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Heroin Addiction and Related Clinical Problems: 2009, 11, 1 (pages: 15 - 22)

Dihydrocodeine for the Treatment of Alcohol Dependence

Ulmer A., Müller M., Frietsch B.

Summary: Objective: In most cases, alcohol dependence shows a profile similar to that of many chronic diseases, but no effective basic treatment comparable to that adopted with the other illnesses has been established up to now. In particular, patients with repeated relapses, despite a broad range of therapeutic approaches, and patients who are unable to attain what is essentially a state of abstinence from alcohol, continued to need a basic medication. Methods: Convinced by a few specialized colleagues who reported successful treatments of alcohol addicts with Dihydrocodeine (DHC) and by a first own patient of ours who showed a complete reduction of his severe alcohol craving when given Codeine-based pain medication, we went on to treat as many as 77 (M/F: 55/22) heavily alcohol-addicted patients with DHC, beginning in 1997. Right from the start, the data were documented meticulously. We present a retrospective analysis of this documentation here. Results: The patients had a history of a total of 1060 medically assisted detoxifications and specialized therapies. The 4 year-retention rate was 26.1%, including 6.5% of treatments that had a successful outcome. In our 12-step scale on clinical impressions, we noticed a significant improvement from a mean of 3.5 to 6.7. The demand for medically assisted detoxifications in patients who had at most 2 years left was reduced by 63%. Mean GGT improved from 201.1 U/l at baseline to 57 U/l after 4 years. The MCV value also showed a significant improvement. Mean GGT of patients with additional chronic hepatitis C improved from 198.3 U/l at baseline to 86.4 U/l after 1 year. Conclusions: Our data are preliminary, and these are practice-generated results, which are far from reflecting the whole potential of this new approach. Between 10 and 20% of these patients recorded no good effects from DHC. In around half of the patients the treatment was abandoned for several reasons, in some cases because of the anxiety caused by the pioneering nature of this non-established therapy: a treatment with partly overcautious dosages. But in about 25% of the patients, DHC was an almost perfect medication, sometimes even crucially better than all previous approaches, even in absolutely desperate cases. A lot of regular studies are needed, comparing different substances, settings, dosages and clarifying the cause and pathomechanism of the effects. This should be done because it seems that we are standing at a gateway leading into immense new opportunities. In the long run the breakthrough will be a question of the right mixture of scientific investigation, well-structured implementation with sufficient control, but also, and this may be most important factor, enough trust in our patients and the prescribing doctors. On a long-term basis there will be no success without a structure that supports and reassures, but also represents, this trust.