UVA alcoholism researcher: “They don’t laugh anymore”

When University of Virginia neuroscientist Bankole Johnson first introduced the idea two decades ago that alcoholism lends itself to pharmacological treatment in just the same way other diseases do, he was regarded as something of a rogue by his peers. Now, Johnson finds himself at the forefront of a large body of research.
Johnson, a medical doctor with two additional doctorate degrees, was at Oxford when he proposed that the type 3 5-hydroxytryptamine (serotonin) receptor was responsible for intersubject differences in euphoric stimulation resulting from drinking alcohol, or even the idea of drinking it. In English, this means that some people are wired to derive a big old buzz from toping, whereas others simply aren’t. This should not come as a surprise; we’re all subject to the whims of our various chemoreceptors. Take taste: Some people like lobster and shrimp (like my dad), and other people would just as soon eat cardboard (like his son).


From a strict reductionist perspective, all behaviors can be broken down into neurochemical elements. So whether a mental or brain disorder is overtly “organic” (e.g., epilepsy, schizophrenia) or seemingly rooted in morality or choice (addictions, radically impulsive behaviors surrounding appetitive stimuli such as sex and food), there is, in theory, a way to guide symptom reduction through biochemical intervention. But clearly, this is much easier with respect to some illnesses than it is in others.
Presently, Johnson is heading up a study that will examine the anti-alcohol-dependence efficacy of a combination of two drugs already used to treat other disorders: topiramate (used to treat seizures and migraine headaches) and ondansetron (used to reduce chemotherapy-induced nausea in cancer patients). Topiramate alone has already been found to “ameliorate the turbulence of anxiety and mood instability that accompanies cessation from alcohol” and produce “a robust effect on improving maintenance of abstinence and reduced alcohol use” (Robert Malcolm, M.D., of the Center for Drug and Alcohol Programs at the Medical University of South Carolina). Similarly, ondansetron alone may reduce cravings. So in simple terms, the two drugs together in theory address both the before and the after of a bender. The value of reducing cravings needs to explanation, and the utility of reducing withdrawal symptoms is obvious when considering the fact that the first thing someone in alcohol withdrawal is likely to do is seek out more to drink in order to get rid of the shakes, anxiety, guilt, sweats, insomnia, night terrors, and whatever else might accompany a post-binge state. (Not that I would know.)
Left out of this interesting discussion are medications that are intended not to prevent cravings or deal with the aftermath of boozing it up, but to blunt the high of drinking itself. Already on the market for this is naltrexone, long known as an opioid antagonist and therefore a comprehensive, unapologetic buzz-kill. Also ignored is the fact that regardless of genetics, if people who abuse alcohol fail to address underlying problems in their lives–and virtually no one drinks to excess in a vacuum–all of the creative pharmacology in the world probably won’t amount to a piss-warm, half-full can of Pabst Blue Ribbon.

(Apologies for the non-religion-mocking post.)

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  1. #1 by bybelknap, FCD on December 8, 2008 - 11:24 am

    Well, if you want to add some religion, you could address the abject failure of AA to do any measurable good, despite the 12 stepper’s strangle hold on D&A treatment. The whole “give yourself up to a higher power” bullshit line they feed you. They say that it doesn’t have to be the xtian God, but if you read the big blue book it sure seems like it is.
    I was always mystified why alcoholism was the only disease around that required belief in a “higher power” for a cure. It’s a friggin chemical addiction, innit? It’s good to see some research that is addressing the chemical basis of the disease and not pissing money down the Group Of Drunks rat-hole.
    Crikey, there are probably a bazillion good ways to treat alcoholism, but they’re undiscovered because they’ve been undermined, underfunded, quashed, squashed and ignored because AA is the “best” way to treat alcoholism. Every damn D&A treatment center says so.

