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HOUSE CALL WITH DR. SANJAY GUPTA
Treating Alcohol Addiction
Aired August 15, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Good morning. Welcome to HOUSE CALL. Millions of Americans are struggling with addictions, from drugs and alcohol to food and gambling. But an exciting new development, a new drug that attacks the very biology of alcohol addiction is giving hope to millions struggling with the disease.
GUPTA (voice-over): Pop a pill and stop the craving for alcohol. Sound too good to be true? Well, a pill approved by the FDA may do that for millions of people who can't shake the urge to over drink. It's called Campral. Used in Europe and other countries for decades, Campral works differently than other alcoholism drugs like Antabuse, which makes you violently ill if you have a drink.
DR. DREW PINSKY, ADDICTION SPECIALIST: It's the first drug that we're gong to have in our armamentarium that actually attacks the biology of addiction itself, actually the drive mechanisms.
GUPTA: Campral targets chemicals located in the reward circuit in the brain. Blocking those chemicals blocks the pleasurable effects of drinking. Simply put, alcoholics no longer having the cravings.
Despite the body of research to the contrary, many consider alcoholism to be a personal failure not a disease, but that is starting to change.
PINSKY: Anyone that works with the disease will tell you that this is clearly a biological process and it couldn't be anything further from the old notions of it being a moral weakness.
GUPTA: They will also tell you there are chemical changes in the brain associated with alcoholism, largely the result of genetics, and those changes can also be treated with drugs. Campral, the newest on the U.S. scene doesn't work if you're still drinking. You have to quit first and then use the medication to stay dry.
GUPTA: Nearly 18 million Americans struggling with alcoholism or alcohol abuse, but the problem of addiction is much larger ranging from chemical addictions to behavioral or compulsive disorders involving sex or food.
Talking with us this morning about all the varied forms of this deadly disease is Dr. Drew Pinsky. You've seen him before. He's addiction specialist and co-author of the new book, "When Pain Killers Become Dangerous."
Thank you for joining us, doctor.
PINSKY: My pleasure.
GUPTA: You've heard about this new alcoholism drug, Campral. Is this a major breakthrough in your opinion?
PINSKY: It's sort of about time. We've been waiting for it. It has been used in Europe for many, many years and finally it's here. It has been a mystery for me why it has not been approved long before this. It is, as you mentioned in the piece you ran a few moments ago, it's the first drug we're going to have that actually goes at the biology of the disease. Everything we've had before sort of was ancillary to the disease process, but now we're beginning to attack the biological mechanisms of the disease itself.
GUPTA: Of addiction -- so, would it work for other sorts of addictions as well or is it just alcohol?
PINSKY: It has been approved for alcohol, but actually we expected it for stimulants. It's very effective. May be useful for nicotine as well, so absolutely. It will have a broader use than merely just what it's approved for I'm sure.
GUPTA: Dr. Pinsky we get lots of questions about this. Let's work through some of them. One from Tracy in New York who wants to know, "Are some people predisposed to becoming addicted to things while others are not. I always thought it was the chemical and the substance that created the addiction." What about that, doctor?
PINSKY: Absolutely. It is a complex disorder, but it clearly has a genetic basis. In fact in the definition of the disease we consider genetics actually a crucial piece of the definition. So the definition, as stated in a consensus conference that was published in the early '90s it's a genetic disorder with a biological basis. The hallmark is the progressive use in the adverse consequence and then finally denial.
Now notice nowhere in there does it say dependency and withdrawal and liver disease or vomiting or any of the consequences that do develop from addiction. But people need to have a clear idea in their head of the difference between dependency, which is the physical dependency upon the drug that creates withdrawal, intolerance and addiction, which is a compulsive behavioral disorder where people chronically go back in an escalating fashion to a substance in spice of consequences.
So, it's why -- I was giving a lecture just yesterday where one of the family members questions well, is an indication just about being afraid of going through the withdrawal? In fact, nothing could be further from the truth. It's easy to get people through the withdrawal. It's easy to get people off drugs. The hard part is not to let them get back. GUPTA: Are there people...
