Amid skepticism, physician touts non-abstinence route for alcohol treatment

By Bill Kauffman, Calgary Herald.

 Treating alcoholism without giving up booze is more than feasible, says a physician helping to bring the approach to Calgary. The harm-reduction route is proving to be far more effective than 12-step programs and abstinence, said Dr. Diane Rothon, whose recovery clinic, Alavida, is launching a service in the city Dec. 11 after treating patients in B.C. and Ontario for the past year-and-a-half.“I’m not opposed to abstinence at all when it works; in fact, I’ve done that for 30 years,” said Rothon, a former B.C. chief medical examiner.

“The issue is the scope of the problem, and abstinence can be quite heavy-handed and negative, moralistic or punishing.”In the short time it’s been operating with a method Rothon said was first proven in Finland, 75 per cent of their clients have reached their goal of achieving lower-risk drinking habits or halving their consumption.She said the success rate of abstinence programs is close to a mere eight per cent, a reality that can lead to self-doubt and despair. “You can feel terrible, so we circumvent that. … You can develop a different relationship with alcohol,” said Rothon, Alavida’s medical director.

Clients ingest a tablet of Naltrexone, a pleasure inhibitor, an hour before they drink, which reduces the desire for alcohol. That’s teamed with psychotherapy conducted by secure video conference. Its attractiveness, flexibility and success rate, said Rothon, means it could eventually rival more rigid programs like that offered by Alcoholics Anonymous. “This is the alcohol recovery treatment of the future,” she said, adding disappointing results from combining Naltrexone with abstinence care persuaded her to change tack.

But operators of some Calgary substance abuse rehab agencies say they’re not about to include Alavida’s approach to their programs. “Harm reduction is clearly not recovery,” said Stacey Petersen, executive director of Fresh Start Recovery Centre. “You wouldn’t say ‘if we can just get rid of 75 per cent of the cancer, it’s really good,’ when the end game is to get them to total remission.”

But Petersen said Alavida could have a place for some alcoholics by bringing them closer to that recovery, adding he won’t second-guess the intent of its proponents. Shannon Towson also said there’s a role for harm reduction in treating substance abuse. But the clinical manager at Edgewood Health Network Calgary voiced skepticism about the approach’s merits in treating chemically dependent clients.“Evidence shows once that switch is flipped, it can’t be reset,” she said.

“If they’ve crossed over to substance use disorder, it won’t work.” Edgewood, she said, deals with clients who’ve already unsuccessfully tried to control and manage their drinking. Towson said it’s hard to peg her clinic’s success rate for alcoholics, but insists it’s considerably higher than the eight per cent cited by Rothon.

Tom, who wouldn’t give his last name, said he recently underwent the Alavida regimen and went from a two-wine-bottles-a-day habit to being a teetotaler. “I was just going to cut back on drinking, but I’ve completely quit,” said the 65-year-old B.C. resident. “At first, they encourage you to drink and I was still drinking every day, and after six months, it stopped altogether.”

While the drug is available, Naltrexone isn’t routinely prescribed by Alberta Health Services’ programs, said AHS spokesman Bruce Conway, who added the non-abstinence approach isn’t unheard of in the province. “AHS works with partners to provide services to Albertans for whom abstinence-based treatments are not appropriate,” he said. Rothon said one goal is to ultimately see her program covered by provincial health care insurance.

For now, the cost of the six- to eight-month outpatient program is $6,500. A three-month outpatient program at Edgewood typically costs $5,000, while a seven- to eight-week inpatient regimen runs about $21,000 and is not covered by Alberta health insurance, said Towson.

When asked if the province should cover the cost of Alavida, Towson was non-committal, saying only that she’s in favour of public support of anything that reduces substance abuse.

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