Alcoholics miss out on costly drug

By MARTIN JOHNSTON

health reporter

Professor Carlton Erickson says it is a tragedy that so few alcoholics are taking the drug naltrexone, which is known to help keep addicts off the bottle.

"I find it amazing that a drug that saves lives is not being used," said the pharmacologist, who heads the addiction science research and education centre at the University of Texas in Austin.

Professor Erickson was brought to New Zealand by the Queen Mary Hospital in Hanmer Springs to talk to health and social workers about drug addiction as a brain disorder and its treatment with other drugs.

After his talk in Auckland, he said that naltrexone had reduced the relapse rate among alcoholics.

Although not a cure for alcoholism, it should be more widely used, as an adjunct to existing psycho-social therapies.

"Some people say it's too expensive ... physicians don't know how to treat alcoholics so they generally don't prescribe the drug ... and Alcoholics Anonymous' belief is that you should not take a drug to treat a drug problem."

Only a handful of New Zealanders are thought to be taking naltrexone, which costs $240 for a month's supply. It blocks the effects of alcohol in the brain and appears to reduce alcohol craving, although it can have sideeffects, including nausea.

Dr Francis Agnew, the clinical director of Auckland's state-owned Regional Alcohol and Drug Service, said naltrexone definitely had a place in treatment and ought to be subsidised by Pharmac, the Government drug-buying agency.

Tom Claunch, who is associated with Queen Mary, said: "We haven't gone to any medical authorities [to lobby for a subsidy] but we're proponents of its use with other therapies."

Professor Erickson said it was commonly accepted in the medical world that alcoholism was a brain disorder, but the public was confused about the issue.

He cited a 1996 United States public opinion poll which indicated that 90 per cent believed alcoholism was a disease, yet 60 to 70 per cent said personality or willpower contributed.

He said alcoholism was believed to involve "dysfunctional brain chemistry" in the "pleasure pathway" or medial forebrain bundle of nerve fibres. It resulted from an inherited genetic disposition or from long-term use of alcohol.

There were thought to be problems with the neurotransmitter chemicals including dopamine, endorphins or serotonin, or with the receptors they affected.

Many alcoholics reported that drinking made them feel normal, a process Professor Erickson likened to a short-sighted person putting on spectacles for the first time and seeing "normally."

"After a while the alcoholic doesn't care about the high and they have this instinctive feeling that they have to have alcohol to stay alive," he said, likening it to the body's instinctive needs for food, water and air.