Medication Helps Alcoholics Control Drinking
Laura Kennedy, Contributing Writer
Health Behavior News Service

A little-known drug called Naltrexone provides a “meaningful benefit” in helping alcoholics moderate their drinking, according to the latest review of evidence from 29 studies on four continents.

The findings, along with the recent FDA approval of a similar drug called acamprosate, open the door to new treatment options for drinkers who aren’t yet ready to face total abstinence.

Naltrexone, which is not addictive, “should be accepted as a short-term treatment for alcoholism,” say authors Dr. Manit Srisurapanont and Dr. Ngamwong Jarusuraisin of Thailand’s Chiang Mai University. Almost all of the studies tested naltrexone, or NTX, in combination with psychosocial treatments such as counseling or self-help groups, and the authors recommend using this approach in everyday practice.

The review’s conclusions are based on “high-quality evidence” that naltrexone reduces by 36 percent the risk of an alcoholic relapsing to heavy drinking in the first three months of recovery. “Short-term treatment of NTX for alcoholism gives a meaningful benefit in preventing a relapse,” the review said, citing an 18 percent lower likelihood that patients will abandon their treatment program.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Dr. Joseph Volpicelli, of the University of Pennsylvania School of Medicine, has been conducting research on naltrexone use for alcohol dependence since the early 1980s. Naltrexone blocks the brain’s receptors for natural painkillers, known as opioids, which normally create the feeling of wellbeing associated with drinking.

He explains that the benefits of naltrexone lie not so much in preventing a patient from having one drink, but rather in breaking the cycle where one drink leads to many more. “Naltrexone helps people have more control over the use of alcohol. For me, that’s the fundamental issue of what addiction is: impaired control.”

However, this approach requires a substantial change from the abstinence-only philosophy that goes back at least as far as Prohibition. Naltrexone is most effective, says Volpicelli, in a treatment program “designed to support the notion that while one drink is not great, what you really want to stop is excessive drinking.”

While few professionals advise people with alcoholism to abandon the ultimate goal of total abstinence, Volpicelli argues that about 20 million Americans suffer from alcohol abuse disorders, yet only about 2 million are in any kind of treatment program. “We should be flexible enough to get at that 90 percent of people who aren’t in treatment,” he says.

The U.S. Substance Abuse and Mental Health Services Administration agrees in its naltrexone treatment protocol, saying, “Abstinence should be a desired goal for the patient; however, reductions in drinking may be an acceptable intermediate outcome … because there are many other areas of a patient’s life that can improve, such as job performance, social relationships, and general physical health.”

Although naltrexone (ReVia) has been available for more than 10 years, Volpicelli says it has been poorly marketed, and most patients and primary care doctors remain unaware of its potential. That may change now that the manufacturer of acamprosate (Campral) has embarked on a campaign to promote pharmacological treatment of alcohol addiction.

Review author Srisurapanont notes that the availability of both medicines now gives patients an alternative if one is not effective for them. And, he adds, the possible benefits of using the medications in combination should be studied. The review also notes that other areas ripe for future study include the possible benefit of continuing naltrexone treatment beyond the first three months of recovery and strategies to further increase treatment completion.

Volpicelli believes psychiatry is on the brink of recognizing a new standard of care for alcohol abuse disorders: allowing patients to choose from a variety of treatments, which may or many not focus on total abstinence. It is, he believes, a time of great hope. To those who suffer with alcoholism, he says, “Be aware of all the options available and find the best one for you. See someone, stay in treatment, and over time you’re going to get better.”

1. Srisurapanont M, Jarusuraisin N. Opioid Antagonists for Alcohol Dependence (Review). The Cochrane Database of Systematic Reviews 2005, Issue 1

Finding Effective Treatment for Alcohol Dependence
By Lloyd Vacovsky
Executive Director, American Council on Alcoholism
and Director of Assisted Recovery Centers of America

Finding effective treatment for alcoholism is a daunting task faced by alcohol dependent individuals and their loved ones. Adding to the confusion is the fact that treatment for alcohol dependence is currently a very controversial subject. For example, the debate continues as to whether or not alcoholism is a “disease”, and what is the most appropriate treatment. Individuals seeking treatment are confronted with the reality that outside of the traditional 12 Step or Minnesota Model programs, there are few alternatives currently available. Human beings are a diverse group of creatures, with unique needs, especially in terms of treatment for alcohol dependence and substance abuse. In general there are three basic camps or treatment approaches.

