In January of 1995, The Arizona Republic newspaper published a short news item that detailed the approval of a medication which the Director of the United States Food & Drug Administration stated would revolutionize treatment for alcohol dependence. The article announced that ReVia® (naltrexone) had been approved by the FDA on December 30, 1994. Lloyd Vacovsky, now Director of Assisted Recovery, at the time was a Social Worker employed by Central Arizona Shelter Services in Phoenix, Arizona. The article stated that studies had demonstrated the ability of ReVia to suppress cravings for alcohol. Vacovsky remembers thinking; “we should put this in the municipal water system, just like fluoride”.

As a social worker at the largest shelter in Arizona, Lloyd was confronted daily with clients suffering from alcohol dependence. Even as a trained professional, it was difficult for Lloyd to understand why a human being, despite all logic and despite all consequences, continued to drink. Up to that point, Lloyd held the view that alcohol dependence was primarily a lack of character and will power. One thing he did know however was that his clients were not able to stop drinking. Intrigued by the article on ReVia, Lloyd contacted DuPont/Merck, the manufacturer of ReVia. Within days, he received information that not only changed his life, but the lives of many people suffering from alcohol dependence.

Research clearly pointed to the fact that alcohol dependence is a very complex disease, having far more to do with brain biochemistry and genetics than lack of character and will power. In February of 1995, Vacovsky convinced the psychiatrist at the Maricopa County Homeless Clinic to prescribe ReVia to a client who had been struggling for years, and had failed numerous treatment attempts. Within minutes of taking the first tablet of ReVia, the client reported an inner calm and the absence of wanting or even thinking about drinking. As the days, weeks and months passed, he was able to maintain sobriety and move on in life. Based on that initial success, a pilot program was created at Central Arizona Shelter Services in November of 1995. In developing the program, clients were asked what would be effective, and what would be counterproductive. Virtually all responded by asking for a non 12-step approach.

Lloyd contacted Dr. Joseph Volpicelli, MD, PhD of the University of Pennsylvania School of Medicine, Treatment Research Center in Philadelphia, and who is generally recognized as the “father” of naltrexone. He agreed that non 12-step options needed to be developed and offered. Dr. Volpicelli emphasized that naltrexone was a tool rather than a “cure” and that counseling was a critical component of the recovery process. Cognitive Behavioral Therapy, combined with effective medications became the foundation of what has now become known as the Pennsylvania Model of Recovery.

In April of 1997, Assisted Recovery Centers of Arizona was born in response for the need for evidence-based, non 12-step treatment option. Assisted Recovery was the first non-academic, non-institutional program in the United States to fully embrace the Pennsylvania Model of Recovery. Assisted Recovery is proud to be a pioneer in the development of pharmacotherapy and the Pennsylvania Model of Recovery.

A Modern Medical Response
to a Medical Issue
by Lloyd Vacovsky, Director

Alcoholism is a tragedy of immense proportions, that affects every man, woman and child in America. It is a disease that knows no boundaries, and does not discriminate. The cost in lives disrupted and lost cannot be calculated. The cost to the economy can be measured in tens of billions of dollars. As immense a tragedy as this is, there is an even greater tragedy.

Today, right this minute, there is available in the United States a state of the art medication that has the potential of vastly reducing the impact of alcoholism on society. The tragedy that I speak of is that no one knows about this marvelous new tool that medical research has given us.

For nine years, I have worked with alcohol-dependent individuals at the largest homeless shelter in the State of Arizona. For years I referred clients of Central Arizona Shelter Services in Phoenix to countless alcohol treatment programs. The results were always the same. My clients either returned to the shelter or the streets having relapsed, or they were dead. I could not document one successful recovery from alcohol dependence. I firmly believed that the alcohol treatment programs were fine, it was just that the individual was not "ready" to become sober. As I surveyed the destruction inflicted upon human beings by this addiction, I could not understand why people would "choose" to live the life of a drunk. By the time individuals reached me, they had literally lost everything, including self-respect and hope. I steadfastly adhered to traditional treatment concepts, and continued to have no success. The frustration of working with this population is great, and more than once I resolved to direct my attention to those individuals who really wanted to improve their lives. In the end however, I realized that the vast majority of alcohol-dependent individuals did want to stop, and indeed wanted to live a happy productive life. I prodded on with my referrals to traditional treatment programs.

In January of 1995, a very short article in the ARIZONA REPUBLIC caught my eye. It stated that the United States Food & Drug Administration had approved on December 30, 1994 a new medication, produced by DuPont Pharma of Wilmington, Delaware that would revolutionize the treatment of alcoholics in the United States. The medication, (Naltrexone HCI) would ease the craving for alcohol. That is about all the article stated. I contacted several physicians that I know, along with treatment programs. No one had heard of naltrexone. Undaunted, I called what seemed like a dozen DuPont 1-800 numbers before I got to the right department. Within a week, I received information that changed my life, and has changed the live of most of the alcohol-dependent individuals whose path I have crossed.

