By Jessica Edwards
The results are in on the drug Naltrexone: It can be effective in
curbing the craving to drink in rural Alaskans battling alcohol dependence if it is taken
in concert with counseling.
"The cumulative pattern is pro-Naltrexone," said Robert
Robin, project director of the Yale University study, which began almost a decade ago and
included residents of Haines and Klukwan. Robin spoke to a small group at the Haines
Borough Public Library recently.
"Not everyone on the medication did well, but the bottom line was,
when (Naltrexone) was statistically evaluated for success, there was a significant
difference," Robin said.
The results show that some people living in rural areas like Haines who
might otherwise have to travel to inpatient centers or advanced medical facilities to
treat alcohol dependence may be able do so using the drug at home.
Robin said a person who benefited from Naltrexone might stay on it
indefinitely, likening Naltrexone to drugs used to treat high blood pressure.
An opiate inhibitor, Naltrexone has been approved by the Food and Drug
Administration for treating alcohol dependence since 1996. Robin said it was more commonly
used in the Lower 48 than in Alaska.
SEARHC is considering an alcohol dependence treatment plan that
includes Naltrexone and counseling. Access to the drug has improved with a drop in price
from more than $4 a pill to 61 cents, but Robin emphasized that counseling was integral to
the drug’s success. "You need to have a well-delivered model."
Researchers administered a 16-week treatment of medication and
counseling to 101 alcohol-dependent residents of Southeast Alaska between 2001 and 2006.
Participants in the study averaged 40 years old. Two-thirds were male,
and two thirds were Alaska Natives. Eighty-one percent had a family history of alcoholism
and 40 percent had a history of treatment for alcohol dependence.
The study broke individuals into three groups for treatment. One group
received a placebo, the second took only Naltrexone, and the third took Naltrexone plus an
antidepressant medication. Neither individuals nor researchers knew who was in each group,
but all three groups received counseling and medical support.
Robin said 76 percent of participants on Naltrexone completed
treatment. "It shows they felt they were getting results." About three times as
many people in the study who took Naltrexone abstained from alcohol through the 16-week
study as those on placebos, and twice as many never had a heavy drinking day.
Importantly, Robin said, negative consequences from alcohol use dropped
by half over the four month study period, and depression rates dropped as well. About 25
out of 100 people treated with Naltrexone would benefit from the drug, he said.
The study originally was designed to test the drug’s effectiveness
in Native American and Alaska Native populations. Previous studies had already found the
drug reduced alcohol craving among Caucasian, African American, and Asian American
populations.
The study’s goal changed, however, when researchers found it
difficult to recruit Native Alaskans. Robin said he wanted to reserve all 198 spots in the
study for Native people who wanted access to the therapy, but two years after the
study’s inception in 2003, only 43 Natives had enrolled.
Robin said some people had been upset their non-Native spouses
couldn’t participate, and others were suspicious of an alcohol treatment program
targeting Native populations.
"Some people perceived it as a stigma," he said. "The
public perception was, ‘Why us?’"
By the study’s end, a total of 68 Native Alaskans and 33
non-Native Alaskans participated, including a few from the Chilkat Valley. Most
participants lived in Juneau and Sitka. Less than 10 percent came from very rural places
in Southeast.
A surprise in the study was that Naltrexone alone proved just as
effective, or even more so, than Naltrexone and anti-depressant medication. The theory,
Robin said, was that reducing the stress that comes with drinking might make the therapy
even more effective.
But study participants were more inclined to quit treatment because of
side effects related to the antidepressants, Robin said. "That group did no
better."
The study will be published in the July issue of the journal
"Alcoholism: Clinical and Experimental Research."
The same data collected in the study will be analyzed in the future for
other predictors of treatment outcomes, such as past trauma, participation in traditional
culture, education, age, and gender, Robin said.