The approach embraced by the vast majority of treatment providers is the Minnesota Model. This is your basic12-Step type of program and was developed at the Hazeldon Institute in Minnesota. This model accepts alcoholism as a disease, but defines the disease as being spiritual in nature. It relies heavily on establishing (or re-establishing) spiritual values and reaching an accommodation with a “higher power”. The primary treatment tool is the group meeting. It must be noted that Alcoholics Anonymous does not consider itself a “treatment program”, but rather a group of individuals bound together by a common issue, alcohol dependence. The vast majority of treatment programs incorporate the 12-Steps as an integral part of their treatment.

The second approach to treatment regards alcoholism as a “learned behavior” rather than as a disease. As such, the focus of treatment utilizes what is known as cognitive restructuring, or cognitive behavioral therapy. Simply stated this means assisting the alcohol dependent individual to assess the various components of their life, and to work on those behaviors, which have been impacted by alcohol consumption. This is the approach often utilized by independent treatment professionals and is usually provided in a more intimate one on one setting. Albert Ellis of the Ellis Institute of New York City is widely considered the founding father of cognitive behavioral therapy.

Finally, there are those who point to the increasing body of evidence that indicates that alcoholism is indeed a disease, albeit a very complicated disease with distinct Biological, Psychological and Social components.
This group believes that treatment should be more broad-based and include such new developments as pharmacotherapy. They embrace the use of effective medications, for example Naltrexone as an important component of the treatment processes. The use of medications addresses the Biological component of the recovery process. In addition, it relies heavily upon counseling that utilizes Cognitive Behavioral Therapy to address the Psychological and Social components of recovery. This position is becoming known as the Pennsylvania Model of Recovery. The Pennsylvania Model does not require a spiritual epiphany or the acceptance of a Higher Power for recovery.

Pennsylvania Model protocols are largely based on the research and work of the University of Pennsylvania School of Medicine, Treatment Research Center, in Philadelphia, and in particular Dr. Joseph R.Volpicelli, M.D., Ph.D., also of the University of Pennsylvania. These protocols fully integrate pharmacological and psychosocial support in the recovery process. This type of integrated program is distinguished from other protocols, which generally reject the use of pharmacological agents as an aid in the recovery process.

The Pennsylvania Model is a medical model, in which a full range of empirically tested treatment options are offered to individuals who are dependent upon alcohol. The University of Pennsylvania has a 20-year history of clinical studies, which has led to the development of these protocols. The medical and scientific community has recognized the research of the University of Pennsylvania for developing important advances in the treatment of alcohol and drug dependence. For example, the University pioneered the use of the pharmacological agent Naltrexone HCI, which suppresses the craving to consume alcohol or opiates, and dramatically reduces relapse. (Archives of General Psychiatry, 49:876-880, 1992 Volpicelli etc.)

The vast majority of treatment providers in the United States incorporate the protocols of the Minnesota Model, which again has as its cornerstone the acceptance of a higher power before recovery can be achieved. This is the model that has been used to train treatment professionals for decades. As a result, the Minnesota Model has been accepted almost without question as the only effective treatment option. It is a very rigid method that does not allow individuals to stray far from established procedures. For example, individuals must work each of the twelve steps in order, and secure a “sponsor” or advisor. The utilization of any treatment technique, other than what is proscribed in the Big Book of AA is frowned upon.

While the use of medications is not specifically discouraged, neither is it encouraged. For many years, even the use of Physician prescribed anti-depressants was actively discouraged by most well meaning AA groups. The bias against the use of any medication that alters mood or the need to consume alcohol is clearly part of the AA mantra. This is largely due to the fact that many medications (especially psychotropic medications) are not understood by the general public, and in turn, by members of the AA community. As a result, this continuing bias against the use of appropriate medications has resulted in disastrous consequences for countless individuals.

While this bias against the use of safe, effective medications to assist in the recovery process has dramatically reduced their utilization. The primary culprit appears to be the lack of understanding among treatment professionals and physicians, as to the proper use of approved medications. The majority have very little experience with pharmacotherapy for the treatment of alcohol dependence. While many are generally receptive to the concept of pharmacotherapy, most have never heard of the most promising medication for the treatment of alcohol dependence, Naltrexone, ten years after its approval by the United States Food & Drug Administration.

