May 13, 2014

Are there medicines to help Indians resist alcohol?

From the NYT:
Effective Drugs to Curb Alcoholism Are Ignored, Study Finds 
By ANAHAD O’CONNOR   MAY 13, 2014 
Two medications could help tens of thousands of alcoholics quit drinking, yet the drugs are rarely prescribed to patients, researchers reported on Tuesday. 
The medications, naltrexone and acamprosate, reduce cravings for alcohol by fine-tuning the brain’s chemical reward system. They have been approved for treating alcoholism for over a decade. But questions about their efficacy and a lack of awareness among doctors have resulted in the drugs being underused, the researchers said. 
Less than a third of all people with alcohol problems receive treatment of any kind, and fewer than 10 percent are prescribed medications.  
In the new study, which was published online on Tuesday in JAMA, the journal of the American Medical Association, a team of researchers based mostly at the University of North Carolina at Chapel Hill compiled findings from the most rigorous trials of medications for alcoholism in the past few decades. Ultimately, they analyzed data on roughly 23,000 people from 122 randomized trials. 
The researchers focused on a measure known as the “number needed to treat,” an indicator of how many people need to take a pill for just one person to be helped. The study found that to prevent one person from returning to drinking, the number needed to treat for acamprosate was 12; for naltrexone, the number was 20. 
By comparison, large studies of widely used drugs, like the cholesterol-lowering statins, have found that 25 to more than 100 people need treatment to prevent just one cardiovascular event. 
According to federal data, roughly 18 million Americans have an alcohol abuse disorder. Excessive drinking kills about 88,000 people a year and costs the health care and criminal justice systems billions of dollars. 
“These drugs are really underused quite a bit, and our findings show that they can help thousands and thousands of people,” said Dr. Daniel E. Jonas, the lead author of the new study and an associate professor of medicine at the University of North Carolina. “They’re not blockbuster. They’re not going to work for everybody. But they can make a difference for a lot of people.”

Since there appear to be biochemical routes to help combat alcoholism, I'd like to see a smart philanthropist like Bill Gates put some serious money into a research program to find out the optimal ways to help American Indians fight the alcoholism scourge. Substance abuse is a horrible problem on Indian reservations, and the white man bears a large measure of responsibility for coming here and introducing firewater to a race genetically unprepared for it.

North American Indians presumably haven't yet evolved the genetic defenses against alcohol that Mediterranean peoples have developed over the last ten thousand years. Notice that in the Book of Genesis, scandalous stuff happens when ancient patriarchs like Noah and Lot get dead drunk, but by the time of the New Testament, people seem to drink responsibly at the Wedding Feast of Cana and the Last Supper: evolution in action.

Native American cultures often put a lot of effort into scrounging up various natural intoxicants (peyote, the peace pipe, etc.), but they were hard to find. That cultural emphasis was disastrous when palefaces showed up offering to trade jugs of distilled corn liquor for pelts.

There are a bunch of stupid laws in the U.S. restricting the genetic research on American Indians that might help figure out exactly what kind of anti-alcoholism drugs could help them most, but Canada, oddly, seems somewhat more open for research and Mexico is another option (although Mexican Indians, who had more technically advanced civilizations, developed their own alcohol before Columbus).
     

47 comments:

Anonymous said...

If the Indians took the initiative they would have found something like declinol.

https://www.declinol.com/

They should take personal responsibility? Right?

Or is it possible that certain people are just so biochemically different that self/impulse control is impossible?

I wonder what type of people take initiative? Is there an HBD explanation for that?

anony-mouse said...

Um, er, there are also paler peoples who have had problems (and still do) with alcohol.

Interestingly I'm not aware of any Asian peoples with that issue.

My understanding it is customary for the Japanese salaryman to go vigorously drinking after work but that this doesn't seem to create problems.

Zippy said...

Serious question -- for information, not a trick or trap.

What are the restrictions on genetic research on Indians? How do they differ from genetic research on whites, blacks, etc.?

Mangan said...

Native American cultures often put a lot of effort into scrounging up various natural intoxicants (peyote, the peace pipe, etc.), but they were hard to find. That cultural emphasis was disastrous when palefaces showed up offering to trade jugs of distilled corn liquor for pelts.

