I haven’t written much about Campral, an anti-craving medication approved by the FDA in July, 2004 for treatment of alcohol dependence. It’s been prescribed in Europe, Canada, Australia and other countries and is growing in popularity in the US. We get a lot of questions about Campral at our discussion board as members prepare to approach their docs. They want to know: does it work? What are the side effects? How does it compare to other meds? Does it take long to kick in?

Here are a few observations I’ve made from MWO patients and members who have shared their experience:

• At this time, it’s generally easier to get a prescription for Campral than other anti-craving meds. Topamax requires off-label prescribing and some physicians are simply uncomfortable doing that. Vivitrol (injectable naltrexone) hit the market only recently and many doctors don’t know about it. Oral naltrexone (ReVia) doesn’t seem to be prescribed very much for some reason.
• Campral is well suited for those who plan to pursue complete abstinence from alcohol and haven’t had anything to drink for at least a few days.
• If you begin drinking while on it, Campral loses its efficacy pretty quickly.
• Patients sometimes complain of diarrhea, gas, and stomach discomfort when taking Campral. This side effect is said to be dose specific.
• Campral kicks in fairly soon for most people.
• Many patients find Campral quite effective. One clinical trial suggested people who took Campral were two or three times more likely to achieve abstinence a full year later than those who took a placebo.
• Others say they were not able to be compliant while on Campral and found other medications (usually Topamax) more effective. Some research supports these findings, however, there are differing views within research circles about the study design in some of the clinical trials.
• Side effects are often considered less harsh for Campral than Topamax.
• People who do drink while on Campral report getting drunk faster and feeling more hung over the next day.
• Campral can be used in combination with naltrexone.
• Like other anti-craving medications, Campral is most effective if used in conjunction with counseling and/or support. Patients who adopt multiple strategies tend to have greater long-term success.

So just how does Campral work?

According to manufacturer Forest Labs’ website, “Campral is thought to restore the normal brain balance, which has been disturbed in someone who is alcohol dependent.”

Hmmm. I don’t know if that’s terribly helpful, but I would certainly agree that our brains are disturbed once we’ve become alcohol dependent.

To be more specific, Campral targets and helps restore balance in two important neurotransmitters: glutamate and GABA. Glutamate is an excitatory transmitter and GABA is inhibitory. They have a see-saw type of relationship. GABA and glutamate receptors are also involved in the reward centers of the forebrain and are responsible for creating a system of positive reinforcement. But when a person chronically overdrinks, as we do, it depletes GABA functioning and results in a hyperexcitable glutamate system.

Drinkers feel great while they’re drinking. But the short-term buzz eventually ends up throwing the entire system off. And when alcohol is removed from the equation, the brain is left with way too much glutamate activity. This causes discomfort, anxiety and eventually an endless craving for alcohol.

Enter Campral, which helps restore the GABA-glutamate equilibrium by acting specifically on receptor sites tied to the alcohol reward signaling center. Or, as Forest Lab explains, again at third grade level, it “makes it easier for people not to drink.” Got it.

Campral is prescribed in two 333 mg. time-release tablets, taken three times a day with food or on an empty stomach. It should be used with caution if you have kidney problems and will not be prescribed if you have severe kidney disease. The medication cost about $150 a month. The package insert is here if you like reading the teeny weeny print.

By the way, if you have questions for those currently taking Campral, be sure to visit our online community. I’m not plugging our message board, but I think you’ll find some really good info because many of our members have tried a couple of different meds, including Campral, and they’re very generous about sharing their experience. You can simply enter the term “Campral” in the search field and you’ll find dozens of posts with lots of rich info, as well.

Do keep in mind that anti-craving medications target different brain receptors and how they work depends on a number of variables. So you won’t really know until you get started how effective they will be for you.

But there’s no time like the present to begin. Who knows, Campral may be just be what your doctor should order.

Okay, first of all: insert your favorite industrial strength medical disclaimer here. You know the drill. Nothing you read on my website, discussion board or blog constitutes, replaces or in any way represents medical advice. Please consult a qualified health care professional yadda yadda yadda yadda.

I’m fessing up. Here’s my experience with smart pills. I am asked about this continually. Calls, emails, and questions to the message board. I certainly understand why, I would ask the same. In fact someone recently posted a question on our board about my vague reference to it in the book. Her characterization was correct. I dodged it. But like many of you, I incorporated Topamax into my program and I faced the same cognitive side effects some of you are now dealing with.