The FDA first approved naltrexone in 1984 under the brand name Trexan for the treatment of opiate abuse. In 1994, the FDA extended its use to include alcohol dependence and was marketed by DuPont Pharma under the brand name ReVia. Since December 1997, it has been available as a generic.

While there was some initial enthusiasm for Naltrexone, most treatment providers became easily discouraged, because it did not produce immediate and positive results for all their patients. At best they reported “spotty” results. The Naltrexone seemed to work well with one individual, while being seemingly ineffective with another. We now believe that many individuals received inadequate dosage and inappropriate time of dosage, for their unique metabolism and life patterns, and in turn reported the medication ineffective. There are numerous additional factors affecting the effectiveness of Naltrexone, for example age and gender. In addition, the presence of pre-existing conditions such as clinical depression probably must be addressed with appropriate anti-depression medication. Other factors include social, relationship, legal, and employment issues, which can all directly impact the recovery process. Cognitive behavioral therapy has been shown to be very effective in helping individuals to address the numerous, recovery complex issues that they face.

Mental health professionals have long understood the need to adjust the dosage of medications prescribed for their patients. Each individual is unique, and reacts to medications uniquely. Alcohol treatment professionals who utilized Naltrexone rarely ventured outside of the Physicians Desk Reference’s (PDR) recommended guidelines. For example the PDR recommends that Naltrexone be taken in the morning. The thought behind this recommendation was that it would improve medication compliance by getting an individual in the habit of taking the Naltrexone first thing each morning. The reality is that very few people drink first thing in the morning. They need the full effect of the medication much later in the afternoon as the thought process turns to going home and “relaxing” with “a” drink.

It is increasingly clear that issues such as dosage and length of treatment can vary greatly from individual to individual, and what may be appropriate for a man, is not necessarily so for a woman. A recent article published in THE SCIENTIST 16(6): 29: March 18, 2002 entitled THE INEQUALITY OF DRUG METABOLISM describes how the same medication and dosage often have different outcomes for men and women. Our experience has shown that a 50 mg dose of Naltrexone, when combined with therapy is usually effective for older males (40 and over), and usually ineffective, even with therapy for older females (40 and over). We have found that the most effective dose for most females is a minimum of 100 mg per day or even higher. It is interesting to note that much of the initial research on Naltrexone was conducted at Veterans Administration facilities, whose subjects were mostly older males.

What most treatment professionals do not seem to comprehend is that Naltrexone is an extremely effective tool, when appropriately utilized, and that it is not a cure. The purpose of Naltrexone is to suppress the intense craving to consume alcohol, generated by alcohol compromised brain chemistry. It is not meant to solve, for example, the legal or relationship issues which are often the result of alcohol induced behavior.

The fact of the matter is that Naltrexone will dramatically affect alcohol consumption. In effect, it forces individuals to face life, on life’s terms. It forces them to deal with the consequences of their actions. Indeed, the most difficult aspect of recovery is learning how to be happy without alcohol. Most alcohol dependent individuals are not well equipped to make the successful transition to sobriety. Even though the actual physical craving to consume alcohol has been suppressed by the Naltrexone, the need to return to drinking often overwhelms them. They have become dependent upon the alcohol to deal with all their problems. Unless they start to successfully address these problems, they will almost certainly begin drinking again. When this occurs, it is simple to blame the Naltrexone for “not working”. Naltrexone does not replace treatment or counseling. Its primary purpose is to create an environment in which an alcohol dependent individual is able to begin to make progress in his or her recovery.

When a human being consumes alcohol, it sets off a chemical chain reaction within the brain that results in the release of a group of chemicals, most notably, endorphins. Endorphins assist people in dealing with stress, anxiety, self-esteem and so forth. When consumed, alcohol travels through the stomach wall into the blood system, which transports it to the brain. There, it attaches to opioid receptor sites. (Receptor sites in the brain can be compared to a message center, which receive and forward commands in response to stimuli.) The stimulated opioid receptor immediately sends a command to the opioid endogenous system located within the pleasure center of the brain, releasing a cascade of endorphins into the system. It is the release of the endorphins that generates the euphoria or sense of well being associated with alcohol consumption.

