A Different Take on Treating Alcoholics - Toronto Sun

Jenny Yuen, TorontoSun. An alcohol addiction treatment company made its debut in Toronto last week, offering up a controversial program that allows alcoholics to keep drinking. And while others insist abstinence is essential, Alavida Health insists its harm reduction method is resonating with booze addicts who have not found success elsewhere.

The Alavida clinic opened its first treatment facility in Vancouver last year with a focus on a harm-reduction approach to battling alcoholism, versus the more traditional route of abstinence and quitting cold turkey. It’s a recovery program where patients can still drink in moderation.“People come to us and they set their goals for change — and that goal may be a reduction in drinking all the way up to achieving abstinence,” said Alavida Health’s clinical program director Lindsay Killam.

“The abstinence model has been the dominant model for many decades, and is the ultimate goal and is seen as a success. The challenge that happens is that it’s very black and white, so there’s only one measure of success and that’s never drinking again.” But Bellwood Health Services in North York counters abstinence is really the only option in addiction treatment. Their residential program runs six weeks to nine weeks, but they also offer an outpatient program with a success rate of more than 70%. But in both cases, drinking during recovery is a no-no.

“Sometimes, abstinence happens quicker with some individuals over others, but we would never treat an individual that wants to continue to use (alcohol),” said Bellwood’s operations director Joshua Montgomery. “We kind of find that unethical in a way. Why are we continuing to teach them to use something that has caused this pain? I don’t know if that’s getting to the root cause.”

Since September, 2016, Alavida has seen over 150 Canadian patients at its Vancouver office. The clinic says 75% of its clients either reduced their consumption by half or achieved lower-risk drinking levels. The concept began 20 years ago in Finland, “using evidence-based and scientific” methods — based on pharmacological and psychological treatment in combination to provide the most comprehensive treatment approach for alcohol use disorder. “This program is very attractive to people who want high confidentiality,” said Killam. “People who are invested in family life or work life and need to have some flexibility in which they approach treatment, that going away to a residential facility at a high cost and having to leave life for one to three months doesn’t seem feasible.”

When patients sign up, they are prescribed a drug called naltrexone, which blocks the reinforcing effects of alcohol. The pill, swallowed an hour before someone drinks — and used up to a maximum of three tablets per day — prevents the brain from registering feelings of wellbeing and pain relief and decreases the desire for more booze. The medication is coupled with eight one-hour sessions — three with a doctor and five with a cognitive behavioural therapist for up to six months. The combination of medication and therapy increases the likelihood of abstinence, if the patient desires, while building on the patient’s strengths, said Alavida founder and medical director Dr. Diane Rothon.

“We remove the power that alcohol has over the brain by prescribing naltrexone and interrupting that reward cycle,” said Rothon. “The patient no longer associates alcohol consumption with positive reward — it becomes neutral. By the third drink, they call it a ‘why bother?’ … It kind of resets the clock to a time before the person was having problem with their alcohol intake.” While there’s yet to be a brick and mortar location in Toronto, the launch in Hogtown is mainly through secure video conference — meaning, sessions through phone or video chat from its Vancouver branch. If there is enough interest, the company will open a clinic in a Toronto building, even though expansion in the city began Oct. 12.

The cost of treatment for the Alavida program is $6,500 and it’s not covered by OHIP, but some private health plans may cover portions of the treatment. The Centre for Mental Health and Addiction, however, said they have already been running a similar program as Alavida for the past five years — except, other than medication, its costs are covered by Ontario’s health plan.

“The situation is a bit of an anomaly because in Canada, we have a public system and we don’t allow private insurance for medical conditions, except addiction,” said Bernard Le Foll, of CAMH’s addiction medicine service department. “It’s a stigma around addiction … there are private companies that take advantage of this. (Recovery) should be put back into routine clinical care.” The 2015 State of Public Health in Canada study that researched alcohol consumption in Canada found that In 2013, an estimated 22 million Canadians — almost 80% of the population — drank alcohol in the previous year. At least 3.1 million Canadians drank enough to be at risk for immediate injury and harm and a minimum of 4.4 million at risk for chronic health effects, such as liver cirrhosis and various forms of cancer.

One woman’s story

It started with joining girlfriends for a glass of wine and quickly escalated to a bottle-and-a-half-a-day habit. About five years ago, Andrea, a 55-year-old entrepreneur from British Columbia, knew she had a drinking problem, triggered by stress. And when traditional 12-step recovery efforts weren’t leading her to a brighter future, she discovered naltrexone.

Andrea went to her doctor, who wouldn’t prescribe the drug — known to inhibit endorphins and quell the urge to drink — and she felt despair until she saw a Facebook pop-up ad online for the Alavida clinic. She called their Vancouver location “the day before Trump took office” — and that saved her life. “There was no judgement at all,” she recalled. “They were kind. It was said over and over again that this was a medical issue, not a moral issue. Nobody wakes up in the morning and says, ‘I’m going to be a drunk and destroy everything in my life.’”

Andrea met with doctors and therapists during her six months of treatment, all done over the phone. She had no idea and is still often astounded that the program “could be so simple. Even though it wasn’t easy.” “I hated myself. I hated that I couldn’t stop. I had tried to stop. I had gone to AA meetings, there are people in my family who are in AA,” she said. “My brother died of this and he struggled his entire life to stop. I had embarrassed myself a few times. I was a 55-year-old woman and I was the drunk girl at the party. It’s just not pretty. I wanted to stop before I lost everything.”

As part of her recovery, she kept a diary and set goals each week. Her goals at the beginning changed by the end — it would be like two drinks a day instead of seven to 10. But she learned as she was getting better — even though she had planned to have a drink on a Thursday and take naltrexone to inhibit wanting more alcohol — she would feel like that urge wasn’t there.

“I’ve got my self-respect back,” she said. “I didn’t even notice a craving. I took the pill when I first started and that went from seven drinks at night to four almost immediately. And within six weeks, I was down to four drinks a week. The change has been phenomenal. I don’t have to worry about being hungover and I don’t take the pills all the time anymore.”


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