Whether cultures put effort into finding intoxicants is unrelated, I think, to their ability to resist alcohol. All cultures have put lots of effort into the search for intoxicants, and Indians aren't any different. There's even a theory that agriculture was invented for that purpose, the first plant cultivated being the opium poppy. The Scythians were smoking pot in the time of Herodotus. American Indians were smoking (and snorting, chewing, etc.) tobacco within a thousand years of reaching South America. But without the mass quantities of grains available to other cultures, they never managed to produce alcohol.

Anonymous said...

Um, er, there are also paler peoples who have had problems (and still do) with alcohol.

Yes, like these guys. And since the predominant drink is beer, visceral fat would likely be a bigger health danger than alcoholism.

Chicago said...

Seems strange that in all those years the American Indians didn't discover how to make it on their own, even by accident. After contact they weren't able to torture the secret process out of some captured white? It's not as if brewing some rotgut is all that complicated; people of limited means, such as convicts, do it all the time.

Anonymous said...

That cultural emphasis was disastrous when palefaces showed up offering to trade jugs of distilled corn liquor for pelts.

Don't forget these same palefaces also strongly discouraged Natives from peyote, shrooms, yage, datura, salvia, and other natural medicines. "Saving their souls" from those devilish altered states of consciousness. Corn liquor doesn't alter consciousness that much, but it is (at least to Natives) addictive as hell, and causes liver damage.

Pochinko said...

"Substance abuse is a horrible problem on Indian reservations, and the white man bears a large measure of responsibility for coming here and introducing firewater to a race genetically unprepared for it."

- The problem with this sort of argument is how far back do you want to trace it? Who introduced it to Europe? Or if it developed in Europe, then who spread it to the rest of Europe? No one is offering to take responsibility for all of the Europeans who died or suffered. For that matter, whoever did that would in turn could arguably be culpable for introducing it to the Indians.

Or we could just say people should take responsibility for their own actions. If you know you have a predisposition for substance abuse, be extra careful to stay away from drugs and alcohol.

I had an uncle who smoked himself to death so to speak. While growing up, I got to watch him grow increasingly feeble with emphysema and associated problems and still lighting 'em up. I realized pretty early on that it would be unwise to even get started. Seemed a better way to go than lighting up myself and blaming Hollywood for making it look cool.

Nely Z said...

"Interestingly I'm not aware of any Asian peoples with that issue."

There are significant numbers of Asians with alcohol dependence/addiction but I don't know how the numbers stack up against Europeans or Am. Indians. I get the feeling its more of an issue for SE Asians than NE Asians.

There are also significant numbers of Asians with a genetic predisposition to become red faced and uncomfortable over alcohol- these rarely ever become addicts.

Interestingly, there are some African populations with a genetic variant of a gene for metabolizing alcohol (different from the aforementioned Asian gene)who also rarely become addicted to alcohol- one theory is that they metabolize it faster than normal and so feel higher spike in blood levels of metabolites that cause discomfort, so don't enjoy drinking.

Anonymous said...

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61939-X/fulltext

Whitehall said...

In college I had a girlfriend who graduated to become a social worker on the Seminole Indian reservation in South Florida.

She shared stories of Indians so desperate to get high they would break open a mercury thermometer to put a drop of mercury behind the eye lid. Mercury delirium would follow from the poison, like the Mad Hatter.

Anonymous said...

Sorry, that study says exactly opposite to what the article's title is. There are no effective drugs to control alcoholism! I happen to be an alcoholic with first hand experience with both of these drugs. I also researched the existing literature extensively and when I am not drinking I spend lots of federal $$ doing neuroscience research.

Naltrexone and acamprosate are drugs that do make a difference in a sense that they are better than nothing. Bottom line is that they are about as effective as 12 steps - i.e., only marginally better than placebo. Acamprosate can be tricky and I would not suggest anyone doing it without medical supervision. Naltrexone is pretty safe and there is a whole community that buys the stuff from India and experiments with self-medication (http://www.thesinclairmethod.net/community/ - need to register top read or post). The so-called "Sinclair Method" is likely a bunk but its mere existence has helped quite a few. I certainly was better off with naltrexone, drinking a "reasonable" 30 drinks a week on it instead of a more typical 120 without it. For some reason (and that's not typical), however, my heart was doing pretty badly while I diligently blocked my opioid receptors daily.