As I read the literature, it became apparent to me that if even some of the reported effects of Naltrexone were true, that this was indeed a break through medication, that could be compared in importance to the discovery of penicillin. The material stated that Naltrexone would eliminate the craving for alcohol, and if taken for 90 days, the effect appeared to be permanent. This clearly was not substituting one "drug," alcohol, for another. The fact that the medication is usually discontinued after 90 days told me that the repair initiated by the Naltrexone meant that it was treating the cause of the addiction, and not just the symptoms. It meant that alcoholism was no longer a chronic disease, whom we could just treat the symptoms with such medications as Librium. It meant that we could now treat the cause of the disease and thus for the first time since the onset of their alcoholism offer real hope to alcohol-dependent individuals, where previously there was none.

Armed with my DuPont material, I went to Dr. Robert Castillo MD, who at the time was the psychiatrist at the Maricopa County Homeless Clinic. He was skeptical, stating that he was aware of naltrexone and that it seemed to work for his chocolate addicts, but didn't see how it would work for alcoholics. I simply said, "Bob, nothing works now, what do we have to lose? If it doesn't work, we are just out the cost of the medication. BUT, if it does work! We had been working with a 30 year old male, Kurt who had attempted sobriety dozens of times. The programs that did not work for him ranged from a $24,000 28 day residential program to basic AA meetings. He was patient X.

In February of 1995 we went to Walgreens armed with our prescription. To my dismay, I was told that it would take two days to get the medication since it was newly approved and not kept in inventory. Kurt had that look on his face that anyone who deals with alcoholics immediately recognizes. Kurt was craving alcohol badly, and I was afraid that we were going to lose him. That night, he drank cheap whiskey, high octane malt liquor, mint mouthwash, followed up with the vanilla extract from his cupboard. The next day Wallgreens called to say that they had located the ReVia and we could pick it up.

Kurt was a mess. In the past he always detoxed by himself and had no history of seizures or complications. He was completely out of money and could not secure any more alcohol. He was ready for Naltrexone. We went to Walgreen's together. As we passed the liquor department, I knew where Kurt wanted to linger. We pressed on to the pharmacist. Finally, here it was, a small, round, 50mg tablet (since revised) that could mean the difference between life and death. As we left the drugstore, Kurt observed that he could not feel anything. Despite having no experience with the medication, I assured him that it would take effect and he would notice the difference.

For the next hour we talked about alcohol and what it had done to his life. As the conversation proceeded, I noticed a calmness and a sense of well being descend upon him. The stress and anxiety that was in his face just an hour before was gone. Out of the blue, I asked him if he wanted a drink. He looked at me, startled, and said no. At that point he realized that the Naltrexone was working. I was shocked, for deep down I really did not believe that it would work. I took Kurt home, hoping against all experience that he would remain sober. The next day, Kurt was alert and sober. He stated that he was not craving alcohol, and the detox seemed to be mild considering what he had been drinking. He took another 50mg tablet and we waited for what the next 24 hours would bring.

I decided to further test the Naltrexone. The next day I took Kurt to lunch at one of my favorite Mexican food haunts, the kind of place where the various aromas including eau of stale alcohol filled the air. Kurt was relaxed and stated that he had no craving for alcohol. In the past, an open beer six blocks away could set off his cravings, and here we were, with open beer bottles all around us, and they meant nothing. At that point I started to have confidence in the ReVia, and in the various studies that I had read. Four days later, Kurt received a $500 income tax refund, and not one cent went for alcohol. Three months later, Kurt was still sober.

I spent the summer of 1995 looking for a program that was or would utilize Naltrexone as a component. I contacted close to two dozen programs and drew a blank from each. The reaction ranged from disbelief to out and out hostility to the concept that a medication could eliminate the craving and need to consume alcohol. I could not believe the close-minded attitude that I encountered. I resolved to implement a program on my own in order to clearly demonstrate the effectiveness of Naltrexone. I had the perfect population: alcohol-dependent individuals who had tried everything else, and failed.

I went to my supervisor at Central Arizona Shelter Services and again was met with skepticism. They would agree to provide the meeting space for a Naltrexone based group, however they insisted upon an outside agency providing the actual program. Since there were no "outside agencies," I took it upon myself to create Assisted Recovery Center of Arizona and established program protocols. I then went to the Maricopa County Homeless Clinic and they agreed to provide the medical component of the program, minus the Naltrexone, which they had no funds for. The last piece fell into place when DuPont Pharma agreed to provide the Naltrexone as a community service at no cost. The components were now all in place.

