Dry. A new treatment for alcoholism defies the recovery movement by susan seligson 42 BOSTONIA Fall 2010 224-51.BostoniaFall10_03.indd4-51.BostoniaFall10_03.indd 4242 99/14/10/14/10 22:12:12 PMPM “It crept up on me.” and has been intrigued ever since Lisa speaks softly as she sips spring water in a by the effects on the brain of every cafeteria at the BU Medical Campus. “My 5 o’clock abusable substance, from LSD to drink got earlier and earlier, until I was filling a glass amphetamines. In medical school he was part of a group investigating the at 3:30.” Then one afternoon in the shadow of lunch- use of psychedelic drugs to relieve time, Lisa’s daughter asked her to babysit her children pain in cancer patients. Since then, at their home just a few doors away. She knew right he has devoted much of his career to away that she had to say no. She was drunk. answering questions about tolerance to alcohol, predisposition to alcoholism, and how the disease ties in with anxiety Serendipity brought 59-year-old himself the epitome of the social and depression. Lisa to the experimental alcoholism drinker; he confined his alcohol con- “I wondered, what leads to alcohol- treatment clinic in the Doctors Office sumption to martinis at a hole-in- ism?” he says. “The first thing you no- Building at the edge of the Medical the-wall pub near his home outside of tice is anxiety and depression, but I had Campus. (Names of the clinic’s Boston. Describing himself as “a boring it backwards. Depression doesn’t cause patients have been changed.) The day guy,” Ned says that with each martini drinking; drinking causes depression.” after she told her daughter she was he lightens up and makes jokes, but is Ciraulo believes that both depen- unable to babysit, she heard a radio never “an obnoxious or mean drunk.” dence on alcohol and the ability to stop announcement about a 16-week alcohol During the last year, it had become drinking lie in the brain’s frontal lobe, study headed by Domenic Ciraulo, more difficult for Ned, who comes ground zero of self-control. “The goal a School of Medicine professor and from a family of alcoholics, to convince of all drug therapies for alcoholism is chair of psychiatry and psychiatrist- himself his drinking was under control. to block the desire to drink,” he says. in-chief at Boston Medical Center. The By the time he found his way to the What is known about that desire is that treatment, it turned out, was unlike clinic, two days after seeing a television alcohol causes a chemical imbalance Lisa’s notions about programs designed recruiting advertisement, he calculated in the brain, apparently by sensitizing to help people beat an alcohol problem. that he was consuming at least 180 and ultimately wreaking havoc with It was also unlike programs that were martinis or gin cocktails each month. the brain’s reward system, involving endorsed by many in the recovery the neurotransmitters dopamine movement. For one thing, it attempts GOAL: BLOCK THE DESIRE TO DRINK and serotonin, which are associated to treat alcoholism with long-term Ciraulo’s interest in addictions grew with pleasure and a sense of well- medication. For another, it allows out of his college experience. He being. While alcohol initially leads those enrolled in the program to have came of age in the drug-addled 1960s to an increase in dopamine, chronic an occasional drink. During that first clinic visit, Lisa recalls, she was relieved to share the intimate details of her struggle with alcohol. “I’m a good news gal; I keep things private,” she says. Handed a 13- page consent form to review, Lisa was interviewed by a research coordinator, Domenic who asked how much she was drinking Ciraulo won- each week. (Participants in this study dered if it must be heavy drinkers. For males, was true that depression this translates to 35 or more standard caused people drinks a week—5 ounces of wine, 12 to drink. Per- ounces of beer, or 1.5 shots of hard haps it was drinking that liquor. For women it’s 28 or more made people drinks a week.) Tallying the drinks in depressed. her head, Lisa came up with 30. At least 30. She was horrified. “Most people, once they talk about it, realize they’ve been drinking much more than they thought,” says principal investigator Maryam Afshar, a MED assistant professor of psychiatry. Ned, a wistful, mild-mannered, 55-year-old gay banker, considered PHOTOGRAPHS BY MELODY KOMYEROV Fall 2010 BOSTONIA 43 224-51.BostoniaFall10_03.r1.indd4-51.BostoniaFall10_03.r1.indd 4343 99/20/10/20/10 99:30:30 AMAM The consumption eventually causes The medical nature of why people dopamine levels to fall, leading to a Symptoms start drinking and why they can’t more anxious craving for alcohol