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Image courtesy of id-iom

The edges of the children’s finger paintings curl up from the wall. The coloured sugar paper has been faded by the sun but underneath the freshly-revealed pigment glows anew. It’s a building which both looks and smells like a small-town community centre; all watered-down PVA glue and drizzle-damp coats. A small group of people sit in a circle of mismatched chairs; the tall woman in a twinset and tasteful gold jewellery fresh from a charity luncheon, the short woman in the red fur coat and vibrant purple hat from a poetry session for disadvantaged youths. Yet there is a sense of camaraderie, brought about by the vague feeling that for once everyone in this room knows exactly what you’re talking about. Everyone in this room knows someone who is an alcoholic.

According to a 2010 study there are 1.6 million alcoholics in England alone. Alcohol-related illnesses cost the NHS on average £2.7 billion pounds every year. £374 million of that is taken up with treating cirrhosis of the liver; an illness which occurs with heavy, constant drinking. Relapse occurs in 90% of alcoholics in the first 4-years of treatment, the medication currently provided is failing and more research needs to be done into how to help these people.

One drug currently being tested is propranolol. At the moment it is used to treat hypertension in the heart and anxiety disorders. But according to Dr Amy Milton, a behavioural neuroscientist at the University of Cambridge, propranolol could be part of the answer in preventing relapse. She claims: “Drug-seeking and drug-taking are learned behaviours, and the likelihood of these behaviours being elicited is increased by the presence of people, places and paraphernalia associated with the drug of abuse.”

Propranolol works by preventing signaling at the receptors which cause memories to be stored. Dr Milton explains: “When a memory is retrieved, for example by seeing cues associated with the drug, it enters an unstable state where it can be disrupted… We hypothesise that erasing the cue-drug memories will therefore stop these cues from influencing behaviour and so reduce the risk of relapse in the long term.”

However Dr James Bell, a consultant in addiction medicine who established the Party Drugs Clinic and has written reports for the World Health Organization, disagrees. He states: “The cause of drug dependence is drugs… For many years people have tried techniques to alter associations – through techniques of cue exposure, for example – but it has been a pretty futile endeavour from a therapeutic standpoint, although it gets lots of papers published.”

Dr Bell’s study on the effects of two drugs currently used to treat addictions, naltrexone and acamprosate, found that neither was any better than placeboes.  Instead he believes that the issue of addiction is more a problem of motivation and reward. He declares: “The attempt to block such association, even if it works in laboratory animals being trained to drink, misses the target in human subjects.”

John Cheese, an internet comedy writer for Cracked.com who has written about his own struggle with alcoholism, didn’t use any medication when quitting alcohol: “Just good, old-fashioned gritting my teeth and shaking until the hell subsided.” He claims he has helped thousands of other addicts through his articles and in person and says: “The most dangerous obstacle they face is their own brain, constantly trying to justify ‘just one drink.’”

Mr Cheese believes that one of the big problems with relapse is the mental issues behind the drinking: “Long after the alcohol has left the system, and the body has adjusted to its physical independence of the substance, we still relapse… Those mental issues are the cause of nearly all falls back into alcoholism.” Yet Dr Bell disagrees: “People treating alcoholics who try to deal with the “underlying issues” generally do more harm than good. For alcoholics, the issue is drinking.”

The next step for propranolol is clinical trials on human subjects however it could be 10-15 years before the drug is available for addicts. But Dr Bell is skeptical, saying: “The brutal truth is that when people realise they have a drinking or drug problem, and they want to stop, they stop. When they realise they have a drug problem but don’t really want to stop, they come for treatment.”

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