PINSKY: The drive to go back is always there.
GUPTA: Are there people who have addictive personalities? You know, people who are just predisposed to that.
PINSKY: It's a complex question. There are clearly features of having this gene. But I don't believe it's specifically a personality. Now people might argue otherwise. But in my patient population every possible personality structure you can imagine is represented there, and yes there are features they have. They are perfectionistic. They're frustration intolerant. They have euphoric response to opiates, essentially always. They're stimulate from alcohol as opposed to sedated.
There are qualities about them that are distinctly different than the average person, but I wouldn't put it under the heading of a personality per se.
GUPTA: Let's try and work through this a little bit more. There are still some people who see addiction as a failure of willpower and not a disease. Kate in Los Angeles writes, "I'm curious how you explain the skyrocketing cases of addiction in so many new arenas.. To me" meaning her, "it just sounds like people unwilling to take person responsibility for their own hedonism. Isn't identifying some type of dependency or use of a vice as an addiction only facilitating this kind of behavior.?
So Dr. Pinsky, obviously this is the other side of the argument. How do you respond to Kate?
PINSKY: Well, Kate is discussing the sort of blanketing of multiple behaviors with the sort of moniker of addiction and I'm not in favor of that actually. I kind of agree with her that every time somebody has an unpleasant behavior they sort of claim it's an addiction. They can't contain it. That's simply not the case.
Addiction clearly is a biological process. I'm sure in the course of this show we'll talk about many of these biological mechanisms.
It is a failure of volition, but it's an overwhelming drive that absolutely crushes volition. And so, volition can no longer be function, no longer works in defense of these power drives. A takeover -- literally addiction is the hijacking of the survival drive mechanisms of the brain. That's fundamentally what it is. I yell this to patients all the time. You must understand the motivational priorities of the brain, survival, reproduction, eating, those motivational proprieties have been usurped and focused on the pursuit of a drug.
So every thought every feeling is colored by that motivational system and that motivational priority every day, even when they're not using the drugs. And so it's an extremely, extremely powerful disease. GUPTA: We are talking with Dr. Drew Pinsky.
Coming up on HOUSE CALL, avoiding the tremors of detox. Stay tuned.
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UNIDENTIFIED MALE: They're very excited when they wake up and they're not craving. They can't believe it.
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ANNOUNCER: Magic cure for addiction or the beginning of a long battle? We'll bring you the latest treatments.
And later, is your eating out of control? We'll show you how to figure out if you're a food addict.
But first, take today's daily dose quiz. How many drinks per week could put you at risk of becoming dependent on alcohol, A)10, B)14 or C)18? The answer when we come back.
ANNOUNCER: Checking the daily dose quiz we asked how many drinks per week could put you at risk for becoming dependent on alcohol. The answer 14 for men, cut that in half to seven for women.
GUPTA: More than 50 percent of the population drinks. That of course, doesn't mean everyone has a problem, but many do from binge and heavy drinking to alcoholism or alcohol dependence. Here are some signs to look for if you think someone you know is in trouble.
If they drink alone or in secret, they have trouble remembering, experiencing blackouts. Also, becoming annoyed if they can't have a drink or seem to have built up a tolerance to alcohol so they need much more to get that euphoric feeling
Other signs, losing interest in hobbies or storing alcohol in unusual places like the car.
Answering our questions on addiction this morning is Dr. Drew Pinsky. He's an addiction specialist and best selling author of the book, "Crack."
Doctor let's just jump back into our questions. This one coming from our roving camera.
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UNIDENTIFIED FEMALE: How much of a high risk if you have a family member that was an alcoholic would you have towards becoming an alcoholic?
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GUPTA: Dr. Drew, you've already talked about the complicated sort of interactions with alcohol predisposition -- alcoholism predisposition. Is there a family link with addiction?
