Costing less than the average beer or shot, a $4 pill might be the long-sought solution to alcoholism and binge drinking. According to recent study results, the drug Selincro has proven highly effective when it comes to curbing alcohol cravings. The idea of miracle cures is as old as time itself—potions promising quick-acting remedies, hawked by shady traveling hucksters. (The Wizard of Oz has nothing on the unlikely traveling-duo of Michael Jackson and Paul McCartney in the “Say Say Say” video, but I digress.) Still, as a culture, we seem to collectively tolerate the idea—maybe because we desperately want to believe the cure to instant weight loss rests in pill form, not diet and exercise. When it comes to alcoholism, though, a miracle might actually exist.
Miracle Drug—or Just Good Medicine?
The very notion of a pill that cures alcoholism calls into question what we understand about addiction as much as the future of treatment. Selincro, otherwise known as nalmefene, was first used by the UK’s National Institute for Health and Care Excellence (NICE) to treat alcoholics. In 2013, the drug saw a “40 percent reduction in alcoholic consumption within the first month” among its users, according to NICE. After six months of using the drug, it increased to 60 percent, which is the equivalent of about one bottle of wine per day.
For many, it’s the next evolution of alcohol treatment. “For a large proportion of patients with alcohol dependence, reduction of alcohol consumption is a more acceptable and realistic treatment goal,” Professor Karl Mann said of Selincro. Dr. Mann’s comments say a lot about the state of addiction medicine without even trying to: the drug is a curious, on-the-go, as-you-need-it approach to managing one’s addiction. One article explains that the drug “works by blocking opiate receptors, stopping the endorphins produced by alcohol that give a feeling of reward and pleasure.” The use of Selincro doesn’t seem to be about completely cutting alcohol out of the picture—it’s just about cutting alcohol out of the picture when someone feels like it. It’s more about keeping the monster at bay than killing it outright.
The Two Brain Regions Related to Binge Drinking
According to the journal Biological Psychiatry, researchers have discovered a connection between two brain regions related to binge drinking. The two areas (the extended amygdala and the ventral tegmental area) have long been blamed for causing binge drinking, but this is the first hard evidence that links them. New data shows that the connection between brain areas can become an on-off switch for alcoholism. By flipping that switch with the drug, it’d be lights-out for binge drinking.
“The puzzle is starting to come together, and is telling us more than we ever knew about before,” Dr. Todd Thiele said of his study. “We now know that two brain regions that modulate stress and reward are part of a functional circuit that controls binge drinking and adds to the idea that manipulating the CRF system is an avenue for treating it.” (CRF stands for “corticotropin-releasing factor”—a substance that maintains and manages how the brain responds to external stressors, as well as regulates anxiety and depression.)
The results in lab mice suggest that CRF neurons up like a pinball machine when someone ingests alcohol. The study also revealed that “CRF neurons become active in the extended amygdala and act on the ventral tegmental area to promote continued and excessive drinking, culminating in a binge.” In other words, when someone drinks alcohol in a short period time, the brain insists that the person keep drinking to keep the neurons firing and, in turn, the dopamine flowing.
“The findings may also shed light on future pharmacological treatments that may help individuals curb binge drinking and may also help prevent individuals from transitioning to alcohol dependence,” Dr. Thiele said.
For me, what’s most interesting about the drug isn’t so much its effectiveness as its implications. As a pill, Selincro can be taken up to once a day, though that’s not the primary aim. It’s designed to be used on an as-needed basis by patients who aren’t heavy drinkers. In targeting weekend warriors rather than career alcoholics, the drug becomes less a cure-all than a solid first step toward sobriety. “If you can stop somebody from binge drinking, you might prevent them from ultimately becoming alcoholics,” Dr. Thiele reasoned. “We know people who binge drink, especially in their teenage years, are much more likely to become alcoholic-dependent later in life.” In some ways, this rationale is the exact same as closing the circuit between the two brain areas: it shuts down alcoholism before it even begins.
The prospect of a $4 pill that helps binge drinkers from falling down the alcoholic rabbit hole is an intriguing one but, in my opinion, could cause more damage than good. The pill’s very existence would feed the very problem it’s trying to combat, serving as something of a security blanket for people who know they can take a pill. It’s more important that researchers have uncovered the link between brain areas than designing a drug to flip the switch. “It’s very important that we continue to try to identify alternative targets for treating alcohol use disorders,” Dr. Thiele says of his study. Perhaps, now that researchers know how the brain drives binge drinking, we may actually be closer to a permanent solution. However, for many, the fact that there still isn’t a miracle cure for alcoholism will remain a bitter pill to swallow.