SEARHC, Yale offer alcoholics option

Native health consortium, university medical school team up for study on whether prescription drugs can curb desire to drink

Posted: Sunday, January 05, 2003

Alcoholics looking for help with their disease have a new option in Southeast.

How to participate

Call 463-3193 or toll-free (877) 909-8755. Office hours are Monday-Friday 8 a.m. to 5 p.m.

The study offices are at 3200 Hospital Drive, across the street from the SEARHC clinic in the SEARHC annex building, second floor, suite 203, through the American Red Cross offices.

Yale University's School of Medicine and the SouthEast Alaska Regional Health Consortium, a Native health care provider, have teamed in a study that tests whether certain prescription drugs can curb the desire to drink.

About 200 Alaska Natives will be chosen over the next five years for the program. It will test the effectiveness of combining the prescription drugs Naltrexone, which is used to decrease alcohol cravings, and Zoloft, an anti-depressant, in combating alcohol abuse among Natives.

Dr. Robert Robin of Yale, one of the lead investigators in the study, said that combination of drugs has been tested before, but never among Native populations.

"The previous studies have been made available to Caucasians, Hispanics and blacks and have principally been done in urban areas," said Robin. "This study is really extending an opportunity to Native Americans and Native Alaskans in rural areas who don't have as many treatment options.

"And as everyone knows, these populations have among the highest rates of problems associated with alcohol."

The study will recruit Natives from Klukwan, Haines, Sitka, Juneau and eventually Prince of Wales Island and Kake, said Bedford "Sonny" Chandler, medical manager for the Juneau-based program and a physician assistant with SEARHC. He added it was important for SEARHC to get involved in the study because, if it works, its effects could be far-reaching for its clientele, who are mainly Alaska Natives.

"Long-term (alcohol) abuse presents all sorts of health care problems, not to mention problems in law enforcement, problems within and without the home. It's been associated with domestic violence," said Chandler. "Hopefully, this will serve as a model for how to treat alcohol dependency in the Native community and have widespread social and medical implications."

Naltrexone is a drug, used since 1992, to combat alcoholism, according to Yale study investigator Stephanie O'Malley. It acts as an opiate inhibitor, helping to decrease cravings and the urge to drink, she said, and it can help people abstain altogether from drinking. Originally it was used to treat addictions such as to heroin, codeine, and morphine, she said.

Zoloft works to increase the serotonin levels in the brain. Serotonin is a naturally occurring chemical that helps in the transmission of messages between nerve cells, the Zoloft Web site said.

Robin said researchers hope Zoloft will reduce the stress associated with quitting drinking, so the Naltrexone can be more effective.

Robin did not have exact statistics on how effective the treatments are.

"In past studies, the success rates have varied," he said. "A vast majority of the studies done show that the people on active meds do significantly better. They drink less frequently than people who don't get any treatment, and in some cases can even abstain from drinking altogether, and overall their quality of life is better.

"Naltrexone is a good tool, but it's not a cure-all. We will work with the client on continuing treatment and encourage abstinence or continuing to reduce alcohol consumption."

The study costs nothing to participants, but the drugs can have side effects.

According to the Mayo Clinic Web site, Zoloft's side effects include nausea, diarrhea, constipation, some weight gain or loss, dry mouth, headaches, some fatigue or insomnia, decreased libido and delayed ejaculation. With Naltrexone, side effects include nausea, headache, dizziness, fatigue, insomnia, anxiety and sleepiness, according to the University of Pennsylvania Health System's Web site.

"The symptoms are usually very mild and do not last very long," Robin said. "They rarely are enough to make clients end the treatment."

Participants must pass an extensive three-day psychological and medical screening before being accepted into the program, Robin said.

Other requirements include being an Alaska Native between the ages of 18 and 65, alcohol dependent but abstinent from alcohol for four to 14 days, and have a stable residence, researcher O'Malley said.

She also said anyone using drugs other than nicotine or alcohol or who require more intensive therapy because of a psychiatric illness can't participate.

Anyone not eligible for the study will be referred to other treatment programs, Robin said. But, he said, the key to any treatment is for the participant to take the process seriously and want to get better.

"This is an extensive process where the clients will be fully informed of what they are getting into and they are free to leave the program at any time," he said.

Once slated for study, participants are put into one of three groups, Robin said: Naltrexone and Zoloft users, Naltrexone and placebo Zoloft users, or placebo Naltrexone and placebo Zoloft users.

About one-third of the participants receive a placebo, or inactive medication, Robin said. That will let researchers compare the effects of using one or both drugs.

Participants are active in the study for 16 weeks. Each client gets counseling with treatment staff including local clinicians from SEARHC. The staff will monitor medical conditions, help administer medications, give support and advice on maintaining abstinence, and give support-group referrals and educational materials to participants.

When the study is complete, researchers will follow up with the clients three times over the following six months to a year to note their progress.

Melanie Plenda can be reached mplenda@juneauempire.com.



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