Pin Sky Presentation

Pathways to Recovery for Alcoholics Drew Pinsky, M.D. Medical Director Department of Chemical Dependency Services Las Encinas Hospital Los Angeles, CA

March 1, 2006

Criteria to Identify Alcoholism 3 or more criteria (during 1 year)

¾ Tolerance ¾ Alcohol withdrawal signs or symptoms ¾ Drinking more than intended ¾ Unsuccessful efforts to stop or reduce drinking ¾ Use despite physical or psychological consequences ¾ Excessive time spent drinking or recovering ¾ Impaired social or work activities due to alcohol

Treatment Goals for Alcoholism are Evolving Based on Emerging Science Complete Abstinence

Relapse Prevention

Emerging Science

According to the APA, the goal for alcoholics is to stop drinking altogether

“Relapse prevention is the central concern of alcoholism treatment”

Normalize imbalanced brain systems

Enoch Gordis, M.D.

STOP DRINKING ALTOGETHER

Former Director National Institute on Alcohol Abuse and Alcoholism

Sources: Koob GF, et al. Neuron. 1998;21:467-476. Messing RO. In: Harrisions Principles of Internal Medicine, 15th ed. 2001:2557-2561. Source: Sass H, Soyka M, Mann K et al. Relapse prevention by acamprosate. Arch Gen Psychiatry 1996;53:673-680.

Only Three FDA-Approved Treatments for Alcoholism Over the Past 55 Years 1949 Disulfiram (Antabuse®) Aldehyde dehydrogenase inhibitor Induces vomiting after alcohol intake

45 years

1994 Naltrexone (ReVia®) Opioid receptor antagonist Blocks the “high” associated with alcohol intake

10 years

2004 Acamprosate (Campral®) Glutamate receptor modulator Restores normal brain balance

Antabuse® is a registered trademark of Odyssey Pharmaceuticals, Inc. ReVia® is a registered trademark of the DuPont Merck Pharmaceutical Company; Campral® is a registered trademark of Merck Santé s.a.s., subsidiary of Merck KGaA, Darmstadt,Germany Source: O’Connor PG, et al. N Engl J Med. 1998;338:592-602.

Comparative Safety of Disulfiram, Naltrexone, and Acamprosate Disulfiram

Naltrexone

Acamprosate

Safe for use during relapses?

No

Yes

Yes

Safe for use in patients with hepatic impairment?

No

No

Yes

Drug-drug Interactions

• Alcohol or alcoholcontaining preparations

• Opioids • Opioid-containing products

• None known

Contraindicated in patients with these conditions

• Hepatic cirrhosis • Hepatic insufficiency

• Opioid dependence • Opioid analgesic Rx • Acute liver failure

• Severe renal impairment

Possible severe AEs

• • • •

• Hepatocellular injury

• None known

Optic neuritis Peripheral neuritis Polyneuritis Peripheral neuropathy

Sources: Antabuse® (Package Insert), ReVia® (Package Insert), Campral® (package insert)

Case Studies: Successfully Treating Patients for Alcohol Dependence

Barriers to Treatment ¾

¾

Stigma –

91% of primary care physicians surveyed believe that there is a stigma towards alcoholics; that figure goes down to 71% once those people enter recovery

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80% of the general public surveyed agrees that there is a stigma towards alcoholics, although the number drops to 51% once an alcoholic enters into a recovery program

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56% think that alcohol is a disease

–

Additionally, 34% think it is a disease combined with a personal or moral weakness

Unmet educational needs for primary care physicians and treating alcoholism – Primary care physicians are the front line Š Š Š Š

Education on available treatments Diagnostic training 51% has prescribed Antabuse® at some point, only 22% are currently doing so Only 26% of primary care physicians have experience with ReVia® and 15% have experience with Campral® (acamprosate)

Source: Survey conducted by Peter D. Hart Research Associates , August 2005, among 1,000 adults age 20 and over, 300 physicians (in general practice or internal medicine) and 503 people in recovery from addiction to alcohol.

General Public is Receptive to Medication and Welcomes Educational Awareness ¾ 83% of the general public surveyed would encourage a loved one to try a physician-recommended medication in conjunction with psycho-social support to their problem with alcoholism, but only 13% are aware of the newest treatment options ¾ Additionally, 66% of the general public surveyed are not aware that there are three FDA-approved medications for treating alcoholism (disulfiram, naltrexone, acamprosate) ¾ 42% of Americans say that their primary care physician has never asked them about their drinking behavior ¾ And 51% think that health insurance providers should require their physicians to screen for alcoholism

Source: Survey conducted by Peter D. Hart Research Associates , August 2005, among 1,000 adults age 20 and over, 300 physicians (in general practice or internal medicine) and 503 people in recovery from addiction to alcohol. Source: Survey conducted by Opinion Corporation’s Caravan, March 24-26, 2005, among a national probability sample of 1,030 adults comprising 517 men and 513 women 18 years of age and older in the United States

Benefits and Solutions to Treatment and Pathways to Recovery ¾ Earlier intervention through improved screening and diagnosis of alcohol dependence ¾ Enhanced treatment effectiveness by supplementing psycho-social support with medication – Maintaining abstinence from alcohol – Reducing risk and severity of alcoholic relapse ¾ Improved quality of life (QOL) and quality of care for millions of Americans by breaking down the stigma surrounding alcoholism ¾ Community networks (e.g. CADCA)