To be honest, I thought I’d found the holy grail when I came upon the smart pills. I was doing tons of research at the time and, and as always, quite a bit of self experimentation. I had been desperate to fix the drinking problem and by that point the program was working great. But the cognitive fog was a killer. I had learned about these new “eugeroics” and they had been helping immensely, but they seemed to offer more to me than enhanced brain power. I wasn’t sure if I should keep this to myself or include it in the book so I consulted one of the MDs with whom I was working. I said I was apprehensive about sharing the info. My experience seemed almost too good to be true and I had relatively little feedback about these smart pills’ use within the context of the program. But I was urged to include the info if it could be helpful to others, who were advised repeatedly in the book to work with their docs.

Brenda, my MWO partner in crime, didn’t like the smart pills at all, btw - they made her jittery and anxious and she quit taking them shortly after starting. I’ve since learned that’s not unusual.

But for me, holy cow. They made me alert and happy and thin. They knocked my brain back into gear after being turned into toast by Topamax. I no longer drove past my house at the end of the day or used my fingers to add simple math. And the weight, my God. I thought it had dropped quickly with Topa - it seemed to melt in my sleep with these two pills from France that I took every morning. So much so that one of the leading women’s weeklies I’d pitched MWO to agreed to run the story if I focused on my weight loss rather than the alcohol program. I refused and so did they.

Smart drugs, also known as nootropics, are a relatively new class of meds. The two I refer to in the book are adrafinil (Olmifon) and modafinil (Provigil). Adrafinil usually makes its way to the US via online stores and costs about $30 for a 20 day supply. A doctor friend who reads French was pretty impressed after translating the info in the package once it arrived and assured me it was legit. Adrafinil is a central nervous stimulant, but like other eugregorics, it doesn’t behave the same way as conventional stimulants. It has a unique ability to affect specific brain receptors and works only when needed. And boy, did I need it. It’s gentle in its action and helps sharpen mental acuity without affecting heart rate or pressure. It’s not like caffeine or speed, either. In fact, as much as I love coffee, I can’t drink it mid-day or it keeps me up at night. But not this stuff.

While I was taking my two 300 mg. tablets each day, I noted a significant improvement in my short term memory, concentration and energy level. But I was also exercising regularly, which may very well have contributed to my improved state of mind. However, much of this change did seem to coincide with the several weeks I took the adrafinil.

People who use adrafinil and Topamax together and who don’t wish to lose weight have to be careful. Because adrafinil can also act as an anorectic (appetite suppressant). It’s really important when you start this program you nourish your body with a healthy, well rounded diet. Otherwise you can crash and burn.

By the way, adrafinil was first used experimentally by French researchers in the 70’s to treat narcolepsy. They later turned to modafinil because of adrafinil’s potential side effects: feelings of tension, heightened liver enzymes, and stomach pain. Modafinil has recently been approved by the FDA for a number of sleep disorders. Interestingly, it’s also been found helpful for recovering cocaine and speed addicts. Some docs say it improves cognitive function, and I gave it a test drive a while back. I don’t like it as much as the other. In fact, I had sorta the same response to modafinil as Brenda did to adrafinil - it made me feel wired and speedy. But I can sure see why the military uses it to keep their pilots up all night.

If you decide to use adrafinil, be sure to get a baseline liver test before and several weeks after you start taking it. It is known to potentially increase liver enzyme levels, and that’s not good. I didn’t have any problem with it, but remember that your liver’s been on double duty with all the drinking. 

I wouldn’t recommend tinkering with any of this stuff unless you find yourself crippled with a cognitive crisis. And I absolutely wouldn’t do it without the support of a trusted doc - you must make sure your liver is up for the gig. Consider it a short term solution. Eat well, even if you eat less. One of the things they don’t tell you about Topamax is that anorexia is a potential side effect. You don’t need another medication mucking with your head.

So there’s the skinny on the smart pill, once and for all. Please use the info wisely.

Many people tell us they enjoy the hypnotherapy aspect of My Way Out and they ask us for recommend-ations about headphones for their sessions. They’re typically listening to the recordings on an MP3 player or iPod and doing so while reclining in a chair or bed.

There are a number of excellent choices. You’re probably familiar with conventional headphones, so I’m going to cover three you may not have tried but are particularly useful when listening to audio in this setting: 

1) In-the-ear buds
2) Pillow speakers
3) Cordless headphones

In-the-ear buds can provide remarkably high quality sound considering their size. When properly seated, they seal and block out external sounds. Apple ships a bud headphone with their iPod Nano but I have to admit I’ve blown through two sets and have not been impressed with the quality.

However, they also sell a number of other buds, including In-Ears, a $39 version that some customers say are quite good. However, they’ve gotten mixed reviews; people seem to love ‘em or hate ‘em. They come with three bud sizes and a relatively short cord (handy under the sheets), as well as a nice little storage case.