Since there appear to be biochemical routes to help combat alcoholism

Alas, alcoholism is far more complex syndrome and substance dependence of them all. Simply because ethanol affects everything to some extent. It will be a holy grail of individualized genome-based medicine to be able to figure out effective alcoholism treatments to all kinds of people. Hence, it will only happen AFTER these things become real for schizo, hearts disease and cancers. Not during my life time and likely not during yours...

biff said...

I wonder if the Aztecs bred and trained their northern neighbours to be alcoholics. You have two tribes of northern barbarians raiding you, give the ones most vulnerable to alcoholism some booze to kill the others, repeat since teosinth was first fermented. . .

Anonymous said...

It powerful medicine?

Anonymous said...

Native Americans are also way more prone to diabetes. Billionaire Oklahoman Harold Hamm (who may be part Indian) gave a ton of money to Oklahoma U to start a diabetes research center since so many Natives live reside in that state and suffer from the disease.

http://www.ouhsc.edu/odc/CoBRE/

The root cause of both the higher proclivity to both alcoholism and diabetes among American Indians is a shorter period of adaptation to agricultural products.

Like Nicholas Wade explains in his latest book (pp. 126-133), a lot of the biological variation among racial groups can be explained by the length of time a population has been exposed to agriculture. The settled populations that developed after humans started growing their food selected for totally different physical and social traits than hunter gatherer groups.

Like American Indians, Blacks have also have relatively few generations that were not hunter-gatherers.

A lot about crime in black neighborhoods, test score gaps, economic inequality, the racial composition of the NFL and NBA can be explained by the obvious evolutionary explanation that blacks have retained the physiology and social behavior of hunter-gatherers.


Lost in Time said...

In Tintin and the Picaros, Herge already satirized natives facility for getting hooked on alcohol.

Carol said...

The root cause of both the higher proclivity to both alcoholism and diabetes among American Indians is a shorter period of adaptation to agricultural products

I thought they didn't have a problem with diabetes until rounded up on reservations, living on white man's food supplies. That's Gary Taubes' version anyway.

Anonymous said...

Interesting statistics: Pure alcohol consumption in liters per capita (WHO - Wikipedia) for selected countries: 1. Moldova, 2. Czech R., 3. Hungary, 4. Ukraine, 5. Estonia, 7. Romania, 9. Belarus, 11. Lithuania, 12. S. Korea, 13. Portugal, 14. Ireland, 15. France, 16. Russia,17. U.K., 18. Denmark, 20. Poland, 23. Germany, 30. Spain, 36. Greece, 37. Italy, 48. Canada, 57. U.S., 67. Mexico,70. Japan,96. China, 140. Israel,170. India, 177. Egypt, 180. Saudi Arabia

Harry Baldwin said...

My understanding it is customary for the Japanese salaryman to go vigorously drinking after work but that this doesn't seem to create problems.

My understanding is that it's only while getting soused together that Japanese salaryman can tell his boos that there are problems at the office that need to be addressed. It's a way around the excessive deference to superiors characteristic of East Asian societies.

Harry Baldwin said...

when our daughter was 16 she became addicted to heroin and we sent her to a wilderness program to detox. The professional advice was that we not let her come back home, but put her in a therapeutic boarding school until she finished high school. The therapeutic schools are in the middle of nowhere and charge in the neighborhood of $80,000 a year. We couldn't afford that and anyway there's no guarantee it would make any difference. Instead, on advice from a local drug counselor, we brought her home on the requirement that she take Naltrexone, which is supposed to block the opiate high. Since addicts won't stick with the program, the plan was for her to get a painful monthly shot. The program pretty much worked, though she drifted back onto heroin a few years later, though that time she was able to get off it by herself. There's only so much you can do for addicts until they decide to change.

She later told us that while on Naltrexone she did do some drinking and was able to get a buzz, though that's not supposed to happen.

Anonymous said...

A good rule of thumb for clinical research is that if you have to run a meta-analysis of a hundred studies to show a mild effect, then the news is not good. A nnt of 20 means that for 95% of the study participants, naltrexone was no better than placebo.