In April of 1996 our initial rookie class of four alcohol-dependent individuals began the Assisted Recovery program at CASS. As the weeks wore on, all four showed dramatic results. They were no longer craving or using alcohol. The focus of our program at the time was primarily relapse prevention, utilizing standard methods. As we expanded the program, and gained experience with the Naltrexone, we realized that while on the medication, relapse was not really an issue. It became clear that the main issue was not how to avoid having a drink, but rather how to "get a life."

Our program participants had burned all their bridges and basically had nothing. Now we had taken alcohol away from them too! The main focus of the program shifted to cognitive counseling and rebuilding bridges. As the effectiveness of the Naltrexone became crystal clear, I again attempted to contact several local programs with our results. Again, absolutely no interest. It must be remembered that we were not conducting an experiment or completing a study. We were utilizing the Naltrexone in a "real life situation." As time passed, most of our participants left the shelter and reintegrated into the community. About one in five would relapse. We discovered that these individuals usually had deep seeded emotional and mental issues, and could not "get a life." We encouraged those individuals to return to the program when they were ready. Our hope was to eventually stabilize their addiction with Naltrexone and work with them so that they could find peace with their sobriety.

We now state in our program that individuals are not addicted to alcohol, but rather they are addicted to the effects of alcohol. The human brain is a miracle unto itself. It regulates every aspect of our lives, and keeps us functioning in a productive and positive manner. When something goes wrong, our lives are dramatically affected. Something has gone wrong with alcohol-dependent individuals.

The human brain contains an extremely important group of chemicals produced in the opioid endogenous system called endorphins. Endorphins assist humans in dealing with stress, anxiety, self-esteem, moodiness, and pain. Endorphins are the natural pain and stress relieving mechanism of the brain. The brain, which can be compared to a computer, seeks to maintain a normal level of endorphins, which in turn allow us to lead a relatively happy and productive life.

There are situations in life that the brain would respond to by releasing an extraordinary amount of endorphins into the system. For example, a death in the family would cause an individual to be upset, in effect falling off the normal plane into what we call a "emotional pit." The stress of the event will cause the brain to be stimulated into releasing endorphins which will gradually make the individual feel better. Another example would be that you just learned that you won ten million dollars in the state lottery, and boy do you experience a "natural high." Again, this is caused by the brain being stimulated by the excitement of winning, and releasing endorphins.

There are artificial methods to stimulate the release of endorphins, and you guessed it, alcohol is perhaps the most potent of all methods. When alcohol is consumed, it travels very quickly from the stomach to the blood system, where it makes it way to the brain. The human brain has millions of receptor sites, which are basically the message center of the brain. The alcohol attaches itself to the receptor, which in turn is stimulated to send an electro-chemical message to the opioid endogenous system to release endorphins. It is the release of endorphins that an alcohol-dependent individual craves. Remember, endorphins help us deal with stress, anxiety, self-esteem, moodiness and pain.

It is recognized that alcoholism is greatly influenced by genetics. If alcoholism runs in your family, the chances that you are susceptible to the disease are greatly enhanced. Individuals, however, are not born alcoholics. An at-risk individual who never consumes alcohol will never become one. Alcohol-dependent individuals become addicted when they, over a period of time, and this varies, but usually in the range of several years, consume alcohol on a regular basis. This does not necessarily mean drinking everyday, nor does the individual have to become drunk. It means that over a period of say two or three years, the individual consumes on a regular basis alcohol.

As this regular consumption of alcohol continues, the brain registers the abnormally high level of endogenous activity. At some point, which is different for each individual, the brain, like any computer whose function is to regulate, makes adjustments. It is at this point that the individual becomes addicted. In response to the high, artificially stimulated level of endorphins, the brain drastically cuts or even shuts down the normal production of endorphins. The individual is now dependent upon the consumption of alcohol in order for these vital chemicals to be released into the system. The individual is now caught between a rock and an even hard place.

By the time that they recognize that they have a drinking problem, the endogenous system is already compromised. If they continue to drink, their life goes to hell. If they stop drinking, guess what? Their life still goes to hell. Continued drinking ultimately leads to death. The primary problem remains, however, is that when the individual attempts to stop drinking, they are so stressed out and uptight, almost inevitably that will resume drinking. It is easy to understand why the vast majority of alcohol-dependent individuals relapse over and over. Each and everyone of them understands that they are just one convenience store away from relief.

