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Alcohol dependence treatment: Case studies in medication use

November 1, 2007
by CARLO C. DICLEMENTE, PHd, abpp
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An introduction from Addiction Professional

's Editor


This is the sixth and final installment in a series of articles designed to provide you with the latest information on the use of medications in alcohol dependence treatment. Medications (pharmacotherapy) used as adjuncts to counseling techniques and biopsychosocial, educational, and spiritual therapies are an increasingly important part of a comprehensive treatment approach for alcohol dependence.

Expanding knowledge of how medications may interact with and complement counseling will help the addiction counseling community optimally coordinate care of patients with other treatment providers. Thus, this article series not only provides the latest efficacy and safety data on these medications, it also explores how we can build better relationships among addiction professionals and medication prescribers.

Previous articles in this series addressed the topics of facilitating the process of change through medication use; examining recent research on the approved medications for alcohol dependence; overcoming biases against greater use of medications in treating alcohol dependence; integrating medication into nonprescribing clinicians' treatment planning; and improving prescriber and nonprescriber collaboration to benefit the alcohol-dependent patient. In this final article, Carlo C. DiClemente, PhD, ABPP, presents case studies that illustrate how medications have helped individuals break their dependence on alcohol.

We would like to hear from you on what you thought of this article series, and on how the emergence of medications to treat alcohol dependence has affected your organization and your patients. Send your comments to genos1@cox.net; we may use them as letters to the editor in an upcoming issue.

Editor's Note: Dr. DiClemente was not the therapist for any of the individuals profiled in this article. He has served as the overall scientific and technical editor of this article. The stories described are from individuals who volunteered to share their experiences.

This article series has covered a number of issues concerning the use of pharmacotherapies as part of a comprehensive approach to the treatment of alcohol dependence. The potential benefits of medication use, as well as its potential drawbacks if not used and managed properly, have been described in detail in this series. There is perhaps no stronger affirmation of the benefits of combining medications with counseling than seeing and hearing about actual patient experiences. Often counselors have concerns about medication use and have some examples of patients who did not take the medication or for whom the medication may not have been helpful. There is another side of the coin. This article focuses on how medications have been helpful in overcoming addiction in the stories of four women, each with a unique background and compelling story about how alcohol has affected her life.

There are similar stories of successful medication use in alcohol-dependent men, but the experiences of the four women profiled here were chosen because each used one or more of the approved medications for alcohol dependence treatment—acamprosate, disulfiram, oral naltrexone, and extended-release injectable naltrexone—and their experiences highlight different points about the various paths individuals take on their journeys to recovery. These women describe how these medications contributed to their recoveries by removing physical distractions (such as craving), which allowed them to focus on the counseling they received and channel their efforts into working through the various tasks of the stages of change and making the necessary changes in their drinking behavior. All of them describe how counseling helped them learn valuable skills to maintain their sobriety, and caution that medication use alone would not have given them the needed insights and skills for sustained recovery.

Other themes of this article series, such as the stages of behavior change through which recovering individuals transition, the biases patients face with regard to medication use, and the necessary collaboration between treatment providers and support groups, are prominent in these patients' stories.

Nikki

Nikki is a 27-year-old woman whose family had an extensive history of alcoholism and some drug use. Nikki began drinking alcohol and using marijuana when she was 11, and by age 20 she was also using heroin and crack cocaine. Her life was in disarray as a result of her addictions: She married a man she hardly knew, was forced to give up her children from previous relationships, and was convicted of four felony thefts within one year. Nikki entered inpatient treatment, which consisted of detoxification and group and individual therapy. Though diagnosed with bipolar disorder at age 12, Nikki only first began using medication for bipolar disorder during this treatment episode. This medication helped her bipolar symptoms; however, her addictions were still powerful and produced “very strong urges,” including dreams of drugs and alcohol and a continual taste of them in her mouth.

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