Q: I am a lawyer who works primarily within the
financial services industry, and in my circle both drugs and
alcohol are frequent accompaniments to business relationships. I
guess you'd say my primary substance is alcohol, sometimes with
side excursions into painkillers and cocaine, and things have
gotten to the point where I've found it almost impossible to stop
my increasing use. I have not been inclined toward participating in
groups of any kind, but through some internet searching and asking
around, I've learned that there are actually medicines used to
treat alcohol problems, such as naltrexone and something called
ibogaine. Do these work?
A: The first point to make here is that
medications targeting alcohol/drug addiction are generally
not meant to be stand-alone treatments. The measures that
a person takes consistently over the long term are most highly
correlated with lasting success, and frequency also makes a
difference in most studies - this is one reason that so called
"self-help" groups (which might be better termed mutual help
groups) have become so central in addiction recovery, though
certainly not everyone finds a way to make optimal use of them. But
in my experience those who use any of these medications without
also making longer-term use of therapeutic supports and lifestyle
changes are likely to find that any improvement is not lasting.
Naltrexone (brand name Revia) is an opiate blocker that seems
(at least for some) to reduce the urge to drink and also blocks the
effects of painkillers or heroin. Acamprosate (Campral) is another
prescription medication that, for some individuals, reduces alcohol
cravings. The effects of both of these medications tends, from what
I've seen, to be quite limited, e.g., people often say something
like, "I think it may be helping, but I'm not sure." Two alternate
means of prescribing Naltrexone claim better results; one, known as
the "Sinclair Approach," uses a different dosing schedule and
begins before a person has stopped drinking; the other, known as
Vivitrol, is a monthly injected form of Naltrexone that is said to
have a more continuous effect. A potential drawback to taking
Naltrexone is that it will block the effect of a painkiller if you
were to need one, for example, after unplanned surgery. (There are
procedures for overriding the opioid blocking effect in an
emergency - which must be carried out with careful medical
supervision.)
Disulfiram (Antabuse) has been around for decades; its effect
only kicks in if a person consumes alcohol, in which case s/he
immediately becomes quite ill. So its real effect is
cognitive - that is, the person realizes that instead of
feeling in an way better upon drinking, the effect will be quite
the opposite, so it is a tremendous deterrent. The main problem
with Disulfiram is that many people stop taking it after the
initial crisis passes; if you don't take it, it does not work. It
is almost never recommended as a long-term treatment (or for those
with heart or liver disease), but for some people it "buys time"
while they develop ways to cope with life sober.
Ibogaine has also been around for many years. The product of an
African plant, it is apparently part hallucinogen, part
withdrawal-symptom reducer, and part antidepressant, and much
touted by those who administer it, as a way to both detox and
dramatically reduce craving for a period of time. Several studies
have been done, mostly of a neurochemical nature, but despite the
claims it remains illegal in the U.S. Even as an addiction
specialist, I've rarely met anyone who has made the voyage and had
this treatment. But even those who tout its wonders confirm that
multifaceted ongoing help and lifestyle change are necessary in
order to sustain good outcomes.
The good news is that it sounds as if you are ready to do
something about your drinking and drugging. As a Massachusetts
lawyer, you have access to a free and confidential clinical
consultation at LCL, where we can more fully examine your
options.
Dr. Jeff Fortgang is a licensed psychologist and
licensed alcohol and drug counselor on staff at Lawyers Concerned
for Lawyers of Massachusetts, where he and his colleagues provide
confidential consultation to lawyers and law students, and offer
presentations on subjects related to the lives of lawyers. Q&A
questions are either actual letters/emails or paraphrased and
disguised concerns expressed by individuals seeking LCL's
assistance.