The fact is there are no good meds for alcoholism, and no great shakes in the pipeline. AA is prob. minimally useful, though its very nature makes it difficult to study. In-patient expensive rehab is no better than the (again minimally useful) outpatient programs.

I speak as an alcoholic who have looked into various treatmemts.

Anonymous said...

Seems strange that in all those years the American Indians didn't discover how to make it on their own, even by accident.

Lacking the quantities of metrials needed to make alcohol they could only make "rotgut" like alcohol in small quantities.

Anonymous said...

"I thought they didn't have a problem with diabetes until rounded up on reservations, living on white man's food supplies. That's Gary Taubes' version anyway."

Exactly. Their ancestors had been hunting and gathering found since time immemorial and they stayed pretty healthy. The switch to a grain-based diet that they were not physiologically adapted to had a drastic impact on the native population.

Foreign Expert said...

I lived in Japan for 25 years. I knew numerous men who drank heavily night after night but functioned normally the next day.

koa said...

Hawaiians didn't have alcohol either but they had multi-day luaus where the strongest intoxicant was ava, which is not strong. Post contact, whole villages -- including children -- would get drunk for days at a time off of okolehao, distilled from anything that would ferment, especially ti root.

This horrified the missionaries, some of the most prominent among them the Baldwins. They would later essentially take over.

I am very glad that Harry Baldwin's daughter recovered.

Steve Sailer said...

Mexicans had an alcoholic drink called pulque that's like a primitive version of tequila for at least a thousand years. Or at least the ones in the highlands had it. It's still sold.

dearieme said...

"Canada, oddly, seems somewhat more open for research": is it really odd? Canada just seems slightly less religious, both in the sense of that Ol' Time Religion, and the modern secular substitutes.

Anonymous said...

I have a pet theory why Northern European peoples such as the Germans, despite their high IQs, did not arrive on the scene of world history until much later than the Greeks and Romans. They were introduced to Alcohol much later than the Mediterranean peoples were, and evolved resistance against alcoholism much later as a result. Even today Northern Europeans have higher alcoholism than Southern Europeans. It used to be much worse. In the period BC, it might have been as bad as the Indians.

dearieme said...

"Notice that in the Book of Genesis, scandalous stuff happens when ancient patriarchs like Noah and Lot get dead drunk": assuming that Genesis, like most of the OT, was written at about the time of the Babylonian exile, that's a claim that drunkenness stories survived from many millennia earlier. I'd guess that it's likelier that the yarn is based on seeing some people utterly drunk at about the time of writing.

Anonymous said...

My understanding it is customary for the Japanese salaryman to go vigorously drinking after work but that this doesn't seem to create problems.

Well, no problems except for the fact that they're going extinct right before our very eyes.

Anonymous said...

"Um, er, there are also paler peoples who have had problems (and still do) with alcohol.

Yes, like these guys. And since the predominant drink is beer, visceral fat would likely be a bigger health danger than alcoholism."

Smacks of damned lying. A couple of years of life span loss across a large population, ie, Canadians, is indeed a big problem. Add to that health costs, and, yes, it's a big, big problem - what they refer to these days as a 'first world problem', ie, the kind of problem fat, functioning-alcoholic, white guys routinely chip away at every day before beer o'clock.

But if you're an aborigine, the utter dysfunction of your community probably seems more pressing.

Gilbert P

Zippy said...

Wait, an Oklahoma billionaire put money into a diabetes research program because it would help people in his native state?

What's wrong with him? Doesn't he know he's supposed to give it either to the football team or a foreign country?

Power Child said...

Can't you get alcohol from basically any fermented fruit?

I never thought of it before, but this would indeed make it puzzling why American Indians never got used to booze.

Someone else made a comment about certain African populations getting a fast metabolic spike, making alcohol consumption uncomfortable.

I noticed that a lot of black people don't seem to like the taste of alcohol, preferring mixed fruity drinks to neat spirits and beer. That may be cultural though, since neat spirits and beer are largely perceived as "white people" drinks--see Steve's previous post on monolithic black culture.

panjoomby said...

true but weird: europeans have a hard time quitting caffeine & tobacco, b/c we've only been around them a few hundred years.

Anonymous said...

