Periodically we like to review various topics of concern to clients. This week we’ll take an up-dated look at Anti-Craving Medications and Confidentiality.
We receive a lot of inquiries about Naltrexone, the benign anti-craving medication, and it’s been awhile since I wrote anything about it. Seems like it’s again time to review what it does, and what it doesn’t do.
First, the chemistry is fairly straight-forward. Naltrexone is an “opioid receptor blocker.” Alcohol goes to all of our brain’s various receptors and the opioid ones are where the “buzz” comes from. For most people, no buzz means not much interest in drinking, and cravings diminish accordingly.
For less well-understood reasons, Naltrexone also interrupts thoughts about drinking which certainly makes avoiding alcohol easier. It may also change the taste of a person’s drink of choice, further reducing the temptation since most of us have only one or two specific drinks that we abuse.
Of course, as with any medication, responsiveness to Naltrexone varies from person to person. This is true both of individuals and ethnic groups. It works best with Caucasians of Northern European extraction and less well with Asians and Blacks. But again, that too varies from one individual to another.
Regardless of the degree, the purpose of using the medication is to create a window of opportunity for instituting life, habit, and other desirable changes, undistracted by cravings. No, Naltrexone does not make change unnecessary, it simply supports the process for three to six months.
Now for the problems, which aren’t with the drug itself – which is quite benign and has no adverse interactions with any medications other than opioid painkillers – but with physicians’ unfamiliarity with it.
That wouldn’t be so bad, but most doctors are unwilling to admit that they don’t know about it, nor are they willing to learn about it. The result is that most resort to spouting such nonsense as, “Oh, that’s a very dangerous drug and only a psychiatrist or an addiction specialist is allowed to prescribe it,” or some variation on that theme. In point of fact, any doctor can prescribe it and the dangers are very modest, far less than continued drinking in any case.
Unhappily, most medical practitioners receive all of their drug information from pharmaceutical drug sales reps. Guess what? Reps aren’t pushing an effective generic drug that costs about $1.50/day. Instead, they push Campral (acamprosate) – which was supposed to be a “relapse prevention aid,” to be started after 90 days of abstinence – as an “anti-craving med.” You’ll not be surprised to learn that this very expensive med has no efficacy in either context – but it is what your doctor will most likely prescribe should you ask for help with cravings and urges.
That brings us around to how Naltrexone is used as a support by our clients.
Usually on the first day you work with us, we schedule a visit with our consulting physician, Dr. Tim Norcross, D.O., who evaluates you both for any withdrawal issues and also for Naltrexone. 95% of our clients have no significant withdrawal concerns and about 80% find Naltrexone to be of varying degrees of support. The rest either decline to take it, or find that the occasional side effects, some nausea and/or sedative effect, to be more troublesome than worth bothering with.
With that issue settled, and you possibly less distracted as a consequence, we can then address the underlying issues you are medicating.
No – Naltrexone is neither a cure, nor a magic bullet. But for those of you who find it both tolerable and effective, it does make the process of fully recovering from your alcohol abuse easier. We think that’s worth adding to our arsenal of effective tools to add to your life.
Again, real change means taking advantage of the research into Ending Alcohol Abuse: What Works, and such aids as Naltrexone. Why not get real help that includes real support rather than waste your time, money, energy, self-esteem, and privacy in return for a demeaning, and inaccurate, label – “Hi, I’m —, and I’m an alcoholic” – and the mantra, “Don’t drink; Go to AA?” All for only $30,000 to $120,000.
Preserving Your Privacy
The vast majority of the clients we see are very concerned with keeping their alcohol abuse from becoming a matter of public record. They – and you – should be. That’s one of the reasons many choose to work with us, the only confidential treatment program in either the U.S. or Canada. (Also see Chapter 7, 21st Century Treatment in Her Best-Kept Secret for an independent program evaluation by writer Gabrielle Glaser.)
Let’s start with a simple issue like taking Naltrexone. In the U.S. it’s prescribed only as an aid in treating “alcoholism” or to treat overdoes in opioid “addicts.” In Canada it’s only official use is in treating overdoses. Both countries maintain data bases which in Canada track all medication usage and in the U.S. track medications purchased through insurance.
Obtain a prescription for Naltrexone in Canada and you’re automatically an addict and in the U.S. you’re either an addict or an alcoholic. And no other treatment program is even warning you, much less actively helping you, to avoid falling into that trap.
We on the other hand, schedule and pay for Dr. Norcross’ eval which means there isn’t any insurance record of that visit. He sends a prescription authorization to a local private pharmacy where you pay with cash or a credit card, never insurance, and your medication is never entered into any data base.
Privacy maintained on that score.
Now let’s move along to other ways in which we look after your best interests.
First, we only work with individuals and couples, never groups, and we only add one new client a week. You will never see another client, nor they you, so you will not be exposed by gossiping.
Second, while our program really lasts 13 weeks, only the first 5 days are here in southern California. Ergo, you don’t end up ratting yourself out by disappearing for 30, 60, or 90 days of very expensive and completely ineffectual “rehab.”
Third, we never ever send people off to AA which, despite its name, hasn’t been “anonymous” since about 1950 – not to mention that you have to agree to be an “alcoholic,” which, most likely, you aren’t.
Fourth, we don’t accept insurance which means, as with the Naltrexone, you won’t be in any data bases with their labels.
Fifth, we report to no one but you. Period. Ever. Unless you specifically request it.
Sixth, at your request, your very modest file with us is destroyed after treatment, and you keep the vast majority of your own “case notes.”
Seventh, we have no employees, interns, students, or other staff who might expose you, innocently or otherwise.
And, we have very bad memories.
There are probably a few more points, but we suspect you get the message.
So, we offer confidential, efficient, effective, research based, and affordable help.
What more do you want?