Ever since NICE issued the final recommendations on nalmefene, “news” and “expert opinion” articles have been flooding the media about the “dangerous” suggestion of using prescription medicine without abstinence to treat alcohol use disorder. It appears so-called experts who run expensive, spa-like addiction treatment centers are afraid of treatment methods with high success rates like The Sinclair Method (TSM). They should be, but not for the reasons they claim.
Driven by Science
Skeptics are quick to reduce nalmefene and naltrexone to “magic pills” in an attempt to discredit the science behind their regulatory approvals. While no pill will work 100% of the time for 100% of the people, there are compelling scientific arguments why abstinence-only methodologies are more dangerous to the general public than treating alcohol use disorder medically.
- More than 50 years of scientific studies have been done on the alcohol deprivation effect. Initiating alcohol deprivation cycles is counter-productive. It makes cravings worse over time and increases the likelihood of relapse. Further, human beings have limited capacity for self-control. Forcing people to concentrate their willpower on a craving that can be medically managed is not only cruel, it reduces the capacity of rational decision making, increasing the likelihood of criminal activity during relapse.
- More than 120 studies and clinical trials have been conducted on naltrexone, which has been FDA-approved for treating alcohol use disorder since 1994. These studies have been done worldwide and published in peer-reviewed journals such as JAMA (the Journal of the American Medical Association), Annuals of Medicine, and Alcohol and Alcoholism, just to name a few.
- Clinical studies have found naltrexone most effective (around 80%) when patients did not follow abstinence guidelines.
- Initial estimates are that nalmefene has helped reduce heavy drinking by nearly 60%. Abstinence only treatments typically result in an expected 90% of patients relapsing within four years.
There is little doubt that 60% or 80% success is better than 90% failure. Anyone who suggests otherwise should have their motives carefully examined.
Where’s the Danger?
The only danger of systematically using naltrexone and nalmefene can be found on the bottom line of expensive addiction treatment centers. These centers can often cost more than $1,000 a day for treatments of up to 90 days. And with 90% of treated patients, on average, relapsing within four year, this cash cow is afraid of losing its milk.
Oral naltrexone costs about $2 per pill. Nalmefene is available on the NHS. It’s a little more expensive than naltrexone if bought privately, but still significantly more affordable than drinking a bottle or two of wine a day. Furthermore, these prescriptions can be utilized in the comfort and privacy of one’s own home.
Any addiction treatment provider or facility who is genuinely interested in helping alcohol dependent people regain their health and mental well-being will look at the science, then the results. However, those worried about the profitability of their business will most certainly be threatened by low-cost, high success alternatives to inpatient treatment.