by Harvey Widroe, M.D.
American Reporter Correspondent
October 4, 2007
MY PROGRAM AND MY CAMPRAL
ORINDA, Calif. -- It was a funny feeling, almost a kind of irritability or edginess. Bob's parents could pick up on it in his angry tone of voice and pressured speech, often before he was aware of it himself.
It had taken Bob months of "working" his Alcoholics Anonymous program to recognize that the tense, edgy feeling was there at all, and to link it to the urge or impulse to have a drink. That drink, then another, then still another, made the irritability go away. He would then feel good again, even happy, at least some of the time.
Bob was 40, divorced, and had been repeatedly fired, usually for erratic work attendance. His ex-wife's refusal to let him see their two kids because of his bad temper at first made him furious, then gave him pause to think. He first attended an AA meeting to prove "They" were all wrong, that he wasn't an alcoholic.
The AA members at the meeting sounded like burned out drunks to him, people who had nothing better to do with their lives than attend AA meetings, talking with one another. But after several meetings he saw a few things in the others that he might apply to himself. It slowly dawned on him that he was, in fact, helpless in the face of his drinking.
On many occasions he had resolved to stop drinking, or at least limit his drinking to one, perhaps two drinks a day. As many times as he had tried, he had invariably failed. He couldn't just "stop" any time he put his mind to it. Even if he didn't drink for a week or two, when he took one drink it always led to more. It was as though he had never stopped drinking at all.
Bob asked one of the more senior AA members to act as his "sponsor," a sober alcoholic who might have been dry for years and who knew the ropes of alcoholism. Sponsors had all been there, in the pit of alcoholism, and had themselves benefited from the program. There was "The Book" for Bob to study, a highly praised volume that had been written by AA's founder. This was a guide through a 12-step program that demanded much introspective work, using a sponsor as the program guide. The sponsor was someone who might be called often, even daily if necessary, to help fight the urge to drink, or just to be there as someone to talk over behavior that would lead to drinking.
But the urge was still there, ready to run rampant without a moment's notice. Bob relapsed frequently, at least at first. But the program is forgiving and recognizes that alcoholics often relapse. It's hard work, takes almost constant vigilance to keep the urges to drink at bay.
Many alcoholics, with the guidance and support of the AA program can become sober for years, even a lifetime. Yet they recognize that they cannot become social drinkers. The urge, once unleashed by one or two drinks, is too strong. Abstinence is the only safe path. Yet it is an extremely demanding goal, and the alcoholic who maintains abstinence is the exception rather than the rule.
To help control the urge to relapse, alcoholics may seek medical help. Is there a pill that might help them not to drink? Or if they do drink, is there a pill to help them limit their drinking so that their lives are no longer controlled by alcohol?
Antabuse, or to a lesser extent Flagyl, taken regularly, helps by making the alcoholic deathly ill within minutes after taking a drink. One shot, one glass of wine, or a glass of beer produces aching all over, nausea, vomiting, a pounding heart, flushing, weakness, and the sense that one is about to die.
The drug's reputation alone keeps most Antabuse users in line, and they stay sober as long as they are taking the drug. More often the prospect of developing these symptoms by the accidental or impulsive use of alcohol is so frightening that an alcoholic won't take Antabuse in the first place. If total abstinence from all alcohol is our goal, daily doses of Antabuse will do the job. A patient's decision to stop Antabuse is usually a thinly disguised decision to resume drinking.
Another drug, naltrexone, works by taking the fun out of drinking. For the naltrexone user, the urge to drink is still there, but a stiff shot somehow no longer kills the craving that used to be deadened by alcohol. Alcoholics don't want to take naltrexone because it takes away whatever pleasure or relief from the urge that they may have experienced by drinking.
The intent of naltrexone use is that after many months of having no fun from drinking, alcoholics will readjust their lives and look for pleasure elsewhere than in the bottle. To keep the alcoholic on a naltrexone program, the pill must be administered by a loving family member, now acting as a tyrannical nurse. Naltrexone also can be given as a single shot administered monthly, often by court order, and usually under protest.
Campral, quite differently, works by dampening the urge to drink. The cravings for alcohol are less intense and so Campral users tend to drink less often, and sometimes not at all. If he or she does drink, a few drinks seem 'satisfying" without going on to get totally smashed. The alcoholic taking Campral still has fun drinking, and because the amount of alcohol consumed is so much less the Campral user is far less likely to ruin his life.
Bob didn't want to know much about brain biochemistry. But he did know that his cravings and urges to drink were caused by two chemicals being out of balance in his brain. Campral restores the balance within hours and makes an alcoholic feel a lot more comfortable and far less driven to take a drink.
Millions of alcoholics don't want to stop drinking. Even if they are not totally addicted, the vast majority are at least dependent on alcohol. For them Campral may be a great friend, helping to significantly reduce alcohol consumption.
With Campral, because the urge to drink has a lower intensity, it becomes easier for us shrinks to push our alcoholic patients toward an Alcoholics Anonymous 12 step program. The combination of Campral, Alcoholics Anonymous, and individual alcoholism counseling is our best bet today in the treatment of alcohol dependence.
Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press). Write them at mailto:firstname.lastname@example.org.