Monthly shot for holiday drinkers on wagon

December 17, 2008

ALCOHOLICS struggling to keep off shots of the hard stuff over the festive season may want to consider an alternative shot: a monthly injection that keeps them off the booze.

For people battling alcoholism, holidays pose a strong danger of relapse. "When you interview patients about triggers for drinking, they often say holidays and family events," says David Rosenbloom, a specialist in substance abuse at Boston University School of Public Health. "For some it's the stress of being lonely, for others it's the stress of being with people." Over Christmas and New Year, social pressure and opportunities to drink add to the intoxicating mix.

Some people take pills containing naltrexone, a substance that reduces the desire to drink by blocking the receptors in the brain responsible for the high that drinking brings. But during the holiday season, pressures often drive alcoholics to stop taking the tablets. "With a pill, they have to make a decision every day," says Sandra Lapham at the Behavioral Health Research Center of the Southwest in Albuquerque, New Mexico.

In 2006, the US Food and Drug Administration approved a slow-release formulation of naltrexone, in which the drug is stored in microscopic spheres made of a biodegradable polymer and injected into muscle once a month. Lapham wondered if this might help people who stop taking naltrexone pills during holidays. Working with the company that manufactures the formulation - Alkermes, based in Cambridge, Massachusetts - she reanalysed data from a previous clinical trial, focusing on the drug's performance during 10 US holidays and celebrations.

The study was small - just 28 patients received full-dose naltrexone shots, compared with another 28 given placebos. The shots reduced the frequency of drinking days, the number of drinks and the percentage of days classed as heavy drinking sessions - five or more drinks a day for men, and four for women. Crucially, the drug was just as effective during the holidays as it was for the rest of the year (Journal of Substance Abuse Treatment, vol 36, p 1).

The results have impressed Rosenbloom, who describes their significance for public health as "huge". Lapham warns that naltrexone injections must be given with care, because they can cause abscesses if the drug is deposited into fatty tissue.

The treatment might also reduce deaths from drink-driving: in the US, 40 per cent of road deaths over Christmas and the New Year involve at least one driver impaired by alcohol, compared with about 28 per cent for the rest of December. Rosenbloom would like to see courts offer naltrexone shots to repeat drink-driving offenders.
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