pathways get reinforced every time a drink is taken, until they are quite strong and begin to generate craving that can predictably move a person from "trigger" to "tipple".

      The tendency for this pathway (located in the area of the brain called the Striatum) to become reinforced to this point is what seems to set the 90% apart from the 10% that can manage via different methods of abstinence.

      Medication Assisted Treatment is evolving to address the craving and TSM is one way of doing this. It has the advantage of being able to be applied while one is still drinking, but there are other ways as well. We need to keep asking what we can do to effectively help people maintain a normal relationship towards alcohol and deliver treatments that restore their free choice in the matter. 

      Ursula, your weakness can change. Therapies like TSM can help you erase the craving that is so powerful that it moves you to drink against your better judgement. Your choice in the matter can be restored and what used to trigger drinking can trigger healthy and beneficial responses that actually address the stress and anxiety instead of just causing more of it.

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    • Posted

      I know I am the binge drinker type. 

      I used to be pretty controlled about drinking and never drink more than the people I was drinking with - went to parties, clubs, pubs etc. and noone thought of me as an alcoholic, and I used to keep a count of my units and try to stay under the 'recommended limit', which I did alot of the time.  I saw drinking as a treat to wait for at the end of the week. If I drank in the week, it would be a few halves in the pub.

      This all changed when I was in my mid-thirties, when I started drinking alot just to alleviate stress, and at different times of the day - not waiting until a fixed time.  I did have a baby at this time, but having him was planned by me and my husband, and we had a good stable set up and support from family and firends.

      I dont know what changed in me - its just weird.  Whatever it is, I wish I could switch it back again!  I presume by TSM you mean Transcendental Meditation?  I'm sure we have a local group - I'll look up when their meetings are.

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    • Posted

      Oh sorry - The Sinclair Method - right!

      Yes, when I started drinking dysfunctionally I had been put on anti-depressants. They never seemed to mix well with alcohol, although they worked quite well for me at first.

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    • Posted

      There are posts on the internet about antidepressants driving cravings up, down or making no difference at all. It's a good one to keep an eye on just in case there seems to be such a negative side effect, might be cause for the doc to change the prescription.

      The other day I came across an article on a blood pressure med called isradipine that seemed to have a beneficial effect on excessive drinking. The studies were small and few, but if one had a drinking problem and a blood pressure problem that was controlled just as well by by isradipine, seems there would be little to lose.

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    • Posted

      I know that fluoxetine and other anti-depressants can 'disagree' with alcohol. I dont know if there are controlled studies on this. Obviously alcohol can reduce any beneficial effect of the anti-depressant. I also have heard pure anecdotal evidence that people on things like SSRI's can become more agressive after drinking than they used to. 

      Being on fluoxetine helps to cut out the depression and feelings of 'doom and gloom', but it also seems to reduce feelings of sadness and sometimes guilt.

      I find it almost impossible to cry when on prozac, which can be a huge relief, but the general dampening down of emotional response isnt always a good thing. 

      Overall its been a good thing for me as I used to waste alot of time getting upset about things. I believe SSRI's dont go well with alcohol, but this is just an opinion, not based on scientific evidence!

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    • Posted

      I think you'll find warnings against using them with alcohol on most of the package inserts, so you're not far off at all, though some are used off-label to help people cut back their drinking. 
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    • Posted

      Youre not supposed to drink on them, but I know alot of people who do. Drs will often just keep prescribing SSRI's for years, and alot of people simply dont have the discipline not to drink with them. The trouble is that taking them seems to be normalised to the extent that no one is suprised when they find out someone takes them and if someone is feeling a bit low, the first thing alot of people suggest is to go on antidepressants.

       

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    • Posted

      I imagine some of that should clear up as MAT becomes more widely adopted and people with AUD get proper treatment the first time around. The anecdotal reports of antidepressants actually causing AUD are concerning, I don't know what's being done to inform patients and the medical community about that. 
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  • Posted

    My view is that whatever works to keep people healthy.  Even switching substances works for some.

    ​I'm in a treatment program...one lady has switched from pill popping dangerous substances...to having 2 drinks 3x a week...it works for her...so I don't care what she does...she is not abusing anymore smile

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