  2. #2 by Kevin Beck on December 8, 2008 - 11:35 am

    One thing I always wondered: If God was responsible for relieving AA founder Bill Wilson of his compulsion to drink, why didn’t He also relieve him of his compulsion to smoke? The guy ultimately died of emphysema.
    Go to an AA meeting and you’ll sit and listen to a series of people talk about how grateful they are to have their lives back, and then 9 in 10 will head out after the meeting and light up before they have both feet out the door. Granted, sober and nicotine-dependent beats drunk and nicotine-dependent, but still.
    As far as God getting in the way of more tangible treatments, not only is a “spiritual foundation” emphasized at the expense of workaday therapies, but some AA old-timers are vehement about not using any mood-altering drug in sobriety, even SSRI’s and various antipsychotics that plainly help people from going off the beam and making a dash for the liquor store. Again, nicotine remains an exception, along with caffeine.
    If there is any value in AA, I think it basically lies in claiming one’s seat as an alcoholic and being around people who at some level can relate, even if they are disagreeable in every meaningful way besides having fucked up their lives through too much drinking. Personally I think one-on-one counseling would be much more helpful, but unlike AA, this is not a free service.

  3. #3 by bybelknap, FCD on December 8, 2008 - 1:21 pm

    Thanks for the response. I think what irritates me most about AA is the powerlessness model. It seems wrong-headed and self defeating. I think it says something screwey about our society when one of our biggest health issues relies on a questionable recovery model. Sure it’s free, but even when you pay for rehab what model do they use? 12 Steps.
    Alternatives are few and far between. As a (sometimes) rational being, I found it really really disturbing that in order to quit drinking and be healthy again I had to throw rationality out the window – according to the 12 Steppers that is. It seemed like just so much woo-woo to me.
    Sure it works for some people, but the amount of decent data supporting a good success rate for AA is small. Their own triennial surveys showed that they have a 95% drop-out rate in the first year. Bill C’s criterion for a member was 10 meetings a year. Other data indicate that a combination of in-patient 12 step group therapy (based on AA) combined with intensive individual therapy including behavioral therapies, is more effective in producing long-term sobriety than AA alone.
    So is AA completely without value? Probably not. But I’m just guessing here in saying that it could probably drop the requirement of belief in a higher power, and get better results by giving people better coping tools than “give up! you’re out of control!”
    Then again, this is the USA, where our fine senators pooh-pooh data that go against their beliefs. Who cares if Abstinence only “education” produces higher pregnancy rates and more STDs? Those sinners deserve what they got for fornicating. Blast them to hell. So who cares if AA doesn’t work as well as real therapy! Those sinners deserve to end up in the gutter. OK, I’ll shut up now. Sorry.

  4. #4 by Kevin Beck on December 8, 2008 - 1:57 pm

    What fascinates me are the people who claim that they experienced some sort of watershed, “burning bush” type of moment in which they wanted very badly to drink, but fell to their knees and prayed and from that moment on never experienced another craving. God had lifted the urge.
    I think the only reason people ever say such things is because the personal stories in AA Big Book are rife with such magical accounts. Regardless, leaving aside the vacuity of these claims (if God whisked away your urge to get drunk, why did He keep you shitfaced and broke for 20 years before that?), I think this is an exceptionally dangerous way to think. I would love to believe that I’ll never want to drink again, but convincing myself that this is the case can only lead to complacency. I’d rather be realistic and on my guard.
    The last time I drank, I became extraordinarily sick. It has never been characteristic of me to vomit after a spree, but this time I spent an entire day puking in the trash can in the little bedroom I was holed up in. In the days that followed, every time I saw someone drinking on TV (especially if it was hard alcohol), I literally had to avert my eyes in order to not puke. Thank you, amygdala. But as much as I’d like to think this kind of aversion reaction could last for the rest of my life, I know better. One of these days, I’ll be feeling hale and healthy and fit, and something will go suddenly awry in my life, and I sure as shit better have something to fall back on other than God or some other delusion.
    Who knows; maybe people really do experience epiphany-like moments, and lose the desire to drink permanently. On the other hand, I’ve seen plenty of people make this claim, only to wind up hammered AA drop-outs. If you’re going to credit God for your sobriety, then you’d better blame His stupid ass for your relapses too.