Current research also points to a genetic link, which can predispose an individual to becoming alcohol dependent. One theory is that most individuals whom become alcohol dependent have a low threshold for the release of endorphins as stimulated by alcohol consumption. When an individual with this predisposition consumes alcohol, they experience an intense feeling of euphoria that the “social drinker” does not. As an individual continues to drink alcohol over a long period of time, the brain acclimates to the artificial stimulation of the alcohol. It is thought that in this process the brain slows down, or actually shuts down the normal production and release of endorphins. At this point the individual crosses the proverbial Rubicon, or the point of no return, when their brain becomes dependent upon alcohol to feel emotionally normal or well. It should be noted that alcohol dependent individuals at this stage are not drinking to feel good, but rather so that they do not feel bad.

Historically, when an individual slipped or relapsed, the blame was placed squarely on the shoulder of that individual. It is clear that treatment providers must now also begin to accept some of the “blame”. Treatment should include the latest scientific advances and should be tailored to the individual’s unique requirements. Reliance on outdated and ineffective treatment methods has created an environment that fully expects individuals to fail, and fail again until such time that rock bottom has been reached. It is often said that once an individual has reached rock bottom that there is only one way to go, UP. The problem with that philosophy is that for many people, the ultimate rock bottom is death.

Many, (if not indeed most) alcohol dependent individuals have lost faith in themselves, and more importantly hope for the future. It is common for such individuals to have numerous attempts at sobriety, most often using 12-Step methods. They have been programmed to accept themselves as hopeless and powerless, with their chance for recovery being slim to none. It is important to recognize that alcohol dependent individuals do have control over their lives and that there is appropriate help for them to be found in the treatment community. It is up to the individual to determine what is the most appropriate treatment. It is up to the treatment community to provide options that set up individuals to succeed, rather than be expected to fail.

New Medications Help Addicts Battle
Drugs and Alcohol
By DEBORAH L. SHELTON
Of the Post-Dispatch
07/31/2005

At his lowest point, Steve Duffie was popping pills and shooting heroin up to 10 times a day. Then he started taking a drug to stop.

Since February, he has been traveling three times a week from his home in Arnold to south St. Louis, where a staff person at Assisted Recovery Centers of America watches him swallow pills containing naltrexone.

"I feel a lot better," said Duffie, 24, who has stayed drug-free. "I feel better about myself and the life I'm living now."

Naltrexone has been around for 20 years, but few people know about it.

Experts say a major shift in thinking about how alcohol and drugs affect the brain is producing more and better medications to treat addiction to drugs and alcohol.

"Based upon an accumulation of research findings, our ideas about what alcohol dependence is, when it starts and how to treat it are changing rapidly," Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism told a recent American Medical Association briefing. "New tools are becoming available, and treatment outcomes, while perhaps better than most people think, are likely to significantly improve in the next decade if we can get these treatments to the people who need them."

Research into medications to treat addiction has taken off.

Twelve years ago, the federal government was funding just a half-dozen clinical trials of drugs for alcoholism, and no pharmaceutical company was conducting research. Today, the government is financing studies of 51 drugs, and nine companies are doing clinical trials.

Like antidepressant medication, some of the newer drugs are designed to repair chemical unbalances and abnormalities in the brain that occur as a result of chronic drug abuse, Willenbring said.

Promising medications include brand-new drugs and those already approved for other purposes. Among them:

Topiramate - approved to treat epilepsy - for alcoholism and cocaine addiction.

Baclofen - approved for muscle tightness, cramping and spasms - for alcoholism.

Ondansetron -to treat nausea and vomiting - for alcoholism.

Nalmefene - approved in 1994 for alcoholism - is being developed as a six-month implant for both alcoholism and opiate addiction.

Federal health officials held a forum Friday at St. Louis University, part of a four-city stop, to raise awareness among doctors and the public about one medication, buprenorphine. Marketed under the trade names Suboxone and Subutex, it went on the market in 2003 to treat heroin, prescription painkiller and other opiate addictions.

Like naltrexone, it can be prescribed by physicians in private practice, so "hopefully it will allow addiction treatment to be incorporated into mainstream medical practice," said Nick Reuter, senior public health advisor at the U.S. Substance Abuse and Mental Health Services Administration.

