The recent focus given by the MPs Liam Byrne and Jonathan Ashworth to the plight of children and families of alcoholics has shed a welcome light on an important question – how best do we support individuals and families affected by substance misuse?
However, the use of exaggerated numbers to support the cause is misleading and unhelpful. Recent reports, including the Guardian’s (16 February) claimed 2.5 million children live with an alcoholic parent. Yet according to the references provided this is in fact untrue by a factor of more than three. The reference by an all-party parliamentary group on the children of alcoholics to a report by the Children’s Commissioner leads to data on hazardous drinking, not alcohol dependency. These are very different things – and it clearly states there are 700,000 children of dependent drinkers, not 2.5 million.
The reference also cites a report written in 2012 that relies on a study published in 2009 that no doubt used even older data. It ignores the fact that over the past 13 years alcohol consumption per head in the UK has fallen, harmful and binge drinking is down, and young people drink less than ever. UK society is becoming ever more moderate and abstemious. It would be far better to have a debate that is honest and balanced, not out of date, inaccurate or misleading. Dave Roberts Director general, Alcohol Information Partnership
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People are no longer stranger to the idea of alcoholism – the problem has been portrayed in movies several times and some can be witnessed at home, too. The depiction of the typical drunkard in TV programs or movies demonstrates the common effects of alcoholism to a person. The incoherent mumbling, the sudden shift to becoming a chatterbox, and the inability to walk straight – these are just what appears on the outside. There are bigger and more serious effects on the mental health of a person.
The regular consumption of alcohol alters the chemistry of the brain. The amount of alcohol that is not processed by the liver is sent back to the bloodstream, reaching other parts of the body including the brain. Technically speaking, alcohol alters the chemical messengers of the brain called the neurotransmitters. When the neurotransmitter levels are altered, signals controlling the body and its behavior are disrupted as well.
The mental effects of alcoholism can be summarized into four: poor cognitive or learning skills, loss of memory, emotional instability, and poor judgment. Read on to know more about these mental side effects and to understand why an immediate trip to the alcohol rehab centers is deemed necessary.
Cognitive Impairment or Poor Learning Skills
Cognitive impairment is a common effect of alcoholism. The persistent and serious changes to the brain chemistry make learning difficult for alcoholics. Most alcoholics also suffer thiamine deficiency. This nutrient is essential to the health of the brain tissues.
The lack of thiamine due to alcoholism may develop an even more serious disorder called Wernicke Syndrome. This refers to encephalopathy which is characterized by severe mental confusion, poor muscle coordination, and paralysis of the eye nerves. Another mental side effect is the development of Korsakoff’s psychosis. This is a debilitating condition that is linked to persistent learning difficulty.
Poor Judgment and Emotional Impacts
The excessive ingestion of alcohol has an impact on the cerebral cortex of the brain. This brain segment is responsible for processing thoughts which is an important step in making decisions. An alcohol person loses control of the thought processing and may eventually lose his or her inhibitions. The problem in the cerebral cortex is the reason behind a person’s talkativeness when intoxicated. The emotional effects of excessive alcohol intake include bouts of crying, hysteria, anger, and other erratic behaviors.
Here’s the tricky part about alcoholism. Excessive alcohol can actually spike a person’s dopamine level which makes him or her feel great. This encourages a person to drink more. The more a person drinks, the faster the brain chemicals are altered. When the dopamine level subsides, the person experiences the opposite. He or she may start feeling depressed.
Cognitive Decline or Complete Loss of Memory
Chronic alcoholism may completely destroy the brain cells as well as the circuits and synapses of the brain. A long-term alcoholic is likely to experience brain deficits even after sobriety. The cognitive decline may begin with memory slips. However, it may also lead far-reaching aftermath of complete memory loss which may require round-the-clock custodial care.
As per studies related to the cognitive effects of alcoholism to the human brain, women are more prone to mental side effects than men. The vulnerability of the human brain can also manifest in the condition called frontal lobe deficits. The frontal lobe is mainly responsible for brain functions such learning and memory.