For $30 to $40 you can buy Sony’s MDR-EX71SL Ear Buds. They’re reported to have good sound and adequate fit. But if you’re willing to spend a little more, you may want to consider Shure’s in-ear ‘phones for about $100. They’ll also shield you a bit better from external noise. Excellent if using at night with someone who snores.

By the way, if the buds don’t fit quite right, some people say to put them in upside down and loop the wires over your ears. Heck, no one will notice if you’re using them for hypno - it’s not as if you’re on the subway. One fella claims to have gone to a hearing aid shop to have a custom ear mold made to replace the ear bud’s rubber. Says it works great. Clever, huh? The advantage of in-ears is that they’re comfortable to use in bed. But they’re not a very good choice if you don’t have a quality pair.

Moving on to talking pillows. They didn’t have these when I started out and believe it or not, I fantasized about inventing one a couple years ago. They’re now available from a number of vendors and you can find a variety of them on Amazon. For $24.95 PillowSonic sells the Pillow Speaker which lays over a flat device. No wires, no tangles and it even comes with its own relaxation CD.

There’s also Pillow Talk’s Memory Foam Stereo Pillow for $39.99. It works with both CD players and iPods. Dreamy. Pillow speakers are a natural solution to a relaxing hypnotic experience. You can easily move your head about without any worries about headphone shift.

And finally: wireless headphones. I love mine. They’re made by Macally and have an innocuous name like mTUNE-N but mine have always been “The Muffs”. They cost $35 and are designed specifically for the iPod, which slides into a slot on the outside of one of earphones (see above). I waited quite a while before investing in wireless headphones because I’d read that most of them sounded awful, were uncomfortable, or cost too much.

But I adore my Muffs. I know I look like a dork wearing them, but I really don’t care. As I wrote earlier, my teenagers wouldn’t be caught dead in them. In fact, they clear out when I put them on, that’s how ugly they are. But what they lack in kewl they make up for in functionality. They don’t need batteries so they never run out. They have no wires, so they never get tangled. They fit so securely, they never fall off. Technology at its finest, that’s what I think.

Whatever you decide, do consider investing in a decent pair of headphones if you can. You’ll probably use them when you exercise, too, and it can make listening to music much more enjoyable. You shouldn’t have to pay too much, either, as there’s a lot of competition out there for your business!

One of the most common topics we hear about on our message board has to do with making the adjustment to all those hours - typically evening  - no longer drinking. People are downright bored. And perplexed. They often don’t understand why they continue to have a powerful desire to engage in a behavior for which they’ve lost the physical craving. Because unfortunately, if not addressed, the psychological yearning remains. This is conditioning that resulted after many years of practice, after all. It takes some time to get past it. That’s why hypnotherapy, counseling, and support can be very useful.

The findings aren’t new but they are important and were published by Duke University a few years ago. In a clinical setting Duke demonstrated that 30 minutes of moderate exercise (e.g. brisk walking) three times a week was just as effective as drug therapy in relieving symptoms of depression.

Researchers studied 156 elderly patients diagnosed with major depressive disorder. They were assigned to three groups: exercise, medication, or a combination of medication and exercise. To the researchers’ surprise, after 16 weeks all three groups showed significant and similar improvement in measurements of depression. They noted some patients who took the anti-depressants saw their symptoms alleviated sooner but by the 16th week, the group differences had disappeared

A follow up study six months later indicated that patients who continued to exercise had statistically significant improvement relative to those who took anti-depression medication or who took medication and exercised.

“One of the conclusions we can draw from this is that exercise may be just as effective as medication and may be a better alternative for certain patients,” said the lead researcher, Duke psychologist James Blumenthal.

And in response to the follow-up study Blumenthal said “the effectiveness of exercise seems to persist over time, and patients who respond well to exercise and maintain their exercise have a much smaller risk of relapsing.”

“Relapse,” of course, means a couple of things to us. I figure we should do anything we can to prevent it. Those of you who’ve read My Way Out know that moderate exercise is recommended three times a week. And those of you who do it already know it helps.

Give it a try if you haven’t. A brisk walk (approved by your doc) is all it takes.

Amino acids play a critical role in craving reduction. They make up the essential building blocks of neurotransmitters and tell our brains whether or not we’re satisfied. Since their adoption in the mid 80’s, thousands of people have benefited from their use. We’re now witnessing a huge resurgence of interest in amino acid therapy.

