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New medications 'bring alcohol and drug treatment into the 21st century,' says ARCA director

This article first appeared in the St. Louis Beacon, Feb. 6, 2013 - As he and his staff prepared for the opening of a new alcohol and drug treatment center in St. Louis last week, Percy Menzies talked about the challenge of getting society to embrace newer approaches to addressing addictions.

Menzies is president of Assisted Recovery Centers of America, whose latest treatment clinic opened Monday on the third floor west wing of the Metropolitan St. Louis Psychiatric Center, 5351 Delmar Blvd. The unit has 25 single-bed rooms and is expected to treat about 1,000 privately insured patients a year. The space for the newest facility is leased from MPC, which can accommodate the program because the hospital has an oversupply of beds.

Menzies says those being served have private health insurance through their jobs. ARCA has contracts with several insurers, including Cigna and United Health, to provide inpatient treatment for up to 28 days, though he says patients generally will have much shorter stays.

He says some uninsured patients can get treatment through money the Department of Mental Health has set aside for treating addictions. He says those patients are assisted through Medicaid.

ARCA is one of the largest area users of the non-addictive drug naltrexone to treat alcoholism and heroin dependency.

Menzies says naltrexone is a medication that blocks opioid receptors in the brain, stemming the euphoric effects of abusing alcohol or heroin. It's the first step in treatment, reducing the craving for addictive drugs, followed by a range of therapies to help the patient stay clean.

He says this new class of drugs is helping to “bring alcohol and drug treatment into the 21st century.”

Traditionally, the therapy for alcoholism has included a heavy focus on willpower and faith. Menzies criticizes this cold turkey approach, saying it's cruel not to offer an alcoholic a non-addictive drug to reduce the craving for a drink. In addition, he says the traditional approach overlooks alcoholism as a disease of the brain rather than a failure of willpower.

“We have to go beyond condemning people as being bad since the disease has nothing to do with being bad and can happen to anyone,” Menzies says. “It’s a disease of the pleasure system, which is excessively stimulated in addiction.”

He says society needs “to put aside our ideological beliefs and values and use evidence-based treatment. You have to treat it (drug and alcohol abuse) as a chronic illness that requires a combination of medication, counseling, behavioral therapy and psychiatric help. That’s what we specialize in.”

For the record, Menzies, a pharmacist, is a former sales rep for DuPont, which developed naltrexone. Still, that connection in no way undercuts his argument or the National Institutes of Health studies showing that naltrexone therapy produces good outcomes in treating certain addictions.

Initially, naltrexone had to be taken daily, but a newer form, called Vivitrol, allows addicts to get by with a single monthly injection. Menzies says, “The introduction of Vivitrol, the monthly injection of naltrexone, is a game changer. For the first time the compliance with the medication has significantly increased, and the relapse rates have come down drastically.”

His approach to addiction has drawn national attention, including a visit last August from R. Gil Kerlikowske, director of the Office of National Drug Control Policy. The drug czar met with some patients and families at ARCA's clinic at 6651 Chippewa St. ARCA’s work also was featured during a Nine Network town hall on heroin addiction and a Beacon and Eggs discussion on KTRS.

Still, Menzies concedes that treatment facilities have been slow to embrace naltrexone. “It’s one of the most underutilized medications in the treatment of alcoholism and heroin addiction. It’s also the first and only non-addictive drug developed to prevent heroin patients from relapsing.”

He says the company’s goal is to “bring alcohol and drug addiction into the mainstream of medical treatment. If you have diabetes, you can go to your doctor. If you have an alcohol or drug addiction, the advice is to call an 800 number. Why do we treat alcohol and drug addiction different from any other chronic condition?”

Menzies says some Missouri's public policies stand in the way of addressing alcohol and drug addictions, which he says are influenced partly by easy access and the relatively low cost of the addictive substances. He notes that Missouri ranks very low in taxes on tobacco and alcohol, making those products more affordable to consumers who might abuse them. “Price is a major component of addiction, along with easy access,” Menzies argues.

Patients coming in for treatment for alcoholism at the Delmar clinic will automatically get help for tobacco use. “Quite often, people who stop drinking take up excessive smoking. This is the first clinic that will be treating both at once. After all, what good is (treating) alcoholism then dying of emphysema or lung cancer?”

Menzies and his wife, Judy, a nurse at ARCA, are examples of immigrants who come to America in pursuit of their dreams. Some eventually start small businesses that create jobs for others, as ARCA is doing at several treatment locations. But the couple’s real motives for moving to the United States was to search for medical treatment for a severely handicapped child. In their native India, the couple said, the boy would have been doomed to an early death.

“That was unacceptable to us,” he says. “We cannot play God, deciding who should live and who should die. So we came to this country under very difficult circumstances. And he is now 37 years old.”

Being from India, it might seem odd that Menzies and his wife are Catholics. He explains that Jesuits had a heavy presence in the part of southern India where he grew up. He praises the religious order for expanding education in India.

Because of the Jesuits, he says, “We got the best schools and the best colleges.”

Many educated in the Jesuit tradition learned to speak English fluently, he says. That fact often led to a variation of a question often heard in St. Louis, he says.

“When you found someone who spoke good English, the question would be: Which high school did you attend?”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.