Health Science Center partners with NIH in $35 million national alcoholism study

San Antonio partners unite to demand treatment

San Antonio Demand Treatment! partners

NIAAA provides facts about alcohol disorders and alcohol problems

Dr. Johnson

The U. T. Health Science Center is one of only 11 institutions nationwide selected to conduct a major new alcoholism treatment study, investigators at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) announced last week. The NIAAA is part of the National Institutes of Health (NIH).

UTHSC soon will begin clinical research to test the effectiveness of two medications, both alone and together, with behavioral treatments for alcoholism. The study is known as Combining Medications and Behavioral Interventions (COMBINE).

Alcoholism affects about 13 percent of Americans at some point in their lives. Dr. Bankole A. Johnson, Wurzbach Distinguished Professor and principal investigator for the San Antonio project, says: "Alcoholism is a major health problem in the United States and in Bexar County. Finding effective treatment medications is a top national and local health priority."

The Southwest Texas Addiction Research & Technology (START) Center, site of treatment research studies in addiction at UTHSC, will recruit several hundred people for this study. Participants will receive counseling in behavioral change and one or both of two medications (naltrexone and acamprosate) or a placebo. They will attend outpatient sessions for four months, then return for follow-up visits over the next year.

Naltrexone is approved by the U.S. Food and Drug Administration for the treatment of alcoholism. It can interfere with brain neurotransmitter systems that reduce alcohol's pleasurable effects. Researchers have shown that people treated with naltrexone are less likely to relapse to heavy drinking. Acamprosate has been used in Europe for about 14 years and is under review by the FDA. It is believed to ease the discomfort of abstinence and withdrawal, thereby helping to prevent drinking.

Counseling and therapy is designed to support sobriety and increase medication compliance and involvement in mutual-help groups such as Alcoholics Anonymous. Says Dr. Johnson, "Using multiple treatments that can have additive effects is one of the strategies being pioneered at the START Center."

The study is recruiting people 18 years and older and there is no cost to participate.

Call (210) 562-5400 for more information about this and other alcohol and drug treatment research studies at the START Center.

The Alamo City is one of 16 U.S. cities selected for the Demand Treatment! project, a nationwide campaign aimed at increasing the number of people who receive quality treatment for alcoholism and drug abuse in their communities. Significant barriers and discrim-ination prevent some 3 million Americans from receiving treatment that could help them recover from drug and alcohol disease.

San Antonio Demand Treatment! is a countywide effort of 35 diverse organizations. Over the next two years, this initiative will increase the number of people assessed for alcohol and drug problems in hospitals and primary health care settings, thereby driving up the demand for treatment.

"We want the people of San Antonio to know what they can do if they or someone they know needs help with an alcohol or drug problem," says the program director, Michelle Shenberger of the Health Science Center, lead agency on the project. Project strategies include publishing an addiction impact report to define the cost of addiction to Bexar County in terms of health care, criminal justice and diminished workplace productivity. The partnership also will develop a bilingual public awareness campaign to combat the stigma surrounding addiction. "Addiction is a disease, not a disgrace," Shenberger says.

Demand Treatment! is organized by Join Together, a national resource for communities fighting substance abuse and gun violence, through a grant from the Robert Wood Johnson Foundation. The project will be coordinated by the Southwest Texas Addiction Research & Technology (START) Center at the Health Science Center.

• Alamo Area Association for the Prevention and Treatment of Addiction (AAAPTA) -- a collaboration of 12 treatment providers funded by the Texas Commission on Alcohol and Drug Abuse

• Alcoholic Rehabilitation Center of Bexar County

• Alpha Home

• Center for Health Care Services

• City of San Antonio Community Initiatives

• Community First Health Plans

• Employee Assistance Professional Association of Central Texas

• Family Service Association Employee Assistance Program

• The Hispanic Broadcasting Corporation

• KBBT 89.5 FM "The Beat"