How to Address these Mental Side Effects
As with any other form of addiction, addressing problems related to alcoholism require an effective treatment, commitment to sobriety, and several follow-ups. Most of the time, people who have been affected with alcoholism for a long time have already had suffered mental and physical deterioration. Treatments may offer improvement of condition, but it is expected of the alcohol-dependent individual to go through the process of detoxification, withdrawal, as well as psychological conditioning.
It is also recommended that a person consults an addiction recovery specialist when addressing the problem of alcoholism. An abrupt abstinence can do more harm than good. Therefore, having an expert to guide you throughout the journey to recovery is immensely helpful. Making improvements – no matter how little is a good indication that a treatment is working well.
A drug being touted and prescribed as a cure for alcoholism may not work any better than counselling, Dutch researchers have said.
Without proof of its efficacy, prescribing high doses of the drug known as baclofen may be irresponsible, they warned.
“Prescribing baclofen widely as it currently happens in France might be premature and should be reconsidered,” a Dutch research team wrote in the journal European Neuropsychopharmacology.
Two years ago French health authorities approved use of the drug for treating alcoholism. It was originally designed and widely used to treat muscle spasms.
Many people in other countries are thought to use the drug without a prescription for alcoholism.
Interest was sparked in 2008 by a book, Le Dernier Verre (The Last Drink), by French-American cardiologist Olivier Ameisen, who claimed to have self-treated his alcoholism with high doses of baclofen.
A subsequent French trial said high doses of the drug caused a significant percentage of heavy drinkers to give up or moderate their intake.
Several trials since then have come up with contradictory findings.
The latest study was the largest randomised, double-blind, placebo-controlled trial – widely considered the gold standard for drug trials, said the researchers.
Volunteers were randomly divided into groups – some receiving the drug and others a dummy “placebo” pill without the participants or the researchers knowing who was getting what.
The study enrolled 151 people from alcohol treatment centres in the Netherlands. They were divided into high, low and no-dose groups, and all received psychological counselling throughout.
Comparing the outcomes, the group concluded that “neither low nor high doses of baclofen were effective in the treatment of AD (alcohol dependence)”.
There was no difference in relapse speed or rate between the groups.
“We need to consider safety and side effects,” said study co-author Reinout Wiers from the University of Amsterdam.
“We are not closing the door on baclofen but we are saying that we need more research.”
According to the World Health Organization 3.3 million deaths around the globe every year are the result of harmful alcohol use – almost 6% of all people who die.
One morning when he was 12, Samuel Blaise decided to skip school with his best friend Cyril. Both boys hitched a ride across the French countryside, back to their small Normandy town. By noon, they were home unsupervised. “Let’s have a drink,” Cyril suggested. “We can try the whiskey, the one my father likes.”
They had a nip, and then another. “It tasted horrible,” Blaise recalls. “But something clicked. I suddenly felt relaxed and at peace. We polished it off and spent the afternoon lying down on the tiled floor. It felt like I was sleeping in cotton wool. I had discovered my drug.”
Soon Blaise started drinking on his own every night, raiding his parents’ cabinet for potent liqueurs. To avoid being found out, he would mix a “coffin” – a slug of every other bottle he could find mixed in a tall glass. He would sip it quietly while the rest of the family slept upstairs.
Blaise, who is now 46 and an entrepreneur in Paris, says that for decades, only booze could ease his “pathological anxiety”. In his late 30s, at the height of his addiction, he would down between one and two liters of strong beer, followed by a bottle of wine and servings of vodka or whiskey. Sometimes he would wake up in the street or in hospital after a blackout.
Finally, a doctor confronted him with enough force that Blaise believed him: he was a handful of years from death. Blaise tried AA, multiple medications, and three week detox programs. Nothing worked. He and his partner – they have two children together – knew something drastic needed to be done. So on Christmas Day 2011, Blaise sat down at his computer and started and started typing, looking for help.