  5. #5 by bybelknap, FCD on December 8, 2008 - 3:09 pm

    Can I get an AMEN!?
    People are generally full of shit, and believe whatever the hell they want to believe, regardless of the realities that beset them. I got no problem wid dat. I just wish they’d leave me and public policy the hell out of their weirdness and woo.
    I’d love to see some real data demonstrating AA’s effectiveness. If courts are going to make mandatory AA attendance a part of DWI probation, then it seems we should have some sort of handle on whether it actually works or not. One, I’m all for keeping drunk people off the road. And two, I’m all for effective treatment of addictions of all sorts. So if there’s an effective treatment that will keep drunks off the roads by golly let’s use it! But even if an adjudicated drinker attends ALL of his meetings, it’s not doing us or him any good if he falls off the wagon during or after his probation is done. Plenty of people can postpone drinking until it is “safe” to do it again.
    So, if the Johnson study finds two effective drugs that can be effective in combination, it seems that it would behoove our public policy makers and judicial system to take notice, and perhaps require drug therapy, rather than talk therapy. It’s not unheard of.
    Oh, and welcome back – a bit late to say it, but you were definitely missed.

  6. #6 by Kevin Beck on December 8, 2008 - 3:19 pm

    “I’d love to see some real data demonstrating AA’s effectiveness.”
    Obviously this would be all but impossible to measure, but one thing I’ve noticed is that at the meetings themselves, the statistics the regulars pull out of their asses always play down the number of people who stay sober rather than exaggerate it. This, of course, is so those present can feel better about themselves. (I used to go to one meeting where a favorite refrain was “only 1 in 37 people stay sober in this program.” If that were true, the number of drunk Americans would far exceed the number of total Americans.)
    It’s also poor reasoning to assume that just because someone stops coming to a meeting, he’s back to drinking. This may be the case more often than not, but folks in the rooms would have you believe that detachment from the AA tit and relapse have a correlation of 1.
    I once went to an AA meeting in San Francisco where, instead of closing with the LORD’S prayer, everyone joined hands and sang the theme song from The Muppet Show. You won’t see that in what H. L. Mencken liked to call “The hookworm belt.”

  7. #7 by Pierce R. Butler on December 8, 2008 - 4:49 pm

    … underlying problems in their lives–and virtually no one drinks to excess in a vacuum…
    Well, technically, a frat house is not a vacuum… (except intellectually, ethically, esthetically, etc)

  8. #8 by Christie on December 9, 2008 - 3:52 pm

    As Kevin points out, if the underlying problems aren’t addressed then pills won’t solve the problem — when alcohol doesn’t produce the desired effect, the subject will use drugs, or gambling, or sex, or food to get the same relief.
    If you take the ‘higher power’ BS out of the 12 steps, what you have left (in 4, 5, 8, 9, 10, and half of 12) is effective at addressing those underlying problems and the resulting depression that the alcohol was ‘treating.’ What’s left, without a god, is cognitive behavioral therapy.
    The thing is… it is very difficult to get an alcoholic to *do* the work of CBT, which is where ‘powerlessness’ and ‘submitting to a higher power’ come in. Unless they believe that they have no choice, they are not likely to follow through. Alcoholism is a very tough nut to crack.
    p.s. hahah DAMN do I wish they finished meetings with the Muppet Show theme around here.

  9. #9 by robbie on December 13, 2008 - 9:27 am

    i have sruggled with alcohol for a few years now.as a result of my last spree i am court ordered to a 1/2 way house.A.A.is a constant thing here.all it seems to do for me is to alienate me from my peers as i refuse to get a “sponsor” and work the “steps”.i take topamax an a antidepressant.i have tried to drink with little success.the fun wasnt there or something wasnt right.i am grateful for the medication and indivdual counseling they have allowed me to get my life back together.A.A.isnt the only way.

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