Alcohol treatment at MUSC emphasizes scientific approach

Singer and guitarist Martin Butcher calls himself an open book, with good reason.“I was a moron. I was in a car accident. I got away with my drinking for a long time, but that was it.

”Butcher is funny, blunt and insightful about the alcohol addiction that caused him to crash his car on the way home from a concert three years ago. Nobody was hurt, but the 41-year-old father knew it was time to kick a habit he’d had since he was a teenager.

“I didn’t want to be president or an astronaut or a CEO. I wanted to be a rock star. My heroes could chug booze, do drugs and rock out. I wanted to build tolerance. I remember drinking alone when I was younger so that I wouldn’t look like an idiot passing out when drinking with friends.”

After his crash, Butcher’s wife signed him up for treatment at the Medical University of South Carolina. MUSC has one of only 15 specialized alcohol research centers in the country supported by the National Institute on Alcohol Abuse and Alcoholism, so its clinical trial and treatment programs offer more than traditional therapy. They incorporate cutting-edge science, involving brain imaging, genetic assessments, medications and more to help alcoholics cut back or stop drinking.

The director of the Charleston Alcohol Research Center at MUSC, who is also a professor in the Department of Psychiatry and Behavioral Sciences, said alcoholism is a medical disease. “It’s a biologically-based problem,” Howard Becker, Ph.D., said.

A biologically-based problem needs scientific solutions. And those solutions are becoming more precise and personal, based on a growing body of knowledge.Butcher liked MUSC’s scientific approach and was highly motivated to quit. He started treatment along with counseling, providing urine samples to prove he wasn’t relapsing.

MUSC used a fairly new test pioneered at the center to check those samples. Alcohol binds to a specific chemical in the body, creating a biomarker that shows whether a person has been drinking long after the alcohol has left the body. The test checks the level of that biomarker.

Butcher’s tests always came back clean, and he and his therapist worked to make sure he stayed sober. He continued to play at clubs around Charleston, but only ones where he knew he wouldn’t be pressured to drink.During his treatment, he saw something that really stuck with him in a group counseling session at MUSC: a presentation on how alcohol affects the brain, complete with images illustrating how heavy drinking alters brain circuits, making it very difficult for alcoholics to quit.

“It broke away from the emotion and all this background and the touchy feely stuff, and it was straight science. It was so interesting,” Butcher said. He was finally able to see why alcohol had become such a persistent problem for him.

Becker said the kind of brain imaging that impressed Butcher was developed in the center. It tells an important story about the effect of alcohol. “It produces a sense of intoxication by altering communication between cells in the brain. While early on alcohol charges up reward pleasure centers, with continued heavy use of alcohol there are changes in brain circuits involved in decision making, judgment and control.” The center’s scientific director, Raymond Anton, M.D., agreed.

“Drinking changes from a pleasurable experience into one based on habit or compulsion. Some people don’t even feel the pleasure any more, but they have this incredible urge to keep drinking.” 

Medications can help suppress that urge, and it’s an important part of the center’s work. When it opened in 1995, Antabuse was the best-known medication used for alcoholism. It works by making a person feel sick when drinking alcohol. Naltrexone was approved that same year and is still in use as well. It suppresses the urge to drink without making the person feel sick. A handful of other options have come on the market since then, but Becker said more effective medications and other treatments are needed.

Thanks to an explosion of information about neuroscience over the past decade, they’re on the way. Scientists know a lot more about how the brain and genes work, and that’s helping researchers at the center develop other medications and treatments aimed at specific biological targets.Soon, they may know even more about genes and alcohol use. Anton said they’re about to analyze the results of a study that they’ve been working on for five years. “This could lead to a genetic test we can do that will predict your response to a medication.”

The center also explores personalized treatment, based not only on brain imaging and genetics but also personality. If a person with an alcohol problem is a thrill seeker, that personality trait is a factor to be considered in deciding which treatment might work best. If the drinker suffers from anxiety, that person might do better with a different treatment program.What lies ahead for alcohol treatment? Big changes, according to Anton, a Distinguished University Professor of Psychiatry and Behavioral Science at MUSC.

“I can see maybe five to ten years from now, when you come in for treatment for alcohol dependence, it’s going to be quite different than it ever was,” Anton said. “You can maybe go to the brain scanner or you can have your genes tested. All that information’s going to come back to the physician, who might say: ‘Well, this is your alcoholic subtype, and this is the medication you need.’”

Anton said it’s not very different than treating high blood pressure, diabetes or cancer. The Charleston Alcohol Research Center relies on the National Institute on Alcohol and Abuse and Alcoholism for funding, and has just applied for an additional five-year grant support.

The NIAAA is part of the National Institutes of Health, the government agency focused on public health-related research. Anton and Becker should find out this summer if the center will get the funding. In the meantime, they’re celebrating its 20th anniversary. Becker said it’s a promising time in their field and MUSC is fortunate to be on the cutting edge.

Butcher is grateful for that innovative approach. His treatment helped him through the difficult process of giving up alcohol in part by using science to show him how his problem developed. He still sees a therapist occasionally and carries a card in his wallet listing phone numbers to call if he thinks he’s about to relapse. He also realizes how lucky he is to be in treatment after the crash that totaled his car.“It was divine,” Butcher said. “There’s no reason for me to be alive, but I didn’t hurt myself and didn’t hurt anyone else.”

For information about enrolling in a clinical research trial at the Charleston Alcohol Research Center, call 843-792-2727.For information about getting treatment for substance-abuse related concerns, call the MUSC Center for Drug and Alcohol programs at 843-792-5200.