New treatments developing for alcoholism

Anton, left, and Margolis

ATLANTA, Georgia (CNN) -- Experts say alcohol abuse in America causes more than 100,000 deaths every year, and more than half of adult Americans are believed to have a direct family experience with some alcohol problem. To explore the alcoholism issue and find out about new treatments being developed, CNN Anchor Stephen Frazier spoke with Dr. Raymond Anton, scientific director of the Alcohol Research Center, and Dr. Robert Margolis, who is with Solutions, an organization that helps adolescents. The interview took place after a preview screening of a program special called "Wasted" for the CNN program "CNN Presents."

FRAZIER: Dr. Anton, if I may, let's start with you. You heard Martin there say genetics and the brain. He didn't in that clip explain what you've learned about those two things. First, the brain: Are we talking about brain chemistry here?

EXTRA INFORMATION • CNN Presents: Wasted in America   • Transcript of the interview

ANTON: Yes. Actually, in the past five to 10 years, we've learned considerably a lot about how alcohol affects the brain. There are certain cells in the brain, there's certain neurochemistry that are more affected by alcohol. And when people drink very heavily over a long period of time, these cells adapt or change, and they become different.

We think that the brain is permanently changed in people that have alcohol dependence.

FRAZIER: Did you also find that the brain may come with a predisposition or perhaps a genetic predisposition in some people to sensitivity to alcohol?

ANTON: Well, Stephen, that's an excellent question. That is exactly the type of information that many investigators in the country are studying literally as we speak. There's definitely a great interest in the genetics of alcoholism. We think that perhaps almost half of the people that have alcohol dependence have a genetic risk for it. That means that half don't, however, and it probably means that the stresses of life, environmental stresses of various sorts can predispose people to alcoholism as well.

FRAZIER: I'd like to talk in a minute about the pharmacology of all of this, because there are some new drugs at work. But let's talk to Dr. Margolis about the other thing that Martin mentioned in that clip, the new things that have been learned about psychology. And surely Megan must have triggered your interest, Dr. Margolis, when she said, you know, I didn't realize just how much I was drinking, a sort of denial there.

MARGOLIS: Well, yeah, that's true. I mean, many, many alcoholics lose track of the amount that they're drinking, and they actually convince themselves what they're drinking is less. And that enables them to keep going and this disease process to progress to very dangerous levels.

FRAZIER: Your work in the Solutions program deals with adolescents. Have they started that denial process even as adolescents?

MARGOLIS: Yeah. In a lot of ways, their denial process is worse when they're adolescents, because many of these kids are hanging out only with other kids who drink and do drugs. So it seems very normalized for them. It's difficult for them to see themselves as different.

FRAZIER: And is drinking an isolated behavior or do they mix it with those other drugs you just cited?

MARGOLIS: Well, it's very rare to find an adolescent who just drinks. The only adolescents who just drink are pretty much nonsocial adolescents. Sociable adolescents who are out in the community get exposed to really a pharmacology of different drugs and they're abusing a variety of different things.

FRAZIER: When you're looking at a young person, how can you tell the difference between someone who's just introducing himself to alcohol, perhaps prematurely, perhaps underage, and someone who is an alcoholic?

MARGOLIS: Well, that's a real difficult question, because so many kids do abuse alcohol and drugs and they don't go on to become alcoholics or addicts. But what you do is you look for warning signs. You look for people who have that genetic predisposition that Dr. Anton just alluded to. You look for kids who don't adapt or don't change their behavior even as negative consequences accumulate. And I think that's the real difference. Some kids will alter their behavior as consequences accumulate. Some will not.

FRAZIER: As consequences accumulate, you mean they get wasted, to use the word of the show, and get in -- do things that hurt them?

MARGOLIS: Yeah, that's it. They get -- they get wasted. Their grades go down. They run away from home and they get arrested, and then they go out the next night and say, I think I'll try that again.

FRAZIER: Oh, jeez. And Dr. Anton, how about the -- how about the people who get wasted and then manage somehow to mask that?

ANTON: Well, alcoholism is a complicated disease. It comes in all favors and forms. Many people who are not that severe can function at their jobs or in their family for a while.

FRAZIER: Isn't that the old word -- I don't know if it's still used -- but the idea of a functional alcoholic?

ANTON: Well, there's all different types of functioning. If people drink long enough, however, their functioning usually deteriorates because of the changes that we talked about in their brain.

FRAZIER: Right, right. Now, tell me about these new drugs. These are tough words to say; I'm not sure I can pronounce them correctly, so help me out here. Naltrexone.

ANTON: Yes, that's good. Naltrexone.

FRAZIER: And the other one -- how do they work?

ANTON: The other one is called acamprosate. They work on special neurotransmitters, or the chemistry of the brain. As I said before, when people drink long enough and hard enough and severe enough, it changes the brain in ways that we can measure in the laboratory. And we think that these drugs normalize those changes or make the changes -- make the brain back to normal.

Naltrexone particularly blocks the pleasurable effect of alcohol, so when people slip or have some relapse drinking during treatment, they don't completely lose the control and go on to a complete relapse, and they can utilize therapy better.

