Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque, says there has long been resistance in the United States to the idea that alcohol-use disorder can be treated with drugs. For a brief period, DuPont, which held the patent for naltrexone when the FDA approved it for alcohol-abuse treatment in , paid Hester to speak about the drug at medical conferences. There has been some progress: the Hazelden center began prescribing naltrexone and acamprosate to patients in But this makes Hazelden a pioneer among rehab centers.
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And now that naltrexone is available in an inexpensive generic form, pharmaceutical companies have little incentive to promote it. The drug helped subjects keep from going over the legal threshold for intoxication, a blood alcohol content of 0.
Naltrexone is not a silver bullet, though. Other drugs could help fill in the gaps. So, too, have topirimate, a seizure medication, and baclofen, a muscle relaxant. It was here that J. After his stays in rehab, J. In his desperation, J. Then, in late , J. During those sessions, Willenbring checks on J. I also talked with another Alltyr patient, Jean, a Minnesota floral designer in her late 50s who at the time was seeing Willenbring three or four times a month but has since cut back to once every few months.
At age 50, Jean who asked to be identified by her middle name went through a difficult move and a career change, and she began soothing her regrets with a bottle of red wine a day. When Jean confessed her habit to her doctor last year, she was referred to an addiction counselor. The whole idea made Jean uncomfortable. How did people get better by recounting the worst moments of their lives to strangers? Still, she went.
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Another described his abusive blackouts. One woman carried the guilt of having a child with fetal alcohol syndrome. Then she found Willenbring. During her sessions with him, she talks about troubling memories that she believes helped ratchet up her drinking.
In his treatment, Willenbring uses a mix of behavioral approaches and medication. Moderate drinking is not a possibility for every patient, and he weighs many factors when deciding whether to recommend lifelong abstinence. He is unlikely to consider moderation as a goal for patients with severe alcohol-use disorder. Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or a lack of social support.
The difficulty of determining which patients are good candidates for moderation is an important cautionary note.
But promoting abstinence as the only valid goal of treatment likely deters people with mild or moderate alcohol-use disorder from seeking help. The prospect of never taking another sip is daunting, to say the least. No one knows that better than Mark and Linda Sobell, who are both psychologists. In the s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence. Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely.
In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely. Both groups were given a standard hospital treatment, which included group therapy, AA meetings, and medications. The Sobells published their findings in peer-reviewed journals.
In , the University of Toronto recruited the couple to conduct research at its prestigious Addiction Research Foundation. In , abstinence-only proponents attacked the Sobells in the journal Science ; one of the writers, a UCLA psychologist named Irving Maltzman, later accused them of faking their results. The Science article received widespread attention, including a story in The New York Times and a segment on 60 Minutes. Over the next several years, four panels of investigators in the United States and Canada cleared the couple of the accusations. Their studies were accurate.
The late G. Alan Marlatt, a respected addiction researcher at the University of Washington, commented on the controversy in a article in American Psychologist. They also run a clinic. Like Willenbring in Minnesota, they are among a small number of researchers and clinicians, mostly in large cities, who help some patients learn to drink in moderation.
We can change the course. During my visit to Finland, I interviewed P. He told me that for years he had drunk to excess, sometimes having as many as 20 drinks at a time. A year-old doctor and university researcher, he describes himself as mild-mannered while sober. His wife found a Contral Clinic online, and P.
It was harder to appeal to other women. I took the easier path. And maybe, because women held their applause, I started to resent them. I preached from the bible of loyalty to friends. I ended up having a long relationship with the crush, and I never considered it a theft. By January the mayor of Puhoi was fed up. His assistant kept turning up to work drunk. So the mayor, Petru Frunze, decided to hold a competition. Twenty couples signed up, but only one succeeded. As promised, Frunze found them jobs as cleaners in the capital city of Chisinau, around 15 miles away.
He even covered their travel costs. But within a few months, they had both relapsed and turned back to alcohol. The competition never ran again. In Puhoi, alcohol is the lifeblood of the economy and the community. Almost everybody works for the local Asconi winery, and almost everyone distills their own wine.
Alcohol is currency, used to pay people for small jobs and favors. Puhoi is no different to many other villages in this Eastern European country that borders Romania and Ukraine. But the country is dependent on alcohol in many more ways than one. Moldova has the highest levels of alcohol consumption in the world and the highest death rate linked to drinking. Following closely is Lithuania with 15 liters and the Czech Republic with The wine-drinking culture sets Moldova and Georgia apart from other post-Soviet countries, where people prefer to drink spirits. In Moldova, where liver cirrhosis is more common than anywhere else in Europe, men live to an average age of 68 and women, In the Soviet Union, little was done to curb excessive drinking.
It was even encouraged as alcohol production was a very profitable industry for the Soviet government, according the Marya Levintova , a public health expert on Russia. While generating revenue for the government, it has also stymied dissent and promoted autocracy. Frayed wires poke from holes in the cracked ceiling.
A warm smell of onion and garlic fills the hall.
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Next door, pensioners gather under a portrait of the Virgin Mary, waiting for a free bowl of soup and bread. Outside elderly men smoke around a table, watching the young construction workers balancing on a brick wall as they pass each other tools. A bus shelter down the road is plastered with adverts for jobs in other European countries. Inside the shelter hangs a painting of an idyllic house nestled in tranquil woodland.
Puhoi, like all villages in Moldova, has changed a lot since the fall of communism in One million people have emigrated from the country since then, leaving behind a population of 3. After Russia, Italy has the largest population of Moldovan migrants, with more than , Moldovan residents.
Mass emigration has fueled alcohol abuse, says doctor Vasiliev, as families and communities are broken up. Read the full text. Tools Request permission Export citation Add to favorites Track citation.
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