Half Empty

One in 20 Americans has an alcohol use disorder, according to a recent perspective published in the Journal of the American Medical Society. In Russia that number is one in six. No doubt New Orleans is somewhere in between. Why do some folks drink in moderation and others to excess? Alcoholism is a complex disease with definite genetic overlays.

The North Alabama area of my youth is the epicenter for the Church of Christ, a Southern fundamentalist sect that makes Southern Baptists look liberal. Their preachers preach, turning red in the face, against a laundry list of societal evils including alcohol, dancing and wearing shorts. They preach that a single sip of alcohol leads to a life of sin on Earth, a first class ticket to hell and an afterlife of dancing with the devil. Yet their congregants always seemed to have more alcohol-related problems.

Since Jesus was famous for turning water into wine, alcohol as a pulpit issue was a mystery in my high school years. Now I suspect that the penetrance of the genes responsible for alcoholism explains why some religious faiths are so opposed to drinking – period. If a larger-than-normal number of congregants in a certain religious group carry genetic material that responds in an unhealthy way to alcohol, their collective health is best served by abstinence.

Several New Orleans treatment programs target persons with substance abuse problems, including alcoholism. Many medical diseases have acute, sub-acute and chronic phases of disease and treatment. Alcoholism is no exception. In more severe cases detoxification requires an actual hospitalization, but the key to long-term success is aftercare.

“Detoxification isn’t treatment. It is merely a prerequisite for treatment,” says Dr. Ken Roy, a psychiatrist for substance abusers, well-known for his work with impaired physicians and others plagued with chemical dependency problems. Roy has designed, implemented and prescribed a variety of treatment options over the years including ambulatory detoxification, intensive outpatient treatment including partial hospitalization and long-term residential care.

Townsend Clinics is another fast-rising player on the block originally founded by a businessman in Lafayette with a vision to address addiction after his own scrape with chemical dependency. This clinic has no relationship to Louisiana State University psychiatrist Dr. Mark Townsend, a local anxiety expert with clinic offices in the Touro area. In fact, Townsend in the clinic’s name supposedly honors a relative of the founder.

Townsend Clinics reorganized in 2009 with a “focus back to home in Louisiana” according to Abhi Bhansali, their publicist. Bhansali, a New Orleans homeboy with a New York University education, works for a local public relations company. He helped “manage accounts for Absolut and Moet-Hennessy promotions in major metropolitan cities” before returning home to ply his public relations skills for a spectrum of clients in the alcohol food chain from NOLA Brewing Company to the Townsend Clinics.

For decades, Antabuse was prescribed for alcohol avoidance. It blocks an enzyme in the liver needed to detoxify alcohol. A person who drinks alcohol with this drug on board develops a throbbing headache, nausea and vomiting. Unfortunately, the long-term success using Antabuse is marginal at best.

“The midbrain houses the pleasure center of the brain. It has an on and off switch that normally controls emotional highs and lows. Somehow alcohol breaks this switch in the brain, and alcoholics need more and more alcohol to experience pleasurable sensations,” says Dr. Reed Pitre, a psychiatrist originally from Houma who specializes in treating addiction disorders in Atlanta.

“Naltrexone fixes this broken switch and allows natural endorphins to function. It decreases the craving for alcohol. Alcoholics taking naltrexone don’t get the buzz. It is a generic drug and the oral version costs about $50 a month. There is also a long acting formulation called Vivitrol.”

The convenience and assured dosing of a once-a-month injection of extended-release Vivitrol isn’t cheap. Since no study shows therapeutic or long-term benefits for the once-a-month injection over the generic daily dose by mouth, most insurance companies don’t cover the $1,000 or so injection without steep co-pays. The drug company offers discount coupons of up to $500 a month for some folks, but the true price is shrouded in layers of drug company propaganda about assistance programs devised to keep the drug price high.

Dr. Howard Wetsman (see profile and interview in August 2012 New Orleans Magazine) is the Chief Medical Officer of Townsend Clinics. He gives lectures in which he catalogs medications used to treat addictive disorders into those that are used to treat withdrawal such as the benzodiazepines (Valium, Librium) in addition to those that block, mute or modulate the effect of addictive drugs. Other underlying psychiatric problems abound in folks with alcohol use disorders, and many more drugs are available for these coexisting medical problems, such as mood disorders.

Just as cancer treatments are progressing from more toxic radiation blasts and nauseating chemicals to therapy targeted against specific cancer cells, the armamentarium of selective agents to treat drug abuse has increased. The problem is access to this care. For decades, effective management of advanced alcohol dependency in this area began with a long stay in a locked facility somewhere upstate or in Mississippi.

Newer outpatient treatment centers and judicious prescribing of more specific psychiatric medications are making treatment of alcohol abuse disorders more accessible albeit not less expensive. One former Townsend patient told me he paid about $7,000 cash for treatment sessions lasting just under two months. He was also encouraged to attend Alcoholics Anonymous meetings. Even though his problem was alcohol, he received frequent urine tests for other drugs along with a surprise $4,000 bill later for these “pee tests.” When he called the laboratory billing office, he was told they would cancel the extra lab charges because he didn’t have insurance.

The current owners of Townsend Clinics are businessman Michael Handley, aforementioned psychiatrist Dr. Howard Wetsman and former Touro Infirmary emergency room physician Dr. Kevin Jordan. In a national magazine ranking earlier in the year “Townsend’s revenue grew 1,907 percent over the three years ending 2011 to $4.4 million.”

Bottom line: Even with more effective drugs, the treatment of alcoholism remains an expensive stool with many legs. Lifestyle modifications and long-term psychosocial support groups, such as AA, remain essential components for long-term results. One day there may be a specific blood test to detect persons prone to alcoholism; those folks would be best served by heeding the warnings from the abstinence pulpits. Consider them allergic to alcohol.

Finding help
Addiction Recovery Resources has offices in Metairie and on Canal Street in New Orleans. Medical director Dr. Ken Roy supervises a variety of highly structured ambulatory programs in addition to some residential services. Also ARR has a contract with the state to provide therapy for some persons with limited means and no insurance. 780-2766, arrno.org

The Townsend Clinics list office locations in Metairie, Covington, Lafayette, Baton Rouge and New Orleans. Some are more active than others. They have an intensive outpatient treatment program with some exotic genetic testing that Dr. Howard Wetsman believes is important in tailoring therapy.

(800) 760-8561, TownsendLa.com

 Addiction Counseling and Educational Resources covers the Greater New Orleans area with multiple active offices from Arabi to Slidell. They have an income based fee schedule that’s very affordable. 941-7580, ACERCanHelp.com

Alcoholics Anonymous is the granddaddy of all alcohol treatment programs. Even though its mission isn’t based on medical intervention with the use of other medications, most treatment programs refer patients to meetings on an ongoing basis. Trying to get some basic information from AA, such as how many people in our area attend their meetings, is difficult; they don’t share that kind of information. I like that. Their website will help anyone find a meeting site. AA-NewOrleans.org

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