FRAZIER: What therapy?

ANTON: Well, we've had the good fortune in the recent years to develop new sophisticated ways of doing talking therapy with people that have alcohol problems. Unfortunately, the talking therapy doesn't work completely for everybody. So they oftentimes have considerable amounts of craving. Craving is a hallmark of alcohol addiction and other addictions. We think the medications can reduce the craving that has a biological and a brain chemistry basis to it. So when the craving is reduced, they have more control over the craving and the urge to drink, and therefore use the therapy and not relapse or leave therapy as easily.

FRAZIER: Now, there's a lot of that involved in Solutions, too, isn't there, Dr. Margolis, and the same kind of support groups we've seen commonly in a 12-step program?

MARGOLIS: Yes, there are, and let me just say that I agree completely with what Dr. Anton said. Anything that can reduce the craving that the addict or the alcoholic feels in the early days of recovery is a tremendous asset. In Solutions, one of the things we do is try to introduce kids to a 12-step lifestyle from the first day that they come in, and we teach them how to work that program, as well as use the talk therapy that Dr. Anton referred to.

FRAZIER: If there isn't any kind of pill involved in Solutions, then how can you help with the physical effects of a craving?

MARGOLIS: Well, we're very supportive of kids or adults receiving those kinds of medications. I think it's important to note that those medications are still in an experimental phase. When they become more widely available, we're going to be right in the forefront there.

There are other medications, though, such as antidepressants and drugs for ADD and other types of medicines that do help addicts and can be a protective factor.

FRAZIER: There was a time -- and maybe this is just urban myth -- wasn't there a drug in use for a while that actually made drinking repulsive and made people ill if they were drinking?

MARGOLIS: Yeah, there still is, and it's called Antabuse. And the data on Antabuse is kind of mixed, but it certainly does make you extremely sick, and if you drink on it, you're going -- you won't die, but you think you're going to die.

FRAZIER: And what's different for these adolescents in Solutions that they wouldn't find if they were to go to an Alcoholic Anonymous meeting?

MARGOLIS: Well, I think it's important to know that AA is not treatment. They don't see themselves as treatment. They are simply a self-help group. What we do is accelerate the process of them getting into AA. From day one, we teach them how to work a program, how to get a sponsor, how to be a part of the recovering community. But we also do a lot more. We also help them to function and to cope, and we try to teach them coping skills.

FRAZIER: And COMBINE includes that kind of work, and it's a huge program.

ANTON: Yes. In fact, there are 11 centers across the United States, all funded by the National Institute of Alcoholism and Alcohol Abuse, part of the National Institutes of Health. We're recruiting 1,375 individuals over the next several years to participate in this.

And I do want to say that Dr. Margolis is right that this is still experimental, even though naltrexone has been approved by the FDA since 1994 and acamprosate has been used in Europe for a number of years now. But how we're combining them together is the important thing.

Just like many illnesses, like high blood pressure, diabetes, heart disease, sometimes you need more than one medication, and many times you need behavioral change and health status change through changes in lifestyle. So we think combining changes in lifestyle, combining medications are delivering a big punch to try to knock out this devastating illness.

FRAZIER: Still and all, though, for all that we now know about changes in behavior and inducements to that, it seems like -- and I don't want to get too deeply involved in biological determinism -- but all this new technology that helps map the brain and changes to that, that seems to be where the action is.

ANTON: Oh, that's correct. The technology that's happening right now is just phenomenal. We published a study just a few months ago that looked at how alcoholics' brains respond to pictures of wine and beer, and we saw that their brains respond much differently than people who are social drinkers.

This is a very powerful took, and we're going to be able to eventually see how medications may change brain functions directly by looking at pictures in these scanners. I think it's very important

FRAZIER: You mean we're talking there about some portions of the brain being smaller in people or larger or just not as responsive?

ANTON: Well, I think not as responsive or the overactivity is probably the issue. But we do also know that people that drink for years and years may actually have cell loss in their brain, their brain actually has shrinkage, and parts of the brain actually deteriorate. So, it's really both. One is a functional type of process and the other one really is a pathological or a cell-loss type of process.

FRAZIER: Dr. Margolis, when you're talking to young people, I'm sure you've encountered this sense that they don't like absolutes. Are you comfortable telling them that they can never drink again, or is there any kind of a medium stage or intermediate stage?

MARGOLIS: Well, that's a pretty overwhelming idea. It's not only overwhelming for adolescents, it's overwhelming for adults. And one of the ways AA tries to deal with that is tell alcoholics just don't drink for today. If you can't get through the rest of your life, which is totally overwhelming, just make a commitment not to drink for today, and tomorrow make the same commitment.

FRAZIER: You've seen those bumper stickers, right, "One day at a time"?

MARGOLIS: There you go.

FRAZIER: Well, we have run out of our one day, but I'm grateful to both of you for joining us today for what I thought was a very thoughtful discussion of alcoholism. Dr. Raymond Anton, Dr. Robert Margolis, thank you.