The link between addiction and mental health disorders may be firmly established in scientific circles, but treatments designed to address them together are uncommon.
Some University of Maryland researchers may be taking a promising step to tackle two such intractable, but often related conditions: alcoholism and post-traumatic stress disorder.
Dr. Bankole Johnson, an addiction and brain science expert and professor of psychiatry in the University of Maryland School of Medicine, is leading a team launching a five-year study of the effectiveness of a drug called pregablin for treating alcoholism and PTSD together.
Known commercially as Lyrica, pregablin is now used to treat epileptic seizures, nerve pain and anxiety. Past studies also suggested it helps treat alcoholism, but that use has not been approved by the U.S. Food and Drug Administration.
"There is a lot of suffering among people with PTSD and people with alcoholism, and they are at extreme risk for harming themselves," Johnson said. "So this could be particularly important for treatment."
Johnson said doctors use drugs to treat anxiety or to detox a patient, but there is little research into what works for both. Researchers are recruiting people in Baltimore who served in combat roles in the military or were victims of domestic abuse, for example, and turned to alcohol, perhaps to "self-medicate."
Johnson said pregablin is promising because it modulates over-active neurotransmitters, or chemical signals, from nerve cells that control the drive to use alcohol and the effects of anxiety. Some users say it has Valium-like effects, but Johnson said it's far less addictive.
Any discovery of a medication to treat alcoholism and a severe mental health disorder could help reduce a persistent problem, he said.
While opioids such as heroin and fentanyl have grabbed most of the headlines because of a surge in related overdose deaths, alcohol continues to kill people.
Nationally, the U.S. Centers for Disease Control and Prevention reports that alcohol use led to about 88,000 deaths each year from 2006 to 2010.
A new report from the Trust for America's Health counted more than a million deaths tied to alcohol, drugs and suicide in the past decade, with alcohol deaths up 37 percent and suicides increasing 28 percent from 2010 to 2015. The group says it points to an epidemic of pain, despair, disconnection and lack of opportunity and the need for a "national strategy to improve resilience."
Benjamin F. Miller, chief policy officer for the Well Being Trust and a contributor to the report, noted that in 2016, 44.7 million U.S. adults experienced a mental health problem, 20.1 million had a substance use disorder and 8.2 million had both. He said the numbers are likely undercounted by far.
He said only 1 in 10 who need treatment for a substance use disorder got it and 4 in 9 who need mental health services get them. Frequently treatment isn't coordinated, significantly dampening its effectiveness, said Miller, also a senior adviser in the University of Colorado School of Medicine's department of family medicine.
"I applaud the researchers for their work; this is tremendously important for people on the ground," said Miller about the Maryland team's study. "It is a wonderful step in the right direction. Though people need a whole lot more help."
Too often, Miller said, the approach in research, as well as health care delivery, is treating each disease a person has independently.
Researchers even tightly control participation in studies to get a clear picture of how a drug works on a single condition, Johnson said.
But patients rarely have only one condition. Even if each is initially addressed medically, with mental health and substance use disorders, a need remains for ongoing counseling and support services for the long term.
That's especially true with the most complex and severe cases involving PTSD, said Dr. Lawrence V. Tucker, medical director of the Laguna Treatment Hospital in California, one of several facilities operated by American Addiction Centers, which specializes in co-occurring mental health and substance use disorders.
Tucker said he uses medications related to pregablin now on patients with dual diagnoses but said he'll be looking for results of the Maryland study. New evidence of effectiveness could inform his decisions on which drugs he uses and for how long.
Still, he agreed that these cases call for long-term therapy - sometimes just to understand the root of the disorders.
Young men, he said, are especially resistant to discussing trauma. Left alone, these patients will most certainly begin using alcohol again.
"Someone can get 30 or 60 or 90 days of treatment, but if the root of evil isn't addressed, if you don't address the PTSD, guess what happens? They relapse," he said. "People need to learn how to be sober."
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