Medicating alcoholism

DW: You used nalmefene pills in experimental studies with alcoholics. What were the results?

Karl Mann: Compared to a control group that received placebos, we found the trial group that took nalmefene pills were able to significantly reduce their alcohol consumption.

Does it matter how pronounced the alcoholism is, or how long the individual in question has been addicted to alcohol?

That would be the next question. First, we had to see whether the approach stands a chance of success at all, which is what we saw in this study. There are two other similar studies on the topic. One of them ran over the course of an entire year and it came up with the same positive results. Now we can say it's a very interesting approach.

We've gathered some evidence concerning the correlation of the duration of the addiction and the effectiveness of the therapy: for instance, people who have consumed a large amount of alcohol reacted better than people who were addicted but had drunk less.

Some patients only have to go see their family doctor and have their liver tested to reduce the consumption of alcohol. That is true for about 20 percent of those affected. For the remaining 80 percent, it makes sense to try the pill.

But the pill did not result in your test subjects stopping drinking altogether?

Very few managed to do that. The others reduced their consumption to about 40 percent of what they drank before. That surprised me, too, as I come from a tradition that says, people who are addicted to alcohol must abstain, nothing else works. Here, we were able to gather data over a period of six months that shows that people - although they are addicted - can actually massively reduce consumption under certain circumstances and that doing so, they feel more healthy and do better in their social lives and jobs.

Was it enough to take the medication, or was psychotherapy part of the package?

The pill is part of a package, but psychotherapy as such is not included. That can only be offered to a limited number of patients. The majority of Germany's 2 million people addicted to alcohol either doesn't get to profit from psychotherapy or doesn't want it in the first place. General practitioners prescribe the medication and additional psychosocial care. They will ask how things are going, check on the liver and motivate the patient, maybe even include relatives like the partner. That's all part of it.

How does nalmefene work, what does it do?

Nalmefene is a substance that regulates our body's own opiates. Endorphins and endogen opiates let us feel good, feel desire and put us in a good mood when we drink alcohol. This drug blocks the good mood and the exuberance alcohol usually produces in people. A consumer will no longer get this positive feedback after a glass or two of wine, so there's really no reason to keep on drinking.

Can this be applied in the case of other addictions, for instance "hard drugs," tobacco or eating disorders?

We've known for a while that these substances also work for drug addicts. When the substance blocks these receptors in the brain, heroin can't dock on. What is new is that it is now being used to treat alcoholism and is no longer linked to absolute abstinence, but can also lead to a reduction.

You describe yourself as traditional, that is, you used to believe that people must abstain completely. What is the advantage of using medication versus the classic absolute abstinence?

The relevant point is that with the classic procedure, we only really reached about 10 percent of those affected. That's ridiculous. If general practitioners latch on to this approach, we might be able to raise that figure to 20 to 30 percent. Not only would we be in a position to help more people, we could also reduce the physical and assorted other consequences of alcohol consumption. That would presumably also save costs in the health care system.

Karl Mann is the Medical Director of the Central Institute of Mental Health in Mannheim, Germany.