Medications such as naltrexone (ReVia) and acamprosate (Campral) are by no means considered a "magic bullet"" in the broad Hazelden treatment spectrum. Rather, "they are discussed with our patients as one tool among many," according to Hazelden's National Medication Practices Team that studied and recommended the use of the medications.

Chris Lind, director, National Health Services

In compliance with FDA guidelines and current research, Hazelden medical staff will prescribe medications only to patients whose drug of choice is alcohol and who have experienced multiple relapses, multiple treatment attempts, and who describe a great deal of craving.

Medical and Health Services staff will evaluate patients who are taking anti-addiction meds at the time of admission and will assess patients who request the medications and prescribe them when appropriate. Patients will start taking the medication toward the middle of residential treatment and continue taking it for about a year, with follow-up care provided by the patient's physician. Follow-up data on patients taking the medications will be compiled by the Butler Center for Research.

Acamprosate and naltrexone are the medications that will most often be prescribed, including Vivitrol, an injectable form of naltrexone approved by the FDA in April. Disulfiram (Antabuse) will also be available, but its application is expected to be limited.

Naltrexone, approved for treatment of alcoholism since 1994, is an anti-craving medication. Research shows that people with extensive cravings and multiple relapses tend to show more positive results than other groups of patients. Vivitrol has shown some promising results. Often people don't respond to medication because they quit taking it, so Vivitrol, which is administered in a doctor's office and has an effect for a month, eliminates the issue of compliance that medication often presents, said Lind.

Acamprosate was approved by the FDA for use in the United States as an anti-craving medication for alcoholics in 2004. Studies show some alcoholics have longer periods of abstinence and less relapse when this medicine is prescribed.

Lind emphasizes that the medicines will be used in conjunction with the treatment program. "None of these medicines are as effective if you don't use treatment with them," she said. "Our plan is to provide full treatment as we always have and add the medications for those few individuals for whom research indicates they may benefit, in order to find out how much more effective we can be in helping our patients stay sober."

Fred Holmquist, director, The Lodge

More meds to come
Another generation of anti-addiction medications is on horizon. More than 200 such medications are being followed by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

Current study of the neurobiology of addiction indicates there is a marvelous potential for intervening to help addicts with a pharmacological approach. In the next five to 10 years, these researchers project that medicines will be developed that work better than the current ones, said Lind. "It's important for Hazelden to be at the forefront of these developments. Hazelden is leading the field by combining anti-addiction medications with our treatment program. It's our hope that we can help the entire field learn how it can combine our form of treatment with these medicines to help the most people."

New Hazelden pamphlet is guide to anti-addiction meds

Anti-Addiction Medications: A Clinical Perspective (order number 2601) is a new Hazelden guide to make clinicians aware of the anti-addiction medications currently available, discuss the pros and cons of each medication, offer basic prescribing criteria, discuss the potential side effects of these medications, and provide an understanding of appropriate follow-up care.

The pamphlet is for any clinician or addiction treatment professional interested in reducing relapse and improving recovery success rates by integrating medication use with treatment protocols. It examines the limitations and successes of the FDA-approved medications currently available. The pamphlet packages specific information on each medication, including the type of patient who can be best helped, the form of medication, how it works, research findings, the recommended dose, warnings, and guidelines for administration and ongoing patient care.

--by Linda E. Peterson

Published in The Voice, Winter 2007