Quitting Alcohol with a PILL? What do YOU say?

For two years, Joanna P. of Gaithersburg, Md., watched her husband Adam try, and fail, to quit smoking—over and over and over. "He tried quitting cold turkey, he tried Commit lozenges, nicotine gum, and the nicotine patch," she says.

In November 2007, Adam tried something different: Chantix, a pharmaceutical drug that promised to be the key to sobriety success. According to Joanna, it's worked. Not only has Adam quit smoking, it's no longer pleasurable for him to cheat.

"He had a few puffs of a cigarette in January and it was tasteless and did nothing," she says.

Introduced to the market in 2006, Chantix itself is still fairly new. The concept of treating addiction with medication, on the other hand, is far older—dating back the late 1940s, and a drug called disulfiram. Although they were testing it to fight intestinal parasites, researchers noticed that disulfiram had the odd, and potentially useful, side effect of making any amount of alcohol consumption extremely unpleasant. "You'll get sick with nausea and light-headedness," says Dr. Michael M. Miller, president and board chair of the American Society of Addiction Medicine.

"You'll get a headache and can throw up or pass out."

Sold under the brand name Antabuse, disulfiram has been used to treat alcohol addiction since 1951. Until recently, it was one of a very small number of anti-addiction medications available. But, around the turn of the millennium, that began to change. Today, Miller says there are about a dozen of these medications on the market, most of which are designed to treat addiction to one of three substances: Nicotine, alcohol, or opiates. And, despite health concerns, Miller and his colleagues say these meds are incredibly effective.

"Kyle," a 22-year-old from Madison, Wis., got addicted to opiate painkillers after having his wisdom teeth removed. At age 17, while still in high school, he advanced to a stronger drug, Oxycodone, and soon moved on to heroin. Both physically and mentally addictive, getting off heroin is usually gut-wrenchingly painful and hard to maintain for very long. But Kyle has been clean, without a single relapse, for two years—ever since the day his doctor gave him his first dose of Suboxone, a drug that relieves both the physical symptoms of opiate withdrawal and the cravings.

“Without Suboxone, I’d be in jail or I’d be dead,” “Kyle” says. “I can guarantee that.”

How they work
To understand why anti-addiction medications can be so successful, you have to understand how they work.

There are basically three kinds of anti-addiction meds: antagonists, agonists, and partial agonists. The names are confusing, but the explanations aren't. It all centers on dopamine, the primary brain chemical responsible for creating feelings of pleasure. Substances like alcohol, nicotine, and opiates bind to receptors in your brain, like a key into a lock, opening doors that release a flood of dopamine.

This is where the meds come in. Antagonists will block these receptors, sort of like nailing plywood up over a door. The drugs can't get to the lock, so no excess dopamine is released and the drugs simply don't work. Naltrexone, which can treat both alcohol and opiate addiction, is an example of this. Campral, which treats alcohol withdrawal symptoms, is also thought to be an antagonist, although it isn't fully understood yet how that drug works.

Agonists, on the other hand, fit the lock just like the drugs would and produce similar effects, including high levels of dopamine. The difference is that agonists aren't as dangerous as the drugs they're replacing. Methadone is probably the most famous agonist. In low, random doses it reproduces some of the effects of heroin. But take it on a daily maintenance schedule and it fills and blocks the lock; Relieving the patient's withdrawal pains, overcoming their cravings, and putting them on the path to a healthy lifestyle.

Then there are the partial agonists, a category that includes both Chantix and Suboxone. Like agonists, they fit the receptor lock, but not entirely. These meds don't reproduce the full effect of a drug, but they do somewhat. And, in the presence of the actual drug, they'll also function as an antagonist, which explains why Adam P. couldn't get a buzz off his cigarettes after taking Chantix.

Side Effects

The problem is that, while these drugs are statistically successful, they aren't necessarily instant sobriety in a pill.

Some patients will still need counseling and group therapy to stay sober. Others won't find certain pills useful at all. "One thing that's clear is that some of these medications don't work in everyone," says Dr. Frank Vocci, director of the Division of Pharmacotherapies at the National Institute on Drug Abuse. "Doctors have to work with each patient on an individual basis and see what works for them."

That means managing both effectiveness and side effects, which also vary from person to person. Chantix is a great example of this. According to the Mayo Clinic, clinical trials of Chantix showed a 14 percent to 25 percent success rate over the course of a year. Miller, however, has seen a far higher rate of success in his practice—about 40 percent. The length of time patients have to take the meds can also differ. According to Miller, some patients could need to be on meds for their entire lives. Others will take a pill for several years and then wean off.
Still others will only need a few months before they feel confident avoiding the addictive drug without medical help.

Side effects also seem to vary, particularly with Chantix. The main ones are nausea, vomiting, and headache—similar to what a young, first-time smoker might experience. But over the past few months, there have been reports of far more troubling problems: horrific nightmares, suicidal thoughts and irrational, erratic behavior. In September 2007, Texas musician Carter Albrecht was accidentally shot to death after showing up on his neighbor's porch in the middle of the night, ranting and demanding to be let in. His family blames Chantix for Albrecht’s behavior that night. In January of 2008, Pfizer, Chantix's maker, changed the med's labeling to caution doctors to monitor patients for severe mental side effects.

Who can prescribe them?
Some anti-addiction meds, usually the ones used to treat opiate addiction, can also be difficult to get. Suboxone, the pill "Kyle" credits with saving his life, can only be prescribed by doctors who have taken a special eight-hour training course or who've been certified by the American Board of Psychiatry and Neurology in Addiction Psychiatry, the American Society of Addiction Medicine, or the American Osteopathic Association. It can be hard to find these doctors and the best way to track them down is through the Federal Substance Abuse and Mental Health Services Administration. Part of the reason these drugs are so closely regulated is that they can cause withdrawal symptoms in some patients. Getting off a drug like Suboxone usually involves gradually scaling back the dose over several months or years.

Weighing the benefits
Experts in the field say the benefits Chantix outweigh its risks for most people and it shouldn't be taken off the market or avoided. "It does seem like in a minority of folks there is an issue, particularly people with current or previous psychiatric disorders,” Vocci says. “But for the majority, it's probably beneficial."

Miller agrees. "I'm concerned these reports will end up with people staying away from medicine that can really help them," he says. "If people don't recover from nicotine addiction it has a good chance of killing them. Not treating the addiction is a dangerous thing."

Instead, both doctors advise patients on any kind of anti-addiction medication to look at their meds as a tool that might need to be adjusted or changed. They say to report any odd or uncomfortable symptoms immediately and work with doctors to find a med that best balances health, quality of life, and the ability to stay clean and sober.

• Sound off: What techniques have you used to help you quit?
• Substance Abuse & Mental Health Services Administration
• SAMHSA- Find a doctor who can prescribe Suboxone

Maggie Koerth-Baker’s work has appeared in AARP magazine, The Associated Press and Health magazine.