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Health provider, Yale offer Native alcoholics option

Posted: Tuesday, January 07, 2003

JUNEAU (AP) -- The Southeast Alaska Regional Health Consortium, a Native health provider, has teamed up with Yale University's School of Medicine to study whether certain prescription drugs can curb the desire to drink.

About 200 Alaska Natives will be chosen over the next five years for the program that aims to combat alcohol abuse among Alaska Natives and American Indians. The study will test the effectiveness of combining the prescription drugs Naltrexone, which is used to decrease alcohol cravings, and Zoloft, an anti-depressant.

Dr. Robert Robin of Yale is one of the lead investigators in the study, which is funded through a five-year grant by the National Institute on Alcohol Abuse and Alcoholism and the Office of Minority Health Research. Robin said that combination of drugs has been tested before, but never among Native populations.

''The previous studies have been made available to Caucasians, Hispanics and blacks and have principally been done in urban areas,'' Robin told the Juneau Empire. ''This study is really extending an opportunity to Native Americans and Native Alaskans in rural areas who don't have as many treatment options.''

The study will recruit Natives from Klukwan, Haines, Sitka, Juneau and eventually Prince of Wales Island and Kake, said Bedford ''Sonny'' Chandler, medical manager for the Juneau-based program and a physician assistant with SEARHC.

''Long-term (alcohol) abuse presents all sorts of health care problems, not to mention problems in law enforcement, problems within and without the home. It's been associated with domestic violence,'' Chandler said. ''Hopefully, this will serve as a model for how to treat alcohol dependency in the Native community and have widespread social and medical implications.''

Naltrexone is a drug, used since 1992, to combat alcoholism, according to Yale study investigator Stephanie O'Malley. It acts as an opiate inhibitor, helping to decrease cravings and the urge to drink, she said, and it can help people abstain altogether from drinking. Originally it was used to treat addictions such as to heroin, codeine and morphine.

Zoloft works to increase the serotonin levels in the brain. Serotonin is a naturally occurring chemical that helps in the transmission of messages between nerve cells, experts say.

Robin said researchers hope Zoloft will reduce the stress associated with quitting drinking, so the Naltrexone can be more effective.

''Naltrexone is a good tool, but it's not a cure-all,'' he said. ''We will work with the client on continuing treatment and encourage abstinence or continuing to reduce alcohol consumption.''

The study costs nothing to participants, but the drugs can have side effects.

According to the Mayo Clinic Web site, Zoloft can cause nausea, diarrhea, constipation, some weight gain or loss, dry mouth, headaches, some fatigue or insomnia, decreased libido and delayed ejaculation. Naltrexone can cause nausea, headache, dizziness, fatigue, insomnia, anxiety and sleepiness, according to the University of Pennsylvania Health System's Web site.

''The symptoms are usually very mild and do not last very long,'' Robin said. ''They rarely are enough to make clients end the treatment.''

Participants must pass an extensive three-day psychological and medical screening before being accepted into the program, Robin said.

Other requirements include being an Alaska Native between the ages of 18 and 65, alcohol dependent but abstinent from alcohol for four to 14 days, and have a stable residence, researcher O'Malley said.

Participants will be put into one of three groups, Robin said: Naltrexone and Zoloft users, Naltrexone and placebo Zoloft users, or placebo Naltrexone and placebo Zoloft users.

About one-third of the participants receive a placebo, or inactive medication, Robin said. That will let researchers compare the effects of using one or both drugs.

Participants are active in the study for 16 weeks. Each client gets counseling with treatment staff, including SEARHC clinicians.

Researchers will follow up with the clients three times over the following six months to a year.



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