PINSKY: Absolutely. Just in gross terms it's about 50 percent per child if one or both parents have alcoholism, about 50 percent probability of inheriting the gene. The only exception to that I've seen interestingly is the North American Indians particularly Cherokee heritage where the penetration seems to be more in the order of 100 percent.
GUPTA: Interesting. And aside from your family history other risk factors include steady drinking, as we mentioned in our quiz and your age. The earlier you start drinking the higher risk you have of developing a problem.
PINSKY: There's actually an interesting body of information out there on rats. If you take adolescent rats and expose them before the age of the equivalent of 15 in the human, their risk of alcoholism goes up dramatically, and we see the exact same thing in humans.
GUPTA: That's really interesting. Your genetic makeup may also cause imbalances in brain chemicals increasing your chances of dependence. Plus, you know this Dr. Pinsky, if you're a man you're more likely to become an alcoholic as well.
GUPTA: And lastly, having anxiety or depression puts you at risk. There's also a recent study found 20 percent of those with alcohol or drug problem also suffered from mood or anxiety disorders. No doubt, a tough disease to beat once it has got a hold of you.
Let's get to another question on this topic Dr. Drew. This comes from Jean in Florida who asks, "What's available to help alcoholics get clean," the whole process of trying to stop.
PINSKY: Of detoxification, is that what they're asking.
PINSKY: Well, there's a difference between detoxing and treating. Detoxing is getting off the drug, breaking the cycle of dependency. And actually, it can be a very serious medical problem. Alcohol is one of the common drugs for which withdrawal can be fatal. So it is something that needs to be very carefully medically monitored. Typically people will use, doctors will use Benzodiazepine medication, Valium-like medication. Sometimes they'll use antiepileptic medication, or barbiturates.
GUPTA: There are a lot -- you talk a lot about the 12 step program. There are those who argue against it. Can addicts get clean without them?
PINSKY: I've not seen it. There are certainly behavioral programs. Something called cogitative behavioral interventions that have been show to be quite effective. But by far, the most effective is the 12 step program.
GUPTA: A new form of treatment for drug addiction may save people from the debilitating symptoms of withdrawal, Dr. Pinsky was just talking about that go along with beating this disease.
GUPTA (voice-over) In "The Basketball Diaries" Leonardo DiCaprio is acting the pain of drug withdrawal. But 28 year old Valerie Coody wishes it was just an act for her.
VALERIE COODY, RAPID DETOX PATIENT: You're cold, you're hot, no sleeping. Your body just craves the drug.
GUPTA: In this case the drug was an opiate called Percocet, a prescription pain medication. Her story is not uncommon. A federal study shows 1.5 million of the 30 million patients who use prescription pain relievers in 2002 became dependent. Years ago, after a knee operation, Valerie was prescribed Percocet for postoperative pain. Soon, she was popping 20 to 30 a day.
COODY: It's almost like you can function better when you're on them then having to go through withdrawal.
GUPTA: Scared of withdrawal, but knowing something had to be done and quickly, Valerie tried a relatively new technique called rapid detox. Typically a person is weaned from drugs slowly. With rapid detox patients are given anesthesia and then, given an opiate blocking drug called Naltrexone that causes nearly immediate withdrawal.
Now if Naltrexone were given without anesthesia, the heart rate would increase, breathing would become labored and the patient would feel violently ill. But the anesthesia seems to block all of those ill affects, and detox can be almost immediate, just a few hours instead of weeks.
DR. RICK SPONAUGLE, FLORIDA DETOX CENTER: They're very excited when they wake up and they're not craving. They can't believe.
GUPTA: Still, patients still require several days in the program for medications and further counseling, and some doctors worry about the risks of general anesthesia.
GUPTA: And Dr. Pinsky your new book is about these addictions to pain killers. You're not a big fan of this treatment. It seemed to work for Valerie. What's your take on it?
PINSKY: I'm delighted that there are options for people out there. It certainly is a very viable option for methadone addicts because methadone withdrawal can be miserable for 30 to 60 days. My concern is that people believe that somehow the detox is all they need to do. The fact is nothing could be further from the truth. The detox is just where you start your process of treatment.
