What do you think of naltrexone therapy for alcoholics?

 

Stanton,

What do you think of the use of the drug Naltrexone to curb alcohol cravings?

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Dear Dr. Peele:

Thanks for your erudite, yet accessible approach. I am researching a TV documentary on alcoholism. I have found a David Sinclair and info on alcoholism treatment using the drug Naltrexone ­ an opiate antagonist. I would be interested to hear your views on this treatment. If I understand correctly, this potential treatment offers some hope for sufferers.

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Stanton’s Answer to TV producer:

If you read my books and web site, you will see that drugs that interfere with or replace the effects of illicit drugs are not of much interest to me. Since, in my view, addicts are driven to seek compensatory experiences and gratifications for those they fail to generate through ordinary life circumstances, blocking or replacing drug experiences really doesn’t get to the heart of addiction, does it? People will simply seek to gain these experiences in other ways, and if they are no better able to generate rewards in their normal environments, these efforts will likewise be dysfunctional and addictive.

At one point, I emphasized this replacement addiction scenario in the case of methadone (with a nod to Henry Lennard, whose Mystification and Drug Misuse is a classic). However, since I have become engaged with Ethan Nadelmann in the harm reduction movement, I have come to see that allowing people legal and safe addictions like methadone can offer them substantial advantages. (Hence, the value of heroin maintenance.) However, methadone —as delivered within the current American treatment system —is inevitably polluted with disease moralism and medical attributions (such as that the individual is biologically destined to be addicted) that are wrong and harmful.

In the alcoholism field, we have specifically discovered that effective treatments (1) are of limited duration (albeit with continuing contact with the person), (2) enhance existing skills and competencies for coping with life demands and gaining life gratifications, (3) strengthen community ties, (4) offer people a sense of self-efficacy and do not convince them that they are born and bred to be alcoholics (see “Recovering from an all-or-nothing approach to alcohol“). Naltrexone does not fulfil these criteria. On the other hand, I find intriguing that Naltrexone therapy permits some continued drinking, since the therapy supposedly reduces craving rather than making all drinking impossible (as Anabuse does).