Finding new medications for alcoholism has been challenging because different regions of the brain are involved. That complexity also "opens up many strategies for treatment," said Dr. Raye Litten, associate director of the division of clinical and recovery research at National Institute on Alcohol Abuse and Alcoholism.

Naltrexone was approved by the FDA in 1984 to treat opiate addiction, and in 1994 to treat alcoholism. It also is being studied for use in combination with acamprosate, the latest anti-addiction drug to gain FDA clearance. Sold under the trade name Campral, acamprosate went on the market in January.

An injectable form of naltrexone, Vivitrex, is currently undergoing review by the FDA as a monthly shot.

Down the road, people might take two or three medications that act on specific parts of the brain, experts say. The drug combinations would work much like those designed for people with AIDS, cancer, diabetes, depression, heart disease and high blood pressure.

"Just getting them out on the market would give patients a menu of medications to choose from," Litten said. "Like antidepressants, if one doesn't work, you could try another one."

Researchers are learning that many alcoholics and drug addicts need ongoing or intermittent care much like people with other chronic conditions. "Treatment should not be a one-time thing," said Willenbring, a psychiatrist who directs the division of treatment and recovery research at the federal health agency.

Treatment professionals caution that a commitment to abstinence is essential.

"You can't put this into somebody's coffee every day and expect them to be transformed," said Barbara Mason, a consultant to Forest Laboratories Inc., the company that makes Campral. "It's another tool in the toolbox of recovery."

Yet, for all the excitement about pharmaceutical treatments, naltrexone and acamprosate are largely going unused.

Taking away the high

Only about 5 percent of people dependent on alcohol have ever been prescribed medication, Willenbring said.

Fewer than 3 percent of the nation's 1.1 million opiate addicts have tried naltrexone, even though it's been around for 20 years.

The reasons vary - from low awareness of the medications to lack of drug coverage and a bias against taking a drug to beat an addiction.

"Most people think addicts just need to learn how to change their behavior," said Dr. David Gastfriend, an associate professor of psychiatry at Harvard Medical School. "That's like fighting this disease with one hand tied behind your back."

Naltrexone works by occupying the opiate receptors in the brain. As a result, the feel-good chemicals triggered by alcohol and opiate drugs are blocked, eliminating the high. The brain chemicals are endorphin, dopamine, serotonin and gamma-amino butyric acid, or GABA. The active ingredient of naltrexone is made in St. Louis by Tyco Healthcare/Mallinckrodt, the biggest U.S. manufacturer of the drug.

Studies have found that people who are genetically predisposed to addiction have lower levels of endorphin in their brains but experience an excessive release of the chemicals when they drink or do drugs, well beyond what the average person experiences. Repeated heavy drinkers and drug users build up a tolerance and require more and more to get high.

Eventually, alcohol or drugs are taken to relieve the unpleasant effects of not using, such as irritability, anxiety and craving. "You're drinking to feel normal," said Barbara Mason, co-director of the Pearson Center for Alcoholism and Addiction Research at the Scripps Research Institute in California.

Since naltrexone blocks the release of endorphins, if an alcoholic drinks, speech might become slurred or walking might get wobbly, but there's no buzz. If the person relapses on the medication, he or she is more likely to stop after two or three drinks because the reward of feeling good has been taken away.

After using naltrexone for several months, some alcoholics are able to abstain from alcohol forever. Some treatment professionals describe the drug as a "chemical chastity belt."

Acute withdrawal from alcohol and drugs can last up to seven days. Alcoholics and addicts typically go through a protracted withdrawal that lasts up to 30 weeks, which can include overwhelming feelings of craving, said Percy Menzies, a pharmacist who is president of Assisted Recovery Centers of America.

Naltrexone acts like a "helmet on the brain that protects you if you fall," Menzies said.

No magic bullets

About 22 million people abuse or are addicted to drugs, according to government statistics. That figure includes alcohol and prescription drugs.

"We have a serious drug abuse problem in this country, including with alcohol, even if we don't recognize it," said Dan Duncan, director of community services at the National Council on Alcoholism and Drug Abuse, St. Louis area. "We have a lot of stereotyping going on, people want to think it's an inner-city problem. That's not true. Go to West County. They're doing drugs and have the means and resources to buy whatever they want. It costs all of us and we're affected directly or indirectly by this problem."

