Bör alkoholister sluta dricka?

En spridd uppfattning är att alkoholister som vill komma ur ett destruktivt alkoholdrickande måste sluta helt med drickandet. En nackdel med att insistera på, i behandling av alkoholister, att ingen alkohol någonsin får drickas mer är dock att det kan få många alkoholister att inte söka hjälp. Det tycks nu finnas behandling som fungerar relativt väl för många alkoholister utan att de helt slutar dricka. Det medel som används heter naltrexone. I Newsweek rapporteras om The Sinclair Method (TSM):

TSM’s instructions are simple: take an inexpensive dose of generic naltrexone about an hour before drinking, every time you drink. … The basic concept goes like this: each time we drink, endorphins (called internal opioids) are released in the brain, causing us to associate, mostly at an unconscious level, the pleasurable state of an endorphin-flooded brain with the drink just consumed. In alcoholics—because of genetic predisposition, or some other cause—drinking behavior is “overlearned,” being reinforced until an alcoholic will drink to the point of oblivion. (To be fair, this chemical pathway’s responsibility for the majority of problem drinking is not a view necessarily shared by all researchers studying alcoholism.) Naltrexone, however, blocks opioid receptor activity in the brain. Sinclair and Eskapa say that each session of drinking on naltrexone causes the opposite of reinforcement: one unconsciously weakens, or “extinguishes” in psychological terms, the association between drinking and the state of an endorphin-flooded brain. It’s a process that takes repeated sessions, says Sinclair, to have a cumulative effect. But as many interested in TSM discover, naltrexone is mainly used in the alcohol-treatment industry as an adjunct to abstinence, not continued drinking. It is with continued drinking, however, that naltrexone works best, Eskapa and Sinclair argue.

Läs gärna mer i ”Evidence about the Use of Naltrexone and for Different Ways of Using It in the Treatment of Alcoholism”, publicerad i Alcohol and Alcoholism. Kan denna metod få fler att söka och få hjälp vid allvarliga alkoholproblem ser jag det som ett framsteg värt att lyfta fram.