Saturday, January 01, 2005

Last Minute Thoughts
Alcohol Abuse, Acamprosate, and Hope

It seems that there has not been a lot of reason for hope, in the last month of the year.  I've been digging around on the Internet for the past hour or so, looking for something positive to say.  When everyone sobers up and gets back to life in cyberspace, perhaps some of them will find encouraging news here.

News #1:
Nov. 5, 2004 -- No. 541

New brain cells develop during alcohol
abstinence, UNC study shows

UNC School of Medicine

CHAPEL HILL -- University of North Carolina at Chapel Hill scientists have reported – for the first time – a burst in new brain cell development during abstinence from chronic alcohol consumption.

The UNC findings, from research at UNC’s Bowles Center for Alcohol Studies, were based on an animal model of chronic alcohol dependence, in which adult rats were given alcohol over four days in amounts that produced alcohol dependency. The study is in the Oct. 27 issue of the Journal of Neuroscience.

In 2002, Dr. Fulton T. Crews, Bowles Center director, and Bowles Center research associate Dr. Kim Nixon were the first to report that alcohol, during intoxication, has a detrimental effect on the formation of new neurons in the adult rat hippocampus. This brain region is important for learning and memory – in animals and humans – and is linked to psychiatric disorders, particularly depression.

"When used in excess, alcohol damages brain structure and function. Alcoholics have impairments in the ability to reason, plan or remember," said Crews, also professor of pharmacology and psychiatry in UNC’s School of Medicine. "A variety of psychological tests show alcoholics have a difficulty in ability to understand negative consequences."

In the new study, senior co-author Crews and co-author Nixon found inhibition of neurogenesis, or brain cell development, during alcohol dependency, followed by a pronounced increase in new neuron formation in the hippocampus within four-to-five weeks of abstinence. This included a twofold burst in brain cell proliferation at day seven of abstinence. [...]
News #2
Health Notes
Monday, December 6, 2004
Compiled by Anne Hart

New Year's little helper

Makers of a new drug to help drinkers stay on the wagon is expected to be available in time for New Year's festivities, Time magazine reports.

Campral is the first new drug approved by the Food and Drug Administration in almost a decade for helping drinkers remain abstinent.

Taken as part of alcohol-treatment program that includes psychosocial support, Campral helped 16 to 38 percent of alcoholics who had already stopped drinking avoid imbibing for up to four months, Time reports

Unlike current abstinence aids, Campral works by restoring the nerve activity in the brain's pleasure center that is altered by too much alcohol.
Those interested in Campral can find a little more information at the manufacturer's product website.  According to their package insert (PI), chronic alcohol abuse is thought to "alter the normal balance between neuronal excitation and inhibition."  They add, "acamprosate may interact with glutamate and GABA neurotransmitter systems centrally, and [that] has led to the hypothesis that acamprosate restores this balance.

If that is all geek to you, I will translate.  Most systems in biology are regulated via two opposing forces.   Very broadly speaking, there are two kinds of chemical messengers in the brain: those that increase nerve cell activity, and those that decrease it.  Glutamate is a widely-distributed excitatory transmitter; GABA is a widely-distributed inhibitory transmitter.  It appears that chronic alcohol use causes the brain to decrease the overall amount of inhibitory transmitter activity, and increase the activity of excitatory transmitters.  This is adaptive, since it helps the brain counteract the effects of alcohol.  But when there is no alcohol, the compensated brain has too much glutamate activity; not enough GABA.  This, in addition to making the person very uncomfortable, makes the person have all kinds of nasty symptoms.  In severe cases, it can cause hallucinations, seizures, and death.  The discomfort, though, is what leads to craving, which increases the risk of relapse.

The idea is that Campral might help stabilize the balance between excitatory and inhibitory activity in the brain, thus reducing craving, thus reducing relapse.  Notable, it does not act like Antabuse.  Antabuse causes the patient to become violently ill after consuming alcohol.  That can be dangerous, so it cannot be used in people who have not established some degree of sobriety already.  Also significant is the finding that Campral has no appreciable anticonvulsant activity.  That means it cannot be used to make alcohol withdrawal safer.  People who need to be detoxified from alcohol still will need to take something like Librium, Serax, or phenobarbital. 

Does Campral work?  It is too early to say how useful it will be in actual practice.  Even if it is only moderately effective, that will be a very good thing.  To illustrate: even if it only leads to sobriety in 10% of persons addicted to alcohol, if all alcoholics took it, it would help over a million people in the USA alone.  So the fact is, it does not have to be very effective, in order to have a huge public health impact.  Are there are risks? Who cares? Really: who cares?.  I can guarantee this: it is not as dangerous as alcohol. 

I'll close with this snippet from the NYT article on the New Year celebration:

News #3
Miss Trixie, a transsexual who said she was an actress between jobs, was on Avenue of the Americas in Greenwich Village talking about how she had been sober for 49 days and was determined to make it 50. She said she was returning to Brooklyn as soon as she finished hustling for small change.

"Old people and old places," she said about Times Square, a veneer of 5 o'clock shadow showing through her made-up face. "People and places you want to stay away from.

"My goal in 2005 is to be a productive citizen in society working for some establishment in New York City."

She rattled her Taco Bell cup as people walked by .
You take your hope wherever you can find it.