Harm-reduction approach to alcoholism gains growing credibility

Alcohol use disorders are clinical diagnoses based on a loss of control over alcohol consumption despite adverse consequences. Remission occurs when an individual exerts control over his or her drinking behavior. Abstinence is the safest option, but, paraphrasing Voltaire, the perfect should not be the enemy of the good.

It has long been known that people with a diagnosis of alcohol dependence can moderate their drinking, and that such reductions in consumption reduce end-organ damage and other adverse health consequences. So, it makes complete sense that the opioid antagonists naltrexone or nalmefene that reduce alcohol’s euphoric reward and help alcoholic patients regain control over their drinking should be welcome additions to the pharmacopoeia.

Medicine has long accepted disease-modifying therapies as organ- and lifesaving for other disorders – gold salts and methotrexate for rheumatoid arthritis come to mind. Such remittive agents reduce disease activity without an insistence on complete, total, and lasting cure.

These medications are called effective treatment, and are not burdened by the apologist moniker of “harm reduction.” Effective remittive therapies for alcohol dependence such as naltrexone and nalmefene should not be viewed any differently.

Peter D. Friedmann, M.D., M.P.H., is professor of medicine and professor of health services, policy, and practice at Brown University, Providence, R.I. He has received research support from Alkermes and a speaker’s honorarium from Orexo.