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You are here: MEDICA Portal. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. April 2010: Addiction. Drugs.

"A Better Quota Than Rehabilitation for Back Pain"

"A Better Quota Than Rehabilitation for Back Pain"

Photo: drunken man sleeps in the underground Mr. Mann, anybody who has been addicted to alcohol is not allowed to drink alcohol for the rest of their life. Otherwise they risk a relapse. Why is the risk after detox still there for many years?

Karl Mann: The risk of relapse is tied to the addiction memory. Pathological procedures can be retained in the body even ten years later as a program – and just like a computer program launched new at any time. Many people have suffered through this experience. 90 to 95 percent of recovering alcoholics are at risk for relapse. Exactly which five percent are not in danger of relapsing, is unfortunately not identifiable. That is why we warn everybody. There are drugs, which are supposed to subdue alcohol cravings. They act differently though and do not always work. Why is that?

Mann: Indeed there are three such drugs: The oldest of the three is making a comeback again at the moment. Many of my patients would absolutely like to have it. If you take this drug, you get nauseous as soon as you drink alcohol. You have to vomit and feel physically really sick. Then there is an aid that balances the neurotransmitters in the brain. And thirdly there is a drug, which inhibits the effects of the body’s own opiodes from being increasingly released through alcohol. In Germany, thus far it is only permitted for detox of illegal drugs and not, like in other countries, for detox of alcohol. The last two drugs mentioned are affecting different mechanisms of the brain. Since alcohol addicts drink for different reasons, one drug works better than the other for them.

MEDICA: Does this mean there are different types of alcoholics?

Mann: There are two most common groups. The one group drinks because they are depressed and they want to reduce their fears and stress. The other group takes to alcohol, because they are looking for a kick and want to experience something. Several studies have shown that alcohol addicts can be classified into these two main groups. Of course aside from these two there are concurrent types.

MEDICA: In what way can the different effects of these drugs help to customize therapy for alcohol addicted people?

Mann: To improve the success of the therapy, you need to know which agent works better for which type of alcoholic. Generally speaking, the success quota for all current therapies is not yet very high. They work about one and one half times as well as a placebo. We were able to show in a study that this can be improved on: For those that are looking for a kick, the agent we suspected would be better suited, actually did work better – we were able to achieve nearly twice the therapeutic success when we specifically administered the drug that targets the body’s own opiodes. Conversely, we were unfortunately not able to verify that those people who drink due to anxiety and stress, would do better detoxing with another drug. It still requires more research to be able to make more reliable statements.

MEDICA: Alcohol is a centuries-old problem. Why is it so difficult to this day to treat affected people?

Mann: This has to do with the fact that only during the last century we realized what alcoholism does to public health. Alcohol is second after smoking as a trigger for diseases. In the past, drinking was viewed as a trivial offence or as a character weakness, but it is not. Alcoholism is also destiny. About 50 to 60 percent of alcoholism is tied to genes. The Dopamine-deficiency theory assumes that some people are prone to alcoholism, because their dopamine levels are too low. They have a decreased sense of happiness during beautiful experiences. With alcohol they can activate dopamine, so they are able to raise levels to those of a healthy person. All these findings are relatively new. So today there still is little hope for alcoholics?

Mann: The main issue is that too few affected people are willing to do therapy. Of the two million addicts in Germany, only 160,000 are being treated. Those that are willing to undergo treatment, have at least a 60 percent chance to be cured using a mixture of medicine and psychotherapy. Even if it is far from being a hundred percent: It is a better quota than the one that’s reached in back pain rehabilitation for example. The medical scientist Olivier Ameisen swears by a spasticity drug as the ultimate weapon against addiction. He tested it in a self-experiment and was able to get off alcohol. What do you think about his report?

Mann: Without question it is a very interesting substance and could possibly be a valuable addition to the existing lineup of drugs. However, thus far there is not enough research to really support this, and it is definitely not the silver bullet, Ameisen promises in his book. Addiction researchers of the Berlin Charité meanwhile are still testing the effects on alcohol addicted people.

Mann: Yes, but just like in our case, this is a very small study on individual patients. There were proposals for bigger studies, but to my knowledge those were denied, because nobody wanted to pay for them. : Could it still be the future remedy for alcohol addiction?

Mann: There will never be a universal remedy for alcoholism. And we are talking about individual cases here and a very subjective point of view, which is not scientifically substantiated. Ameisen also tried to get off alcohol using the drugs you tested, but it did not work for him. Ameisen thinks they are less effective than the spasticity drug.

Mann: There are thousands of people, who were helped by the drugs we tested. They just did not write any books about it. Yet there are 70 to 80 studies on these agents with tens of thousands of test participants. In contrast, there is only one study with 65 alcohol addicted participants, which took the spasticity drug and otherwise only studies with less than ten test participants. Are all those drugs to quench the desire for alcohol not also some type of surrogate drug which by themselves can trigger another addiction?

Mann:: We wean the drugs off after half a year. Studies have shown that this works fairly well. If you take them for the rest of your life, it is indeed risky and can also become a surrogate drug. Patients don’t have to do that though.

The interview was conducted by Anke Barth and translated by Elena O'Meara


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