Then, after scrolling through pages and pages, he found his holy grail: a medication called Baclofen.
The doctor who played guinea pig
Oliver Ameisen, a noted French cardiologist, also knew a thing or two about alcohol.
Ameisen was, from the outside, a wildly successful man. He had a private practice in Manhattan, had been awarded the Légion d’Honneur for his work and, to top it all, was a brilliant pianist. But the physician was also helplessly addicted to alcohol and regularly hospitalized after binges. Like Blaise, every single treatment had failed him.
His situation was desperate, but a thought kept nagging him. After reading a New York Times article describing how Baclofen eased the muscle spams of a cocaine addict, he developed a hunch that the drug – a relaxant typically used to treat patients with multiple sclerosis – might help him.
With nothing left to lose, he decided to turn himself into a guinea pig, reasoning that it was “more dignified to die during my own clinical experiment than it was to die of alcoholism”. In 2004, he started taking small, and then increasing doses of the drug. He was astonished when, a few weeks in, his cravings disappeared. He simply had no desire for a glass of wine anymore.
The Last Glass, the account of his miraculous recovery, came out 2008. Its publication turned him into something of an evangelist for Baclofen.
With more than five millions “problematic drinkers” in France (120 people die from alcohol-related diseases every day), it was only a matter of time before addicts found themselves frantically banging on their primary care doctors’ doors to get their hands on the treatment.
But it wasn’t that straightforward. The drug had to be prescribed off label (that is, not for its original medical use), which health authorities frowned at. To make matters worse, most doctors had never heard of it, and those who had were wary to recommend a treatment which could have severe side effects, including severe insomnia, drowsiness, depression, heightened anxiety and mood changes.
‘I didn’t care about side effects, I just wanted to be free from the booze’
Blaise, too, had come to believe Baclofen was his last chance after reading online testimonials. In a frenzy, he contacted doctors in Canada, Lyon and Paris in the hope of finding someone willing to prescribe him the drug. He finally found Bernard Granger, a psychiatrist and addiction expert turned true believer in the treatment’s efficacy. At the end of his tether, Blaise left a desperate message on his phone. “Please,” he said. “I would do anything to get help.”
A few days later, the two met and talked about the treatment, potential side effects and titration (the process of gradually adjusting the doses until optimal results are reached.) Blaise signed a waiver discharging Granger of any wrongdoing in the event of his own death.
I suddenly understood my addiction was over. I’ve been cured of my alcoholism ever since
On 7 January 2011, full of hope, he swallowed his first pills.
Blaise was, by his own account, not the perfect patient. Two weeks in, he was taking 340mg per day, way above the recommended dose (the French health safety agency allows for a maximum of 300mg, while most doctors in the UK prescribe less than 100mg).
At this stage, Blaise recalls, “ I didn’t care about secondary effects, I just wanted to be free from booze.” He knew that studies had shown very high doses are often necessary to produce a state of complete indifference to alcohol. He also knew there was a significant relationship between the amount of alcohol consumed before treatment and the maximal dose needed by patients to obtain results.
In a 2008 French study, 88% of patients reported “at least one undesirable side effect that could possibly be attributable to Baclofen”, some so unbearable that patients had to stop treatment.
As it turned out, the side effects experienced by Blaise were brutal. He developed both psychotic and manic behaviors, couldn’t sleep, had night sweats, muscle spams, and his sense of taste and hearing changed. He found himself talking to God and thought he understood the world’s great mysteries (in his delusion, he says, “I was sure I had finally cracked the number Pi in its entirety.”) Granger promptly put him on anti-psychotics, which induced a deep depression. He switched to anti-depressants, which finally stabilized him.
On 17 January, still drinking, Blaise got arrested for disorderly conduct and cocaine possession. He also had dozens of Baclofen pills on him, which police officers mistook for drugs. “They didn’t believe a word I said,” he said, still amused by the incident. “They were laughing hard when I begged them for the pills. I was kept in jail for 33 hours.”