So to think that going through rapid (UNINTELLIGIBLE) detox and your done, you're sorely mistaken. And it's a lot of money to spend on the earliest piece of the treatment process and the part that is not the most important in my mind. I can get anybody off -- we've sort of perfected withdrawal. We can get anybody reasonably comfortably off almost any medication in three to five days. It's not as bad as it used to be.
And to spend the resources on the rapid detox when it should be spent on the other end, on the treatment concerns me quite a bit.
GUPTA: We're talking with Dr. Drew Pinsky. Let's get to another e-mail on the topic here. Tracy from Texas wants to know, how addictive is marijuana when compared to heroine? How about when compared to tobacco and alcohol?
Dr. Pinsky, marijuana is the most commonly used illegal, and there's a perception that it's not dangerous and not really addictive. What's the comparison.
PINSKY: Let me -- I'm -- take two long, I think, to compare to each of those drugs. The fact is it is addictive and it seems to be an opiate mechanism very much like heroine, very much like the Percocet you just had in the previous piece.
PINSKY: And the marijuana -- I should go through the syndrome because it's the same in all people. It's someone with a family history of alcoholism, about 85 percent of the time, who initially doesn't think much of pot, but somewhere around the third or fourth exposure as though it has some priming effect on the brain, they suddenly get this intense euphoria, oh my God, I love this stuff, and that is what they preoccupy about. From that day forth they will use everyday some from somewhere between one and 30 years.
During that time the effects will wear off. They will start being depressed. They smoke more to try to compensate and they will slip into a depression. At that point, they either come to treatment or they switch to another drug, typically amphetamine.
GUPTA: That is remarkable.
PINSKY: Amphetamine reverses the depression. So, most of my amphetamine addicts, nearly all are actually marijuana addicts for whom the marijuana stopped working.
GUPTA: Initially they were marijuana addicts and now amphetamine. Really interesting stuff. We're talking with Dr. Drew Pinsky. Coming up, drugs and alcohol not a problem. What about food and gambling? Stay tuned to HOUSE CALL for help. ANNOUNCER: Abstaining from drugs and alcohol is one thing, but if you're a food addict you can't stop eating. We'll tell you how to beat the habit. Plus, West Nile is heading out west. We'll bring you an update on this deadly virus.
GUPTA: Welcome back to HOUSE CALL. We're talking about battling addiction. Alcohol and drugs are what we usually think of when talking about this disease. But in recent years other compulsive behaviors are starting to fall under this umbrella as well, for example, food.
A recent study found the mere display of foods, smelling and tasting without actually eating caused increased activity around the brain similar to the desire that a cocaine addict experiences. So, can a person be addicted to food? Let's get the answer from addiction specialist Dr. Drew Pinsky.
So what do you say, doctor, can food be addictive as well?
PINSKY: Well, it's a complicated issue. I don't actually it can without first there having been a pharmacological addiction because food is a physiological process. Pharmacology alters physiology, causes extra physiologic changes in the brain. And once those extra physiological changes have been induced then the drive systems can become out of control and food can be one of those things people turn to to satisfy those drives, though not typically.
GUPTA: Is there a difference...
PINSKY: Not typically.
GUPTA: Is there a difference between addiction and compulsion? What's the difference.
PINSKY: Absolutely. Compulsion is a troublesome behavior that continues and people have difficulty containing. An addiction is a progressing disorder with mounting consequences with a genetic biological heritage and often denial in addiction. While compulsive behavior people will usually tell you they're not in denial about it. They're troubled by it.
GUPTA: They know that they're overeating for example. Let's keep on topic here. We got lots of e- mails on this. Let's get to one from Tommy in North Carolina who asks, "what are some of the symptoms of food addiction?" Well first of all Tommy, there are typical signs of any kind of addiction like needing it on a regular basis and failing attempts to stop abusing the item.
