Two medications could help dramatically lower alcoholism in the United States, yet the drugs are rarely prescribed to patients, researchers reported on Tuesday.
The two medications, naltrexone and acamprosate, work to reduce cravings for alcohol by fine-tuning the brain’s chemical reward system. They have been approved for treating alcoholism for over a decade yet are hardly used by those who need it most. This under usage has been attributed to their efficacy and a lack of awareness among doctors, the researchers said.
Less than a third of all people with alcohol issues get treatment of any kind, and less than 10 percent are prescribed medications. The Affordable Care Act requires that insurers provide coverage for substance abuse treatments and services, and addiction specialists expect to see a rise this year in the number of people seeking help for alcoholism.
George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, said the new study should reassure doctors that naltrexone and acamprosate can help many patients.
“This is an important paper,” said Dr. Koob, who was not involved in the study. “There are effective medications for the treatment of alcoholism, and it would be great if the world would use them.”
The study, published online on Tuesday in JAMA, the journal of the American Medical Association, comprised a team of researchers based mostly at the University of North Carolina at Chapel Hill. They compiled findings from the most rigorous trials of medications for alcoholism in the past few decades. They analyzed data from roughly 23,000 people from 122 randomized trials.
The researchers focused on a measure known as the “number needed to treat” – an indicator of how many people need to take a pill for one person to be helped. The study deduced that to prevent one person from returning to drinking, the number needed to treat for acamprosate was 12; for naltrexone the number was 20.
In comparison, large studies of widely used drugs, like the cholesterol-lowering statins, have found that 25 to upwards of 100 people need treatment to prevent on cardiovascular event.
“These drugs are really underused quite a bit, and our findings show that they can help thousands and thousands of people,” said Dr. Daniel E. Jonas, the lead author of the new study and an associate professor of medicine at the University of North Carolina. “They’re not blockbuster. They’re not going to work for everybody. But they can make a difference for a lot of people.”