• KCOR 1350 AM La Primera

• KROM 92.9 FM Estero Latino

• KXTN 107 FM Tejano

• KCCY "Y100" FM Country

• KENS Radio AM 1160

• KKYX 680 AM Classic Country

• KONO 101 FM Good Time Oldies

• KRRT Fox 29 & WB 35 Television

• KXXM-FM MIX 96.1

• Methodist Health Care Mental Health Services Marketing

• Methodist Health Care Ministries of South Texas

• Mission Vista Behavioral Health System

• Palmer Drug Abuse San Antonio

• San Antonio Council on Alcohol and Drug Abuse

• San Antonio Fighting Back of United Way

• San Antonio Metropolitan Health District

• San Antonio Police Department

• Southwest Texas Addiction Research & Technology (START) Center at the UTHSC (Lead agency)

• The Patrician Movement

• Time Warner Cable Advertising Sales of San Antonio

• The San Antonio Current

• United Way of San Antonio and Bexar County

• University Health System - Correctional Health Care Services

• University Health System - Psychiatric Services

What is alcohol dependence (alcoholism)?

Clinicians recognize two disorders related to alcohol use. The more severe disorder, known as alcohol dependence (commonly called alcoholism or alcohol addiction), is characterized by impaired control over intake, physical dependence (evident from withdrawal symptoms when alcohol is stopped after a period of heavy drinking), and tolerance (the need for increasing amounts of alcohol to achieve a desired effect). Alcohol abuse, a less severe clinical disorder, is a pattern of chronic alcohol misuse that causes life problems but stops short of physiological addiction and dependence.

Does alcohol cause other problems?

Alcohol problems occur in individuals (trauma and injuries, health, legal or financial problems) and society (health care, criminal justice and economic problems) as a result of drinking by persons with and without clinical diagnoses.

Chronic heavy drinkers are prone to health problems including liver diseases such as cirrhosis (the 10th leading cause of death), brain damage, cardiovascular damage, pancreatic disease, certain cancers, traumatic injury, suicide and increased overall mortality.

Who is affected by alcohol disorders?

In 1992, nearly 14 million adult Americans met diagnostic criteria for alcohol dependence (8,132,000 people, or 4.4 percent of adults) or alcohol abuse (5,628,000 people, or 3.0 percent of adults). This information is from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

At some time during their lives, about 18 percent of Americans experience one or the other disorder. Thirteen percent experience alcohol dependence (alcoholism), and more than 5 percent experience alcohol abuse.

More than 50 percent of Americans have direct family experience with alcohol disorders.

What are the causes of alcohol disorders?

Alcohol abuse and alcohol dependence are caused by a combination of genetic and environmental factors. Researchers recently identified chromosomal regions believed to contain genes that either increase or decrease the risk for alcohol dependence. They expect soon to identify the actual genes, paving the way for new medications that precisely target alcoholism risk. Research also is under way to precisely define environmental risk factors.

In addition, researchers are beginning to understand the role of neurochemical factors, some of which are genetically determined, in the development and maintenance of alcoholism. A focus of current research is developing medications that target the hallmark features of alcoholism: impaired control over drinking, craving, tolerance and physical dependence.

What are the current treatments for alcohol dependence?

Behavioral therapies have been used for many years to treat alcohol dependence. NIAAA researchers recently demonstrated that motivational enhancement, cognitive-behavioral skills training and professionally facilitated involvement in mutual-help groups such as Alcoholics Anonymous can increase abstinent days and reduce heavy drinking.

Medications currently used to treat alcohol dependence are naltrexone and acamprosate. Naltrexone, approved by the U.S. Food and Drug Administration (FDA) in 1994, has been shown to block the rewarding effects of alcohol and, thereby, help to prevent relapse to heavy drinking. Acamprosate, which has been prescribed in Europe for more than 14 years, appears to normalize brain neurotransmitter systems involved in alcohol withdrawal and, thereby, to reduce the likelihood of a relapse to drinking. Acamprosate is under review by the FDA.