Fundamental treatment shift for alcohol dependence coming

Physicians can do a lot to help people with alcohol disorders, said Mark L. Willenbring, MD, director of the division of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. Brief, repeated contacts between physician and patient can result in substantial improvements, he said.

Dr. Willenbring was among a panel of experts on alcohol dependence who spoke at a July 21 AMA media briefing in New York City.

There is a spectrum of alcohol use disorders, Dr. Willenbring said. "The idea of staging the illness -- like we do with cancer -- and then applying the appropriate interventions for it is critical in understanding how to approach these disorders."

The understanding and treatment of alcohol dependence and similar disorders is expected to fundamentally shift over the next decade, allowing physicians to customize treatment to each patient, he said.

About one in every 13 adults in the country is addicted to or abuses alcohol, noted AMA Trustee Cecil B. Wilson, MD, in opening remarks. "That's nearly 14 million Americans." But the compulsion to take a drink can be overcome, "and medical science continues breaking new ground in understanding the dynamics of this complex disease," he said.

A better understanding of the brain mechanisms that trigger alcohol dependence is leading to the development of drugs that reduce the desire to drink, said Raye Z. Litten, PhD, co-leader of the medications development team and associate director of the division of treatment and recovery research at NIAAA.

Acamprosate and naltrexone already have been approved by the Food and Drug Administration to treat alcohol dependence, and more drugs are in the pipeline.

But there's unlikely to be a single breakthrough drug that will cure alcohol dependence for everyone, Dr. Litten said. He envisions alcohol treatment that will resemble treatment for depression with a variety of behavioral treatments and medications available.

Clues on the causes of alcoholism are also emerging from new findings about the genetic patterns of young drinkers, said Marc Schuckit, MD, professor of psychiatry at the University of California, San Diego, and director of the Veterans Affairs San Diego Healthcare System Alcohol Research Center.

One risk factor is a low response to alcohol that pushes some adolescents to drink more heavily to produce the desired effects, he noted.

Dr. Schuckit is seeking genes that may be related to this low alcohol response.