So we ask, "How does one recover from alcoholism?" Essentially, the process that got an individual addicted in the first place must be reversed. Remember, an individual becomes addicted by the regular consumption of alcohol over a period of time, or to put it another way, practice, practice, practice. To recover, an individual must completely abstain from alcohol for over an even longer period of time in they spent in becoming alcohol-dependent. This recovery process can take five years, ten years or even longer to achieve. During this period of recovery, the alcohol-dependent individual must completely refrain from the consumption of any alcohol. Eventually, the brain will recognize that it is no longer being artificially stimulated by alcohol, and will again begin to produce endorphins normally. During this entire period however, the alcohol-dependent individual is focusing almost entirely on alcohol. They are either attempting to gain the courage and strength not to drink that day, or trying to figure out how to beat "the system" and have just one drink. Recovering from alcohol is a full time job that is 24 hours a day, and this process lasts for years before recovery is achieved.

It must be noted that recovery is different from being "in recovery." Recovery means that the individual is no longer alcohol-dependent. It means that when the individual wakes up in the morning, alcohol is not an issue, and that it is not an issue the entire waking day. Being "in recovery" means that the individual must maintain their complete focus on maintaining abstinence, and putting up with the emotional and physical discomfort associated with achieving sobriety. Recovery is that point when alcohol is no longer the primary focus of life. Indeed, it means that the individual can proceed through the day, constantly bombarded by elements of the alcohol world, and not have a problem.

Within one hour of taking Naltrexone for the first time, an alcohol-dependent individual will experience the intense relief of not craving, not desiring, not needing to consume alcohol. It's as if a large monkey, that has been on their back for years, clawing deeply into them as it hangs on, suddenly jumps off. The relief is very subtle in that one does not get "high" or experience any physical effects. The individual simply realizes that they are no longer focusing on alcohol.

The Naltrexone is taken for 90 days, at which point it is usually discontinued, and the individual is no longer alcohol-dependent. That does not mean that the individual has gained immunity from alcoholism. It means that the damage incurred by their current period of alcohol consumption (and this can mean 40 years or more of drinking), has been repaired by the Naltrexone. The individual is still highly susceptible to the disease, and can easily fall victim again. What we are saying is that the physical and emotional craving to consume alcohol have been eliminated. However, if the individual starts to drink on a regular basis again, the brain will say, "been there, done that," and shut down the endogenous system, and the whole process of the addiction cycle starts over again. Hopefully, however, the wealth of experience gained by the individual over the years of being alcohol-dependent will deter any thought of becoming a "social drinker."

Essentially what happens is that the Naltrexone repairs the chemical imbalance in the brain and returns the individual to that point in their life before they started drinking. At age 15 for example, before the onset of the alcoholism, it was very easy to turn down a drink. In addition, the tolerance for alcohol is greatly reduced. If an individual attends a wedding reception six months after they have discontinued the Naltrexone, and have a drink in a social environment, they will find that the drink will impact them the same way that it would impact that 15 year old non-drinker. Also, the taste of the alcohol is no longer appealing. Again, Naltrexone is not magic or a miracle cure, it is a modern medical response to a medical issue.

The Naltrexone is an absolutely essential element of the alcohol recovery process. Equally important is the participation in a Naltrexone-based recovery group. It is extremely important to have peer support during the recovery process. Often, family and friends simply do not believe or understand the effects of Naltrexone, and it is important to associate with people who do. In fact, the mark of a good program will include counseling for family and friends. Group participation is an invaluable source of information, as individuals at all different stages of recovery share their experiences. Group participation reinforces the fact that recovery is expected, not just hoped for.

Naltrexone has implications for humanity that can be compared to the impact that penicillin had in the 1930's. In the immediate future, Naltrexone has the potential to dramatically improve the lives of literally millions of individuals. It will impact not only alcoholics, but their victims. Individuals who have run afoul of the law due to their alcohol dependence can now be mandated to Naltrexone based programs, insuring that not only will they in all probably achieve recovery, but they will not pose a threat to the community in the process. The financial impact on society is staggering to say the least. Medical bills, lost time at work and the cost to the community in dealing with alcohol-dependent individuals runs in the billions of dollars. Naltrexone, which is relatively inexpensive, and extremely effective, can ultimately save society the vast majority of those billions of dollars.

Naltrexone is clearly one of the safest medications in the arsenal of modern medicine. Its effectiveness has been proven by countless studies. The side effects are non-existent or very minor. It does not cause anyone to get sick or feel bad. After a week or so on the Naltrexone, individual after individual reports that the "fog clears" and that they are able to focus on priorities that have long been submerged by alcohol. Family, friends, hobbies, even the job reemerge as issues in life to look forward to. Naltrexone is not an experiment, it is a fact. It is no longer necessary for anyone to suffer the pain, suffering and humiliation of being alcohol-dependent.

Run, don't walk, to any local program that utilizes Naltrexone. Do not hesitate. Naltrexone can save your life, or the life of someone you love.

Contact Assisted Recovery today at
(602) 264-7897 or toll free (800) 527-5344