The Madeleine Brand Show for February 16, 2012

LA expands a promising, but expensive, alcohol abuse treatment

Ted S. Warren/AP

Brian Steik sits in his cubicle at an apartment building for homeless alcoholics in Seattle.

The LA County health department says it spends two hundred million dollars a year fighting substance abuse, a large part of which is alcohol related. In 2009 alone the county treated 15,000 people for alcohol abuse. Many end up in a familiar circle of detox, rehab, and relapse. But a new program is looking to stop that with an injectable drug.

It's called Vivitrol and it shows promise at helping curb cravings, it's also very expensive.

Todd, who won‚t give his name because of patient confidentiality, told KPCC's Sanden Totten his story.

Todd remembers the moment he decided to get sober. He'd been drinking for more than 20 years, and he was living on the streets.

"It was in the middle of the day and I had missed my daughter's birthday again because of my alcoholism. At that point, I just felt a shiver in my body," he recalled. "I had never felt that before. I said, 'I'm done,' and I just dropped my alcohol and that was it."

Todd tried to get clean before, but it was always a losing battle.

"Just have a drink. Just have a drink or two. One and two would turn into six [...] and six turned to twelve into a bottle," he said. "It was non-stop, and I would just drink myself into submission and into sleep. And that's just not good and not healthy."

All that changed when he began treatment with a new drug: Vivitrol. Todd said, after just one injection, something clicked.

"Killed it. Killed the voices in my head. Because I had no desire to look at alcohol at that time," he said.

Dr. Ken Bachrach is the clinical director at Tarzana Treatment Centers, the place where Todd goes for monthly injections. His clinic is part of a pilot program to see how well Vivitrol works on alcoholics.

"When we talk to patients on Vivitrol, what we found is that many of them report that their cravings have greatly diminished or gone away completely," Dr. Bachrach said.

Researchers think the drug dampens the brain's response to alcohol and alcohol-related stimuli, making a drink less appealing.

According to Bachrach, it's really an old drug in a new form. It used to come as a daily pill. But Bachrach said the old method of intake wasn't effective.

"What would happen is that people stop taking the pill because they often either had forgotten or they didn't want to take the pill – there were some side effects, some nausea and things like that – but more likely than not it was because they just maybe weren't totally committed," he continued.

With Vivitrol, patients just need a shot in the hip once a month. If there are side effects they are usually gone in a day. And for many, it takes only three or four doses to reap the benefits.

Still, Bachrach pointed out that Vivitrol alone isn't enough to treat an addict. Twelve-step programs and counseling are also an important part of recovery. But kicking the cravings helps a patient focus.

All of this sounds good to Los Angeles County. The Department of Public Health set aside $3.4 million to expand use of Vivitrol in its clinics. It's the largest test of its kind in the U.S. But here's the catch: Vivitrol is expensive – more than $800 a shot.

Dr. Raye Litten works with the National Institute on Alcohol Abuse and Alcoholism. The NIAAA researches how effective various treatments are.

"If you are spending $800, is there a long term benefit? Are some of the people getting better? Is this a good thing?" he inquired.

In large amounts, Vivitrol can cause liver damage. But Litten said that at a normal dose it's safe. However, he added that it's not always effective.

"In the studies that have been conducted so far, it appears to work in sub-populations. Some people benefit greatly from it, but not everybody," Litten noted.

Litten said that overall, Vivitrol seems to make a big difference for around one in 10 patients. "Even if it only works in 10 percent of the patients, that's pretty good progress," he continued.

L.A. County said they've seen a much higher success rate in their pilot program so far, closer to 70% of patients. But with a single dose of the drug costing nearly 800 taxpayer dollars, you want to be sure you get your money's worth. The County hopes that it can eventually get a reduced rate for the medication.

Litten said that in the short term, Vivitrol does improve healthcare costs and utilization. Studies have show that patients who get clean with Vivitrol save the government money by staying out of rehab and hospitals.

For Todd, who was once homeless because of his drinking, the benefit is much more tangible.

"I have a place to live I have a roof over my head. I have food in my fridge, warmth in my bed. My life is beyond my wildest dreams. But still there is repairing the damage that I caused," he said.

This year, instead of missing his daughter's birthday, he sent a card. He hopes that if he stays sober, maybe next year she'll invite him to her party.


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