I am surprised that Islam is not making inroads for Native Americans. It would be better for them than the Christian monopoly: more down-to-earth, and anti-alcohol. Right now, most Natives are either evangelical Christian or follow neo-traditional shamanism. Islam would be a much better fit for Natives than for black Americans (whom it serves poorly).

Anonymous said...

"My understanding is that it's only while getting soused together that Japanese salaryman can tell his boos that there are problems at the office that need to be addressed. It's a way around the excessive deference to superiors characteristic of East Asian societies."

From living in Japan, being married to a Japanese, here are my observations.

First, there doesn't seem to be much shame or moral approbation about adults getting hammered, at least to the extent that it is in our culture. The attitude is just something fun, like riding a roller coaster. I'd qualify that this does pertain to getting sloshed at socially approved times, after work happy hours being the far most common events. My impression is that a common attitude is that it is a silly lark, maybe like people used to think about ether parties in the 1800s

However, being drunk at, say work, would be viewed as negatively as in the U.S. As with about everything in Japan, there is a time and place for this particular activity.

And drinking while driving is severely frowned upon, I believe the limit is .03% (vs. .08% in U.S.)

The red-faced thing is extremely common, you can see trainloads of these guys late at night or barfing along the streets. It doesn't seem to deter many, but that may be because they feel social pressure to drink and fit in.

Along with little social disapproval of getting quite drunk is also the toleration of whatever the drunk does. All seems to be forgiven and forgotten after the event. This famously includes sounding off to the boss or coworkers about stuff that irritates them. Japanese are quite aware of this phenomenon.

I strongly believe that this is a social adaptation to the rigid hierarchy of Japanese society and probably serves some important role, just as drinking facilitates mating in, well, just about all societies.

Anonymous said...

Their ancestors had been hunting and gathering found since time immemorial and they stayed pretty healthy.

Book on shipwrecks had a guy live with Indian tribe and they were constantly starving like their neighbors.

Anonymous said...

Book on shipwrecks had a guy live with Indian tribe and they were constantly starving like their neighbors.

Did these sailors have the same hunting-and-gathering skills as the Indians?

Anonymous said...

"Um, er, there are also paler peoples who have had problems (and still do) with alcohol.

Interestingly I'm not aware of any Asian peoples with that issue."

Exactly.

The more centuries a population's diet has depended on grains the better able they are to process alcohol (because of the sugar?) hence the difference in alcoholism between northern and southern Europeans and the difference between northern Europeans and American Indians.

Anonymous said...

"What are the restrictions on genetic research on Indians? How do they differ from genetic research on whites, blacks, etc.?"

The dominant culture says race is a social construct so genetic research based on seeing if there are genetic differences doesn't get funded unless there is a clear medical case and mostly not even then.

It's the big lie in action.

Anonymous said...

Mexicans had an alcoholic drink called pulque that's like a primitive version of tequila.

They took analogies off of the SAT, but pulque is to tequila as beer is to whiskey. More or less.

Pulque is pretty strange stuff - it's milky white and sort of viscous and sour tasting and is fermented by a bacteria instead of yeast. After beer was introduced in Mexico, it pretty much took over from pulque in the marketplace because it is more palatable (and was perceived as the higher status drink). The Aztecs restricted its consumption because they knew that alcohol and Native American peasants did not go well together. It was permitted only to nobles and priests and pregnant
women and the elderly.


Anonymous said...

"I thought they didn't have a problem with diabetes until rounded up on reservations, living on white man's food supplies."

Processing the sugar in grains / corn syrup /alcohol. All the same thing.

Assistant Village Idiot said...

My clinical experience with naltrexone isn't impressive.

Anony-mouse. There are lots of alcohol problems in Asia, including Japan.

Anonymous said...

> Islam would be a much better fit for Natives than for black Americans


Islam seems to have spread (during the AD 1100-1300's)like wildfire.... but only amongst truly primitive aboriginal populations along the Tropical belt.

The Spaniards also never colonized against any advanced peoples.

Anonymous said...

in addition to Pulque, there is chicha, which is corn beer

Anonymous said...

Pulque = puke.

Anonymous said...

Book on shipwrecks had a guy live with Indian tribe and they were constantly starving like their neighbors.

Did these sailors have the same hunting-and-gathering skills as the Indians?


Yes that is why they were constantly starving.