Another treatment option

Doctors now have another option for treating alcohol addiction – a delayed-release tablet that helps maintain abstinence by restoring the chemical balance disrupted in the brain by long-term excessive drinking.

Campral is the first new drug available in the United States in nearly a decade to treat alcoholism, a disease that affects as many as 8 million Americans. Only 139,000 of those take medication for their addiction.

Also known as Acamprosate, Campral is available only by prescription. Though it was approved for use last July by the federal Food and Drug Administration, it is just now being made available to physicians. The drug has been used in Europe since the late 1980s.

“We believe that Campral, in combination with psychosocial support, sets a new standard for treating the chronic disease of alcoholism,” said Howard Solomon, chairman and CEO of New York-based Forest Laboratories Inc., which is now aggressively marketing the drug.

The exact mechanism that makes Campral effective is not completely understood. Scientists believe Campral works by restoring the normal activity of certain neurotransmitters in the brain that become overexcited during alcohol withdrawal and cause a person to crave alcohol again.

Experts said this kind of hyperactivity can last a year after someone has stopped drinking, leaving the alcoholic prone to relapse.

“What Campral does is help people sustain and maintain abstinence once they become abstinent; they feel more stable and even,” explained Barbara McCrady, director of the clinical division of the Center of Alcohol Studies at Rutgers University.

Before now, the only medications available to treat alcoholism were Antabuse and Naltrexone. Antabuse, or Disulfiram, is an alcohol deterrent that induces severe nausea if a person takes a drink. Naltrexone, also called Revia, decreases the craving for alcohol so that if someone does drink, he ends up drinking less.

Campral works differently.

“The brain really changes as you go from use to abuse to dependence, and this is the only medication we have that acts to restore the function in those key brain areas,” said Barbara Mason, professor of neuropharmacology and co-director of the Pearson Center for Alcoholism and Addiction Research at the Scripps Research Institute in La Jolla, Calif. She also is a paid consultant to Forest Labs.

William Annitto, chairman of psychiatry at Newark (N.J.) Beth Israel Medical Center, said he would have no problem prescribing Campral for his patients, although cost would be an issue in the low-income population he serves. Product recommendations call for patients to take two tablets three times a day, costing approximately $4.50 per day.

“It’s almost pointless for me to order it if they can’t have it when they go out the door,” Annitto said.

A national trial is in progress to determine which combinations of various therapies are most likely to help alcoholic patients stay in treatment, remain abstinent or reduce their drinking. Patients in the study, called COMBINE, are receiving either Campral or Naltrexone, or a combination of the two drugs, in conjunction with behavioral therapy. Others are getting a placebo pill.

Studies of patients who took Campral have shown that it helped patients maintain abstinence longer than people who simply received psychotherapy. The most common reported side effect of the medication was diarrhea.

But not everyone believes the answer to alcoholism can be found inside a bottle.

“You can give a person a pill, but what will it do about their attitudes and behavior? Alcoholism is a life-dominating problem,” said Galindo King, clinical director of Freedom House, a long-term residential halfway house in Hunterdon County, N.J., for adult men recovering from alcoholism.

Arthur Dean, chairman and CEO of Community Anti-Drug Coalitions of America, a private nonprofit based in Alexandria, Va., said the introduction of Campral as a strategy in fighting alcoholism is “no silver bullet,” but can help.

“I think that in order for one to recover from illicit drugs or alcohol, there are an array of strategies that must be employed,” he said.