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The no-thrill pill: Help for alcoholics?

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Media outlets last week were abuzz about a new treatment for alcoholism. As reported in the Journal of the American Medical Association, the drug ondansetron may be a powerful therapeutic device for treating patients in the early stages of alcoholism. But a Georgia woman who operates an alcohol treatment facility in Savannah says another pharmaceutical treatment -- the little-known drug naltrexone, marketed under the trade name ReVia, that has been approved to fight alcoholism since 1994 -- is readily available, relatively inexpensive, and a proven method for getting problem drinkers off the bottle. And, although some alcohol treatment centers will provide the drug if a patient or physician requests it, it is seldom used; currently, naltrexone is used by less than 1 percent of America's estimated 20 million alcoholics.

For Terry Bruce, naltrexone was literally an answer to her prayers -- an answer she wants to bring to Atlanta, as well.

Bruce isn't a doctor or scientist. She's a middle-aged mother who isn't herself an alcoholic, but has been surrounded by the ravages of alcoholism almost her entire life.

"If you've lived around it for 30 years, sometimes you know better than anyone else," says Bruce, who has lost several family members to drinking-related illness and accidents. Her faith in traditional treatment was shattered when she checked a family member into a well-known facility on the Georgia coast. Twenty-eight days and about $28,000 later, the family member was released -- and relapsed within a week.

Desperate for lasting help, Bruce found out about naltrexone while surfing the Internet. Inspired by well-documented claims of success, she began calling local treatment centers to find out if they offered the drug.

"They told me they knew about it, but had no plans to start using it," Bruce says. "I said, 'Well if they won't, I will.'"

Undaunted, Bruce decided to open her own treatment center, based on the protocol developed by one of naltrexone's early champions, Lloyd Vacovsky of the Assisted Recovery Centers of America in Phoenix, Ariz. In May, she opened Assisted Recovery Center of Georgia, an outpatient office affiliated with a Savannah physician, Dr. Keith Hall.

The center's all-inclusive fee for a standard six-month treatment is $4,462; an intensive two-week regimen -- which also includes hotel fees, medical profiling and individual counseling -- runs about $4,600. For any patient who completes either program and relapses, additional sessions are free.

Originally developed as a treatment for heroin addiction, naltrexone breaks the "cycle of alcohol craving" by blocking what are called opioid receptors in the brain. When one drinks or experiences pain, the body releases pleasurable substances called endorphins -- the body's natural painkillers, which also provide the "high" that drug-abusers crave.

Those who have used naltrexone say that the pill just plain kills the buzz. If they go to a bar and have a drink, they're just as likely to leave half of it because, as the song says, the thrill is gone. (This is marked contrast to the most common chemical treatment, Antabuse, which -- if taken with alcohol -- renders a subject violently ill.)

But, for most alcoholics, the most widely available means of getting sober remains Alcoholics Anonymous and the 12 Step Program. While its adherents swear by it, such a regimen can take a lot of time and a lot of money -- $1,000 a day in some recovery centers.

Bruce says AA-type programs are fine -- she offers such techniques as part of her own plan, for those who desire it -- but laments that naltrexone isn't more widely used.

Some experts wonder why.

"I'm not sure why the vast majority of treatment programs fail to use naltrexone routinely in this country," says one of the pill's prime advocates, Dr. Joseph Volpicelli of the University of Pennsyl-vania. "It is all the more ironic given the increasing worldwide acceptance of naltrexone. In fact, naltrexone is in short supply due to skyrocketing use, particularly in Europe, the Near East and Australia."

But in the U.S., says Bruce, the medication is hardly mentioned -- and she thinks she knows the reason.

"Years ago, DuPont started marketing this under the name ReVia," she says. "Back then, the traditional treatment had always insisted 'no drugs.' ... By the time [the treatment] began to take off, DuPont's patent had run out, and other companies were marketing it for lower prices, so it was no longer profitable. Now, they're making so much on it outside the U.S., they're not focusing on spreading the word."

So Bruce made spreading the word her mission.

She found a similarly motivated partner in Atlanta mortgage broker Jane Jones, an old friend who hopes to launch an Atlanta branch of Assisted Recovery within the next couple of months.

"I guess everybody's seen friends or loved ones suffer with this disease," she says. "My grandfather was in and out of programs all his life ... with this misunderstood disease. It's so wonderful that it can be treated. And it's just a crime that it hasn't been treated just because the drug isn't very profitable." -- (Greg Land contributed to this story.)

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