Alcoholism is a disease of behavior, spirit and the brain, Mason said. "There are therapies that deal with each aspect of the disease. AA is a spiritually-based fellowship. There are alcohol-specific types of counseling. But the brain has been largely ignored in recovery. Campral is the very first drug that addresses the underlying brain aspect of the disease and helps to restore that piece to normal."

Naltrexone doesn't repair anything in the brain, it keeps people from getting high and eases withdrawal. Campral, or acamprosate, works differently.

Alcohol overstimulates the glutamate system, causing it to react like a car that's idling too fast, Mason said. The abnormality can continue as long as a year after the last drink in some alcoholics. Acamprosate regulates the chemical activity in the glutamate region.

Campral is shipped to pharmacies across the country from Forest Laboratories' national distribution center in St. Louis.

Other drugs used to treat addiction are methadone and disulfiram. Methadone is an opiate given in small doses to prevent the effects of withdrawal from drugs such as heroin. The narcotic is designed to block the high and reduce craving. Disulfiram, which is sold under the trade name Antabuse, has been used to treat alcoholism since 1949. Drinking while on the drug makes a person violently ill with nausea, vomiting, heart palpitations and other symptoms.

The aim of researchers is to design newer drugs that don't make people sick and are not habit-forming or mood-altering. The side-effects of naltrexone and acamprosate are generally mild, if any. They are not addictive and don't produce a high. The drugs usually are prescribed from three months to a year.

Research on naltrexone, disulfiram and acamprosate is uncovering other benefits.

It appears that disulfiram helps cocaine addicts. People with a family history of alcoholism appear to do better on naltrexone. And while acamprosate doesn't appear to have a gender effect, one study on the naltrexone monthly shot reported that it seemed to work better in men.

Counseling is critical

Jim Selby keeps a bottle of naltrexone on the kitchen counter as an insurance policy.

A leg injury led to his five-year prescription drug habit. "Before I knew it I was taking it all the time," said Selby, 47, of south St. Louis County. "That's the way I was getting by. They had complete control over my life."

He credits his turnaround to his mother, Patricia Selby, who worked many years for the Al-Anon Information Center in St. Louis. She directed him to Assisted Recovery Centers of America. He has been drug-free for two years.

Menzies often keeps the pills of patients who haven't been abstinent as long as Selby at his clinic so he can monitor whether they are taking them. Patients are advised to attend frequent group therapy sessions and to phone regularly.

"The more contact, the better the outcome," Menzies said.

Dr. Robert Swift is a professor of psychiatry and human behavior at Brown University. "The medications that we have are effective but not as effective as we would like them to be," he said. "Not all people are helped, and the cure rate is not 100 percent. These medications need to be used in the context of counseling and psychosocial treatment."

Addiction impairs motivation, so getting people to take their pills every day can be a formidable task, said Gastfriend, who's vice president of medical affairs at Alkermes Inc., the company seeking approval of the monthly shot.

Vivitrex could make it easier to stay on the medication.

"By extending the action for 30 days, if they come in one day for medication, they don't have to be motivated to come in the other 29 days," Gastfriend said.

Buprenorphine is used as a replacement drug for heroin, painkillers and other opiates. Subutex is the pure form. Suboxone is a combination tablet of buprenorphine and naloxone. Naloxone was added to prevent addicts from grinding and injecting the tablets to get high.

The benefit of buprenorphine is that it may be easier to quit than street drugs or prescription medicines.

In a phone interview, Dr. Clifford Bernstein, a Beverly Hills addiction specialist, says he has seen an increase in the number of people who've become addicted to it. An informational booklet from the manufacturer warns that patients can become physically dependent.

"Patients need to be educated that it's a replacement therapy which is half opiate in composition," Bernstein said.

But at the St. Louis University forum, Theodore Cicero said research at Washington University suggests that buprenorphine is a safe alternative that has less potential for abuse than opiates. Cicero is vice chancellor for research at the university.

Steve Duffie was prescribed Suboxone for two weeks. Then he was switched to naltrexone. His mother, Cathy Duffie, is convinced he would have died without the medications.

"It's amazing what addiction can do to you," she said, glancing at the son she never gave up on. "It's a horrible life."