We’ve recommended a number of blended and specific amino acids as part of the My Way Out program and I’ve recently developed a special interest in 5-HTP, or 5-hydroxytryptophan. It’s a compound created in the body and used to regulate serotonin levels in the brain. It’s believed to be quite effective in regulating mood, treating anxiety and helping facilitate weight loss. Many people coming off alcohol complain of sleep disturbances and irritability, so find it helpful.

We’ve recently made 5-HTP available in our Health Store thanks to our partner at NOW FOODS. We’ve included a link with more info about the supplement courtesty of Wikipedia, the infamous online collaborative encyclopedia.

Less objective but equally interesting are a number of quick blog entries below with general info that I found while googling today. I decided to take this rather unscientific approach after receiving a number of reports within a relatively short time from people (both doctors and patients, interestingly) extolling its benefits for a variety of conditions.

Anecdotal? Yup.  Junk science? I don’t think so:

I have a sex drive, I have energy, I don’t have back pain anymore, I feel good when I wake up…

I have noticed that I do sleep better. I would say even better than when I was on vacation…

Tryptophan (5HTP) is wonderful. I started taking it a week ago. It helps my sleeping (when I let it) and I’m hoping it helps me lose some weight…

As far as the anxiety goes, I take 5-HTP that I get from my holistic Dr. and I haven’t had any anxiety problems since…

I use HTP-5 50mg. twice daily, it a precursor of serotonin, bought over the counter, and 300mg. wellbutrin. I have noticed a significant decrease in my cravings, in fact sweets make me nauseated…

(Please remember it’s important to let your doc know if you’re prescribed any meds before you start taking HTP-5. It is contraindicated when used with with some anti-depressants, herbals or other medications.) 

From US News and World Report

By Katherine Hobson

A wave of new drugs targeting addiction offers hope to people battlling the habit

Read it here

A new member to our message board posted a question about how to approach the doctor now that s/he’s ready to seek help. “Am unsure what to expect,” says C, “are they generally sympathetic?”

It’s a valid question and significant concern for those who finally decide to take that first step. No matter what we say about treating alcohol dependence without stigma or shame, the thought of sharing this most painful secret is often terrifying. It’s why so many drinkers work around their doctor, buy anti-craving meds online and undergo a self-help program with only themselves available for help. They’ve heard about patients shunned by providers, unwilling to assist. “Go to a meeting,” they’re told. Thing is, if they wanted to attend a 12-step program or simply abstain from alcohol they’d have done it by now.

But it doesn’t have to be that way - and shouldn’t. C’s thoughtful questions about what to expect and how to prepare for that visit are often the beginning of a successful health partnership.

Here are some guidelines to help promote a positive experience:

* Identify which of your current doctors are most willing to consider an alternative treatment proposed by you. For example, some patients tell us they are able to work most effectively with their Ob-Gyn because of the long-term, trusting relationship already established.

 * Consult a DO, or Doctor of Osteopathy. These fully licensed physicians often embrace a more holistic approach to healing than traditional MDs.

* Many patients have reported success with a mental health practitioner. Doctors of psychiatry are usually more familiar with anti-craving medications or new treatment strategies than their counterparts. Their medical training requires specialization in the prevention, diagnosis, and treatment of addictive disorders.

* If you feel more comfortable with a new physician, look for an addiction specialists in your local Yellow Pages or search online. Look into one of the web based resources such as 4therapy.com, the US Substance Abuse Locator, or - if your goal is controlled drinking - Moderation Management. Instructions on how to use these resources are located in our online community’s FAQ.

* Prepare your doc! Download the May 2003 Lancet study if you’re interested in using Topamax. Print out information (for providers, not consumers) from Vivitrol and Campral’s website. If you plan to follow the My Way Out program, print out the articles from Newsweek Magazine, Wall Street Journal, and wired.com in which it is featured. Bundle the info together in an envelope and drop it off at your doctor’s office at least one week prior to your visit. Include a note on the outside stating your doctor wishes to read the material before your appointment.

* Become knowledgeable about tests you may be administered to assess your drinking problem. Popular screening surveys include:

The Cage Questionnaire in which a “yes” response to two of the four questions indicates a problem:

C: Have you ever felt you needed to CUT DOWN on your drinking?
A: Have people ANNOYED you by criticizing your drinking?
G: Have you ever felt GUILTY about drinking?
E: Have you ever felt you needed a drink first thing in the morning (EYE OPENER) to steady your nerves or to get rid of a hangover?

(Our medical director, Dr. Linda Garcia, MD, also asks patients if they’ve received a DUI.)

The Short Alcohol Dependence Data (SADD) Questionnaire, a more sensitive diagnostic test than CAGE, which is available online here. It helps doctors distinguish between early alcohol dependence and heavy alcohol use.