But two weeks later, while walking the streets at 4am, he felt a sense of physical liberation comes crashing over him. “It lasted for a few seconds. And I suddenly understood my addiction was over. I’ve been cured of my alcoholism ever since.”
For the entirety of 2012, he stayed stone-cold sober. Nowadays, he says, he will “drink a glass of good wine or two when I have people over. But I can’t drink more than that. I just don’t crave it anymore.”
Clinical trials are in: Baclofen (kind of) works
In the years that followed Ameisen’s discovery, medical authorities in France were put under enormous pressure to allow doctors to temporarily prescribe Baclofen for alcoholism while clinal studies were still underway. Associations of former addicts (which Blaise is now heavily involved in) lobbied hard, but it remained a tough sell – until now.
One of their greatest victories came last week, when a study involving a significant number of patients partially confirmed its efficacy.
Bacloville, the first study led by Philippe Jaury at the Paris Descartes University, administered high doses (the average was 160mg/day) to 320 volunteers aged 18-65 for a year while still allowing them to drink. 56.8% of patients either became abstinent or significantly decreased their to normal consumption levels. The same results were observed in only 36.5% of patients who were given placebos.
A second study, led by Michel Reynaud at the Paul Brousse hospital, had less impressive results. It tracked consumption in 320 patients who had already been abstinent for 20 weeks and ingested an average of 153 mg/day. 11.9% of those taking Baclofen remained alcohol-free, while 10.5% of those on placebo did.
Anne Lingford-Hughes, professor of addiction biology at London’s Imperial College, attended the conference where the results were released. She thinks more data is needed to be truly conclusive on the Bacloville study but so far clinal trials, she says, support the idea that the more severely dependent on alcohol you are, the more likely you are to get benefits from Baclofen.
But, she adds, there’s a lot of concern in medical communities when it comes to giving it to people who drink heavily because of the drug/alcohol interaction, as well as potential overdoses. None of her colleagues in the UK, she says, would prescribe as high a dosage as it is currently prescribed in France.
Not one drop: the problem with total abstinence
The success rate as reported by the Bacloville study is staggering – much higher than rehab centers or even spontaneous rates of recovery (a quarter of people addicted to alcohol eventually recover on their own, while a lot of rehab rates do not even reach that number).
But Dr Jaury, who led the study, says that the idea of such a cure prompted a swift reaction from those with a vested interested in seeing it fail.
According to him, the backlash from the detox industry was swift and ferocious. There was also pushback from some members of Alcoholic Anonymous (AA), which he says promotes a culture of total abstinence. Jaury thinks it’s a shame: “I’ve had patients who were in AA but still secretly took substitution drugs such as methadone or Subutex. They kept it a secret, out of shame and because they don’t want to be excluded from the group.”
Blaise, who still takes Baclofen six years on, agrees and calls the abstinence model “idiotic”.
“For AA,” he says, “the illness is incurable. So I would now have to go to a meeting and say ‘hello, my name is Samuel and I am an alcoholic’. But I am a former alcoholic, not an abstinent one.”
He adds: “They function like a church. Their fourth step commands members to submit to a higher being, but suddenly, scientists arrive with a medication and rationally explain that a biological issue can be fixed. Suddenly, you don’t need abstinence, you don’t need a higher being. The very basis of the church comes crashing with it.”
Blaise says that while he greatly respects members, he has heard a sentiment akin to “you don’t deserve to be cured” from the AA crowd. This makes sense, he says, because to be in a constant state of craving is unthinkably hard. “You need to be at war with yourself to remain sober, minute after minute, day after day. AA people spend years, or even decades before finally reach a state of indifference towards booze, whereas those of us who take Baclofen have to fight a mere few weeks.”
As a result, Blaise says some members believe people like him have merely replaced one drug with another. (When contacted directly, the French chapter of AA says it remains completely neutral on the subject – the organisation “has a rule to never issue an opinion on topics outside our movement”.)
But what about those who can keep their lives together but drink a bit too much?