GUPTA: Also, people with addictions will go to extreme lengths in order to main the addiction. Are the symptoms specific, Dr. Pinsky to someone addicted to food versus something else? PINSKY: I think we think again in terms of medical consequences. If somebody is diabetic, somebody is having vascular disease, somebody is having medical problems from food and still can't contain that's when it really sort of meets the criteria of an addiction.
GUPTA: An estimated two million adults become compulsive gamblers at some point in their lives. They lose control of their betting and sometimes their lives as well. Will from Connecticut has a question on this topic. "Can you explain what causes compulsive gamboling. Is this a genetic disorder? Also how would you recognize this disorder in an individual?
Lots of questions there doctor.
GUPTA: (UNINTELLIGIBLE) with the signs that you may have.
PINSKY: The signs that you may have is that you can't contain your behavior in relation to gambling. University of Nevada, Los Vegas has a gambling laboratory where they're studying these gambling behaviors and they are complicated. Most people, again, that I deal with that become gambling compulsives are people who are trying to deal with a chemical addiction, and the reward mechanisms from the thrill of gambling are very similar to that from chemical addictions.
GUPTA: So, in your opinion and I know you've done a lot of work on this topic, most people who have compulsions are addicted to things besides chemicals have started with a chemical dependency of some sort?
PINSKY: In my clinical work that's the way it works. The chemicals sort of turn the volume up on the drive mechanisms. People try stopping the behaviors and they turn to other things. They turn to criminal, truant behavior. They'll turn to chaotic dramatic relationships, gambling, food, sex, extreme sports. These are all outlets that people have turned to, to try to contain their drives for a substance. But in fact, they're merely just massaging the same biology over again.
GUPTA; Very interesting. We're talking with Drew -- Dr. Drew Pinsky, of course. Grab a pin everybody. When we come back we're going to give you some tools to overcome addiction.
ANNOUNCER: Coming up on HOUSE CALL, from finding treatment help to learning about the disease itself, discovering where to surf for information.
And this week marked an anniversary for stem cells. We'll bring you up to speed with this week's Medical Headlines after the break.
CHRISTY FEIG, CNN MEDICAL CORRESPONDENT (voice-over): This week marked the three year anniversary of President Bush's landmark decision to limit federal funding for stem cell research. Fast forward to 2004, where Bush's decision continues to come under fire from scientist, politicians and even some celebrities who claim that the financial limitations imposed by President Bush are preventing the creation of new stem cell lines, which some scientists say are necessary for further research.
The president has consistently opposed federal funding for fetal tissue research that destroys living human embryos.
And West Nile virus continues to claim new victims, including an 88 year old California woman who died of the disease this week. According to The Center for Disease Control there have been 495 cases of West Nile virus this year and 10 deaths.
Christy Feig, CNN.
GUPTA: Christy, thank you. For more information on battling addiction point your browser to the substance abuse section of The Department of Health and Human Services at firstname.lastname@example.org. You can also look up treatment center in your neighborhood.
Also click on to www.nih.gov follow the health information link and look up addictions from alcohol from drugs to food.
And our guest, of course, Dr. Drew Pinsky, he has his own Web site, drdrew.com, targets young adults with live chats and answers to questions on addictions as well as relationships.
Dr. Drew Pinsky has been our guest. He has been all over the place. He writes books. He's on television programs and takes care of patients as well. What's the final thought you'd like to leave with our viewers tonight, sir.
PINSKY: Well, what I'd like people to know is that his -- they or someone they love, they believe might have a problem with these kinds of disorder realize they probably do. These are not problems that get better on their own. Please get treatment. It works. Talk to a professional
GUPTA: That's all the time we have for today. Thank you Dr. Drew Pinsky for taking time from your busy schedule. Lots of useful advice there. Thank you at home as well for all of your questions.
Make sure to watch next week when we're going to be talking about hair loss, from prevention tips to new treatments. We're going to show you how to stop or at least hide your disappearing hair. E-mail your questions to us email@example.com.
That's next weekend on HOUSE CALL. Don't miss it. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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