The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. It has been validated by several countries and is recognized internationally. You’ll find it here.

The Michigan Alcohol Screening Test (MAST), a tool used widely by courts to determine sentencing for those convicted of driving under the influence or other alcohol related offenses. It’s available online, as well.

A number of other survey instruments are listed by the National Institute on Alcohol Abuse and Alcoholism here.

* Understand and prepare for your medical exam, which may include:

• A physical examination in which the doctor palpates or taps various parts of your body and listens to sounds your body produces. Vital signs such as blood pressure, heart rate, respiratory rate, and temperature will probably be taken.
• A complete health assessment including information about your general and mental health, lifestyle, alcohol use, and family history of alcohol use and/or problems
• A gamma-glutamyltransferase (GGT) blood chemistry test to evaluate liver function. Your blood may screened for anemia and electrolyte disturbances, such as low potassium, magnesium and calcium levels.
• A carbohydrate deficient transferrin (CDT), a blood test some physicians feel is more sensitive than a GGT in identifying and monitoring problem drinkers
• Signs of medical complications due to alcohol consumption, such as abdominal pain, heart problems, alcohol withdrawal or cirrhosis. Additional test may be ordered.
• A referral for individual counseling to be undertaken in conjunction with therapy
• A short-term prescription for a benzodiazepine such as Valium or Ativan to help manage alcohol withdrawal symptoms, if necessary. The physician should first screen for the presence of other medications to avoid interactions such as over-sedation

* When you meet with your doctor, be as truthful as you can about your alcohol consumption and medical history. Don’t withhold any information about medications you’re taking. If you are uncomfortable with what may appear on your chart, first ask your physician if you may talk off the record, but don’t consider it a guarantee that information won’t be noted.

* Assure the physician you’re committed to tackling your alcohol dependence within the context of a comprehensive program and you understand you will not be “cured” by a pill. Let him/her know that you intend to follow up. And do so.

* Tell your doctor about your plans to proactively seek support, whether at local 12-step meetings or an Internet-based forum. Point him/her to the MWO website if you plan to follow this program. Leave a copy of the book, or email us at provider@mywayout.org ahead of time and we’ll provide a complimentary copy.

* Ask questions. Prepare them ahead of time and refer to them at the end of your exam to make sure everything has been answered sufficiently

* If the physician refuses to honor your request for medication or medical services, insist on a referral to someone s/he believes will help you. Be vigilant and honest about your desire to find a provider. Let him/her know you plan to move forward regardless and that if you leave the visit without support your choices about how to proceed will be limited. It it the physician’s responsibility to help you–do not forget this!

* Do not be aggressive, but do not be meek. Remember that this change will benefit your health, your family, your relationships, your future. Prepare yourself mentally for this appointment beforehand. Meditate on it. “Visualize” your confidence and presentation and see yourself leaving the clinic with whatever it is you need to succeed.

We often don’t hear from the many patients who quietly seek help and leave their doctors’ offices filled with a renewed sense of hope and joy. It happens every day and it can happen for you. If not, you must simply resolve to keep trying until you get the help you need for this serious and progressive condition.

You’ve made the decision to get help, so don’t let anything - or anyone - get in your way. You’ve lived with this problem long enough.

It’s time to get better.

It’s Friday…may as well lighten up.

I’d decided earlier not to weigh in on the Mark Foley scandal. It’s been overblogged this week as far as I’m concerned. Everyone seems to have an opinion as to whether or not Foley is a closet drinker and how he’s using it to explain his deplorable behavior.

So I defer instead to the late night comics:

“Earlier in the week, (ex-Rep. Mark) Foley checked himself into rehab. But according to the New York Times, many people question his alcoholism claim. That’s when you know things are bad in Washington. When a congressman can’t even be trusted to be a drunk.”
- Jay Leno

“Actually, this scandal with Foley has finally led to some bipartisan cooperation in Congress. For example, Republican leaders had to meet with Ted Kennedy to find out what’s the best rehab center.”
- Jay Leno

“Alcohol is an amazing thing. It turns completely normal politicians into perverts and completely normal actors into anti-Semites.”
-Jimmy Kimmel

 ”The ex-congressman, if nothing else, is contrite. He says when he gets out of rehab, he wants a fresh start and to turn over a new page.”
-David Letterman

Funniest of all is Stephen Colbert. You can watch recent segments at YouTube. Be sure to check out both Part One and Two of his take on the scandal. As always, he’s hilarious.

We seemed to be getting closer to a less pricey alternative to this effective and expensive anti-craving medication. But that may change, according to today’s Reuters article “J&J seeks to halt possible generic Topamax launch.”

More here…