Sylvie Imbert, a 59-year-old retired computer engineer who founded the French Baclofen Association, didn’t hit rock bottom as Blaise did. Instead, as she was nearing 50, she simply became uncomfortable with the amount she was drinking.
In 2009, she took matters in her own hands and made the two hour long trip from Toulouse to Spain, where Baclofen is sold over the counter. She began taking the drug without medical supervision, and promised herself she would stop should the side effects prove too much (a process she doesn’t recommend). When she reached 120mg a day, her cravings vanished.
She now spends her time spreading the word and counseling people on her website’s forum. “We have up to 2,000 visits a day,” she says. A growing number of her readers are interested in Baclofen for other addictive behaviors, bulimia and gambling among them (a small 2007 trial on seven patients showed that Baclofen reduced binge eating frequency).
Caution before zeal? The novelist who lost her mind to it
Sylvie Imbert and Samuel Blaise both had happy endings to their story. For others, Baclofen was devastating.
In 2008, a British PR executive called Anna Sargent bought Baclofen online to finally stop drinking. She suffered severe side effects and panic attacks when she stopped taking it, and killed herself soon afterwards. Her parents blamed the drug, and said at the time that she “couldn’t face more of these terrible effects of feeling anxious and suicidal”.
The story of Alix de Saint-André, a renowned Parisian novelist, is another case in point.
When Saint-André read about Baclofen, she decided to try the drug “as an adventure” in order to give up smoking. At the time she was chain-smoking three packs a day and had tried to quit many times without success.
Under close supervision (a physician friend of hers who admired Ameisein’s work agreed to give her a prescription), she holed herself in her country home during Christmas break to start the process, always making sure to stay within the recommended dosage.
This was 2008, and while the protocol was relatively new, Saint-André was comforted by Ameisen’s assurance that Baclofen’s side effects were “as hurtful as drinking a glass of water”.
Soon, however, she stopped sleeping and lost her appetite (she also started to write, and was delighted by her sudden rush of inspiration). A few days later, things took a turn for the worse. She had hallucinations, paced her bedroom endlessly, and found herself talking to saints and dead scholars.
A friend of hers quickly became alarmed and forced her to check in a psychiatric hospital, where she stayed for four hellish weeks. In her memoir L’Angoisse De La Page Folle, Saint-André details how her full recovery would take a whole year, and included weekly sessions with a psychiatrist as well as anti-psychotics and anti-depressants.
Her experience left her skeptical of a drug so many called “life saving”. As she researched what had happened to her, she found another case of Baclofen-induced psychosis in medical literature, which spurred her to alert the media about it (they took little notice, she says). Saint-André worries that cases similar to hers are ignored by overenthusiastic doctors – and the thought of patients self-medicating with no professional supervision mortifies her.
French doctors, she says, are quick to fight back with a utilitarian reasoning: if Baclofen can help half of the 120 people a day who die from alcohol-related diseases while only a tiny percentage experience severe side effects, there’s no question it should be used. “I’ve had doctors keen to remind me that some people died when the first vaccines were being tested on them,” she says.
After the publication of her book, Saint-André says she was contacted by readers with similar stories. One man told her about how his wife had been prescribed Baclofen by a dermatologist to, of all things, lose weight.
Three weeks in, she started to suffer from paranoid delusions. Shortly thereafter, she threw herself out of a window.
Repeat it like a mantra: in addiction, no size fits all
As addiction experts are keen to remind us, there isn’t “one size fits all” treatment to cure patients – something of a truism within the addiction field.
Marc Lewis, a neuroscientist and former addict who wrote Memoirs of an Addicted Brain, is keen to highlight that a lot of different approaches can be therapeutic. “The therapy has to fit the person, not the substance [they’re taking].”
But first, he says, physicians have to be trained to identify if a treatment is working, and most importantly trained to understand addiction (Lewis is keen to refer to addiction a “cognitive habit”, as opposed to a chronic disease. A habit can learned, and therefore can be unlearned.)
