This article first appeared in the St. Louis Beacon, Jan. 4, 2011 - After seven years of heavy drinking, business professional James Wienstroer literally hit rock bottom at the age of 32.
A drunken misstep on the MetroLink bridge over Clayton Road plunged him 16 feet, resulting in a severe head injury. He was given last rites and induced into a medical coma for five weeks.
Following a miraculous survival, Wienstroer left the hospital and marked the occasion in his usual way.
"The first day I got out of there, I drank," Wienstroer said.
According to the National Institute on Alcohol Abuse and Alcoholism, Wienstroer is in good company. More than 17 million American adults are addicted to alcohol or at risk for addiction.
Powerful Combo: Anti-craving Drugs, Therapy
Three and a half years after his fall and subsequent deeper dive into alcoholism, partially fueled by a frontal lobe brain injury, Wienstroer is sober. He gave up alcohol with the help of drugs.
Wienstroer took naltrexone, a non-addictive drug that blocks the effects of alcohol in the brain's reward system, preventing the "high." The idea is to curb the incentive to drink.
Naltrexone is approved for use by the Food and Drug Administration only when paired with Alcoholics Anonymous attendance or counseling. As part of Wienstroer's treatment, which began in 2008 at the St. Louis location of Assisted Recovery Centers of America, he also received psychiatric and psychological care on an outpatient basis.
Epigenetics and Alcoholism
If you're going to drink heavily, do it after your childbearing years.
The new science of epigenetics, suggests that children inherit not only their parents' genes but also the brain circuitry changes caused by alcohol consumption, says Theodore Cicero at Washington University School of Medicine:
"Your children would be genetically different than they would have been had you not been drinking."
But at this point, epigenetics has little practical use in the field of addiction. That's because "the way our medical system works is that it's focused on treatment rather than prevention," according to Washington University psychiatrist Laura Bierut.
When does drinking become an addiction? That's still up for debate. Alcoholism -- all other substance abuse -- has four major components: craving, loss of control, physical dependence and increased tolerance.
In advanced stages of the disease, drinking no longer leads to good feelings but is required simply to avoid physical withdrawal symptoms such as nausea and excess sweating.
In its 2013 edition, the "Diagnostic and Statistical Manual of Mental Disorders" -- the standard by which all mental health professionals diagnose clients -- will likely combine "alcohol abuse" and "alcohol dependence" into one category: alcohol use disorder.
Even those who have one or two drinks on weeknights but enough for a hangover every weekend risk brain changes. It's not clear at what point drinking alters brain chemistry to the degree that the changes become part of their DNA. But research proves that genetics is a powerful factor.
"Studies have been done with identical twins in which one was brought up in alcoholic environment and one wasn't, and it's very clear it makes no difference about the upbringing," Cicero said. "It has to do with the biology, the genes."
A University of Munich compilation of 50 studies on naltrexone released last month supports the effectiveness of the medication. The researchers found that heavy drinkers who took naltrexone were 17 percent less likely to return to heavy consumption than patients who were given a placebo.
The drug also increased the number of participants who remained abstinent by 4 percent. According to the researchers, those improvements are on par with the effectiveness of other drugs given for psychiatric conditions. Local ARCA program director Suneal Menzies said naltrexone significantly cuts the cravings for alcohol.
"With medications, we can substantially block the urges to the point where patients say, 'I just don't think about it,'" Menzies said.
The six-month ARCA program costs $7,500, without medication. Many insurance policies cover program participation and the medications. Wienstroer's parents paid for his program. Today, he sometimes attends AA, and relies on Vivitrol (an extended-release form of naltrexone) as a maintenance medication.
"It's like I have diabetes," Wienstroer said. "I will take it the rest of my life."
Drugs Still Not Widely Used
Like Wienstroer, Rick Schmidt, 64, of Columbia, Ill., has alcoholism in his family history. Unlike Wienstroer, Schmidt never lost a job because of his drinking. He never had a DUI. But his one or two drinks at lunch and one to two bottles of red wine at night began to alarm his wife, who contacted ARCA. Schmidt agreed to treatment there.
Today, Schmidt is seven months' sober. He continues the Vivitrol injections but plans to stop and take the drug again only if necessary.
"I couldn't have quit drinking without it," Rick Schmidt said.
The practice of giving such medications to people who are only psychologically addicted to alcohol troubles Theodore Cicero, professor of psychiatry at Washington University School of Medicine.
"It's possibly overkill," Cicero said. "And it has serious side effects."
Naltrexone has been linked to problems at the injection site, including abscess, cellulitis and even necrosis, or tissue death, according to the U.S. Food and Drug Administration. While it also has an association with hepatitis and liver failure, the NIH pronounced it safe at recommended doses, except for those who already have liver disease.
It's been 17 years since naltrexone was approved for the treatment of alcohol abuse. But the drug is still not in wide use in the United States or elsewhere. The limited use of naltrexone is due to the dominant belief that alcoholism is a "disease of the spirit," according to ARCA president and pharmacist, Percy Menzies.
Washington University psychiatrist Laura Bierut, an expert in addictions, said there is no one-size-fits-all treatment; the best remedy varies with the individual. Those seeking help might try several methods of quitting before finding the right one.
"Some people use counseling and Alcoholics Anonymous; others take medications to reduce cravings," Beirut said. "It's trial and error."
Nancy Fowler Larson, a freelance writer in St. Louis, will be joining the Beacon staff later this month.