the Prozac moment

Mark Willenbring dreams of the day that addiction is treated by primary care docs:

…Dr. Willenbring, an expert on treating alcohol addiction, predicts that the day is not far off when giving a pill and five minutes of advice to an alcohol abuser will be all that is needed to keep drinking under control.

“We’re at the same place with alcohol abuse that the treatment of depression was at 40 years ago, when only psychiatrists treated it and most people with depression were never treated at all,” said Dr. Willenbring, the director the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism.

Then came Prozac, followed by similar antidepressants that took the treatment of depression out of mental hospitals and psychiatric offices and put it in homes and in the offices of primary care doctors.

“Now almost all of depression is treated in primary care,” Dr. Willenbring said, “and two-thirds to three-fourths of depression is getting treated.”

But with alcohol dependence, he said, only one person in eight receives professional treatment.

He acknowledges that this is not a likely possibility for the kind of people who currently enter residential and inpatient treatment:

“Those who get into treatment programs are the most severe alcoholics,” Dr. Willenbring said. “But the bulk of alcohol abusers have a more moderate form, with a better prognosis. Most could get well in primary care settings and not have to wait until they are at the end of their rope and forced to go into a rehabilitation program, which can be so stigmatizing.”

What is needed for controlling alcohol abuse early in the disease, he said, are drugs like Prozac that can be easily prescribed by primary care physicians to help people with moderate alcohol abuse. Several such drugs are now in the pipeline, Dr. Willenbring said.

The two already available — naltrexone and Topamax — are not yet the equivalent of Prozac for depression, but they can help many alcohol abusers learn to drink more moderately or abstain altogether.

I think he’s got too much faith in antidepressants.