and stop is hugely under-recognized, says requiring more alcohol to get the same Also known as alcohol dependence, Ciraulo, a plain-spoken, bearded man pleasurable effects. alcoholism the disease is not a sub- whose bearing would suit the set of a With backing from the National jective diagnosis. It is defined by a Puccini opera. “And the genetic influ- Institute on Alcohol Abuse and set of symptoms: a strong need, or ence that interacts with environmen- Alcoholism (NIAAA), Ciraulo, who urge, to drink; not being able to stop tal stresses is a complex model that has been chair of psychiatry since drinking once drinking has begun; very few people understand fully,” he 1996, has joined with David Barlow, a alcohol withdrawal symptoms such adds. “We’re just beginning to figure College of Arts & Sciences professor as nausea, sweating, shakiness, and it out.” of psychology and founding director anxiety; and the need to drink greater of BU’s Center for Anxiety and Related amounts of alcohol to experience BIG PHARMA: DAMAGING THE BRAND Disorders, to attempt to prove a its effects, a phenomenon known in Using drugs to treat alcohol addiction controversial thesis: by adding drug addiction parlance as tolerance. dates back to the late 1800s and a therapy to the mix of short-term misguided notion that alcoholics could behavior therapy, and Alcoholics be helped with opium. Today, only two Anonymous (AA) if patients desire it, vasive 12-step groups like AA, with drugs are FDA-approved to treat the this program can help alcoholics like an estimated membership of 1.2 mil- disease. One, acamprosate, restores Lisa drink in moderation. lion, are widely respected, nearly a a healthy balance between glutamate As chief investigator, Ciraulo third leave the program after the first and GABA, two of the chemicals that presides over a team of psychiatrists, month, with the attrition rate slowing get jostled in the brains of alcoholics. psychologists, pharmacologists, gradually after the first year, according The other, naltrexone, commonly used nurses, and research assistants who to AA’s own informal statistics. And to treat heroin addiction, appears to are recruiting subjects like Lisa and nearly all conventional treatment help prevent abstaining alcoholics Ned to test the relative effectiveness and rehabilitation centers are based from relapsing. The FDA approved of two antiseizure drugs—zonisamide on the 12-step model. Yet long-term the use of naltrexone for alcoholism and levetiracetam— abstinence is elusive, and alcoholism in 1995, to reduce both the desire for WEB EXTRA in curbing alco hol remains pandemic and increasingly a drink and the craving following a A video of cravings. Lisa signed costly to the nation’s health and first drink. An analysis of 20 studies Domenic Ciraulo talking on for a controlled, productivity. The NIAAA estimates found that naltrexone reduced the risk about his work double-blind study that 14 million Americans either abuse of relapse by 36 percent in abstaining is at bu.edu/ comparing the drugs or are dependent on alcohol. According alcoholics taking the drug every day, bostonia. with each other and to the institute, alcoholism and alcohol but the effect doesn’t last for people a placebo. It’s a continuing study, abuse are the third leading cause of who stop the drug or skip doses; one requiring 160 subjects total, with 40 in preventable death in the United States study of men only reported in the New each group. and alcohol is a factor in nearly half England Journal of Medicine found that Many of the results of treating of America’s murders, suicides, and a year of naltrexone treatment didn’t alcoholics with this class of drugs, accidental deaths. Alcoholism costs help hard-core alcoholics. approved by the FDA only to treat the nation more than $3 billion in For the most part, says Ciraulo, epilepsy and migraines, have been lost wages each year. Approximately when it comes to so-called addiction encouraging. Although the mechanism 90 percent of alcoholics are likely to drugs, pharmaceutical giants like isn’t completely understood, anticon- experience at least one relapse over the to keep their contributions low-key vulsants appear to alter brain signals four-year period following treatment, or steer clear of these applications in a way that puts a significant dent a dismal success rate that reflects only altogether. “The drug companies in alcoholics’ cravings. But the drug those who actually seek help. fear that using their drugs to treat most studied, Topamax, has been asso- Considering the influence of alcohol alcoholism would damage the brand,” ciated with side effects such as burn- on our lives, says Ciraulo, whose fund- Ciraulo says.