Medication might have saved people like Ameisen, but for others, AA, talking therapy, mindfulness, exercise and rehab treatment (or a combination) might work. “People recover in very different ways,” Lewis says. “A lot of patients don’t respond to medication. There’s a lot of people with serious sex addiction, eating addiction, serious compulsive gambling problems … and medication can’t do anything for them.”
Whether Baclofen will eventually become a staple for addictions other than alcoholism remains unclear. But armed with the clinical trial results published this September, the pharmaceutical company Ethypharm has already announced its intention to push for a full licensing of the drug specifically to treat alcoholism as soon as the full results of the Bacloville study are published.
The race for a cure doesn’t stop here. In the US, the pharmaceutical company Indivior has already licensed Placarbil, a variant of the Baclofen molecule with more efficient pharmaceutical proprieties and improved absorption rates. Trials are under way, and results are expected at the end of the year.
If the findings are encouraging, a similar controversy than the one currently unfolding in France will be sure to hit the US with some force.
A fairly new anti-seizure drug may aid alcoholics quit consuming, in accordance to a new research.
Researchers at Boston University College of Medicine discovered that ezogabine had the possible to lessen alcohol consumption amongst alcoholics by minimizing the want to drink.
The examine benefits, published on the web in the American Journal of Alcohol and Drug Abuse, were especially fascinating simply because they showed ezogabine, a potassium channel opener, worked to regulate brain exercise by means of a new mechanism acknowledged as Kv7 channel modulation.
The drug in query, GlaxoSmithKline’s Potiga (ezogabine is the generic name), is reasonably new it was only approved by the FDA in 2011. Due to the fact FDA approval was only for seizure ailments, any present use to treat alcoholism would be off-label.
“Ezogabine acts by opening a certain kind of potassium channel in the brain, called the Kv7 channel, which regulates action in regions of the brain that are believed to regulate the rewarding results of alcohol,” mentioned Clifford Knapp, PhD, associate professor of psychiatry at Boston University School of Medication and the study’s lead author.
Knapp summarized ezogabine/Potiga’s epotential effect succinctly: “This analysis indicates that medicines that open Kv7 channels may well be of value in the treatment method of alcoholism.”
Any possible new treatment method for alcoholism has massive relevance because the illness has proved so intractable. Current remedies even now fail in the huge majority of cases statistics demonstrate 90 percent of those who get sober relapse at least as soon as. And people numbers apply only to the 15 % of people who abuse alcohol who even seek out remedy.
And in situation you feel alcoholism does not impact you, take into account this: recent government statistics show that 17 million Americans have an “alcohol use disorder” and close to 25 % of all Americans in excess of 18 report binge consuming (5 drinks or far more in one sitting) at least after inside of the previous month.
A lot more than half of all Americans (53 %) say they have at least one close family member with a consuming dilemma. And each and every yr, far more than 80,000 deaths in the U.S. arise from alcohol-relevant brings about, placing it subsequent after smoking and weight problems as a major preventable lead to of death.
The existing review is only preliminary, however, and Knapp and team cautioned that far more study will be required to recognize how specifically ezogabine functions through Kv7 channels and to assess the drug’s complete results.
There’s also the concern of dosage. Ezogabine is recognized to result in drowsiness, dizziness, and motor impairment, side effects that are listed in the drug’s patient disclosures, and drinking alcohol whilst taking the drug can exacerbate these effects.
As a result, the researchers note, there’s a small dosage window among when ezogabine decreases drinking, and when it starts to impair motor abilities. Simply because of the “close proximity” of the doses, Knapp says, “It is nevertheless essential to continue to investigate how selective the actions of ezogabine are on the neuronal mechanisms that manage alcohol consumption.”
So in other words there is nevertheless plenty of work to be accomplished just before Potiga can be additional to the alcoholism remedy arsenal.
But offered that other anti-seizure meds like topiramate (brand name: Topamax) are being utilized off-label for their possible to treat alcoholism, it seems very likely we can look for potential breakthroughs in this region.
