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Prometa - A Promising Treatment for Alcohol and Stimulant Dependence
by Matt Feehery

s new and updated treatments are integrated into the array of services offered for persons with chemical dependencies, it is imperative that treatment professionals educate themselves about them. We need to become familiar with these new technologies for many reasons, one reason being that consumers themselves are spending more time researching their treatment options before engaging a treatment service or program.

Matt FeeheryA second and equally important reason is that people want to know what their options are. A knowledgeable treatment professional can help guide the potential patient or inquiring family member in the decision making process. In this publication, a variety of treatment approaches and models are regularly presented: food for both thought and individual research.

In the medical arena, we know there have been recent advances in the treatment of opiate dependence and that there are many new medications that can reduce alcohol cravings during the early stages of recovery. Another treatment that is gaining wider acceptance is a program marketed under the name Prometa. Prometa is designed to assist persons dealing with alcohol, cocaine, and methamphetamine dependence.

The most remarkable aspect of the treatment is the way it can help restore mental clarity and significantly reduce cravings. Crack cocaine and methamphetamine dependent persons, as well as some alcoholics, have an extremely difficult time dealing with substantial cravings both during withdrawal and post withdrawal. Combine with that the inability of some addicts to focus on the behavioral aspects of their treatment or follow through with treatment recommendations and it is easy to see why this treatment can offer some hope of relief.

The key to Prometa is the drug Flumazenil, a benzo antagonist that restores the function of the brain’s GABA receptors, the same receptors that are altered by exposure to alcohol or stimulant abuse. Flumazenil has been traditionally used to treat benzodiazepine overdose, such as Xanax and Valium, and this use is off-label for addictions. (Many of the medications commonly used for treating withdrawal symptoms and addictions were developed for other purposes, hence their “off-label” use.)

Prometa treatments are administered intravenously in a series of treatments targeted to the specific drug of use. Both start with a series of treatments over a three day period and the treatment for stimulant dependence is enhanced by two follow-up treatments three weeks later. It is the dosing schedule and administration cycle that makes the treatment unique and effective.

From my perspective and anecdotal experience with the treatment, Prometa affords some individuals with a quicker start to their recovery program, especially in the area of craving reduction. It is not a cure nor is it touted as one. It is not, in my opinion, a stand alone treatment. The person choosing Prometa must address the behavioral aspects of their disease and engage in a program of recovery to achieve the desired results over the long term, which is true of all treatment approaches. Prometa highlights the behavioral treatment component and also addresses the nutritional aspects of recovery health.

Hythiam, Inc., the publicly traded parent company of Prometa, has spent years and millions of dollars developing the program and funding research. Prometa has also gone through many marketing campaigns and missteps since its introduction over four years ago. With a lack of US-based clinical studies to support the claims and the perception of an overly aggressive marketing approach, clinicians and treatment centers were wary of the company’s intentions and its business structure. But marketplace acceptance may be more forthcoming as clinical studies are being completed and reported.

The effectiveness of Prometa medical treatments for alcohol dependent subjects is currently being evaluated in open label and double-blind placebo-controlled studies under the direction of Jeffrey Wilkins, MD at Cedars-Sinai Medical Center in Los Angeles. A similar clinical study testing efficacy for treatment of methamphetamine dependence is being conducted by Walter Ling, MD at UCLA’s Integrated Substance Abuse Program.

Results of these and other clinical studies are expected beginning in the fall of 2008. A previous open-label study conducted by Research Across America and released in 2007 dealt with the safety and efficacy of the pharmacological component and showed cravings reductions among methamphetamine users.

The Prometa treatment program can be accessed in both residential and outpatient settings and can be incorporated into other treatment modalities at almost any time during the treatment process. The medications are non-addictive and use is obviously short term. Prometa treatment program costs start around $13,000 and are offered by licensees in all areas of the country. To find a lincensee in your area go to www.prometainfo.com.

In a positive development, Prometa treatment programs, which have only been available on a private pay basis, will be covered through some of Cigna’s insurance plans in the near future. A number of other managed care providers are also in the process of considering the addition of Prometa to their covered treatments, which should improve accessibility and ultimately drive down the cost. In the last legislative session, the State of Texas approved funding for offering Prometa through some probation and parole programs.

The primary drawback has been its high cost, but even that argument can be countered when you consider the number of repeat treatment episodes that many chemically dependent persons experience or the low success rates achieved with methamphetamine dependent persons. Sometimes we need to try different approaches if we wish to achieve different results.

A secondary drawback involves consumers looking for a “quick fix” and that is not what Prometa is. Counseling patients prior to treatment is an important step in preparing them for the potential benefits and realities. People can and will relapse, so we must do our best to educate and prepare them, no matter what treatment they consider.

Memorial Hermann Prevention and Recovery Center (PaRC) Houston was the second Prometa licensee in the US and has nearly four years of experience with it. Prometa was initially recommended on a limited basis to people experiencing severe cravings post withdrawal, people who had been treated multiple times (chronic relapses), and people whose cognition was heavily impaired by substances. With these types of cases, valuable time in treatment is often lost due to the patient’s inability to engage in treatment sooner.
Over time, the treatment has become more widely recommended for others.

Prometa is another important treatment tool available to treatment professionals and their patients. That is what drew me to inquire about it at an American Society of Addiction Medicine (ASAM) conference over four years ago. I was intrigued by the medical and scientific aspects of Prometa and chose to investigate it. We are treating a brain disease and we need to have better medical tools to deal with it. No single treatment approach is entirely effective for all populations. If we commit ourselves to the bio-psycho-social-spiritual model of treatment and recovery, then we need to be aware of the new medicines and protocols that will enhance and improve the recovery process. When the physical aspects are better managed it is easier to address the behavioral aspects.

Matt Feehery, LCDC is CEO of Memorial Hermann Prevention and Recovery Center (PaRC) in Houston, 713-329-7300 www.mhparc.org Matt has worked in the treatment field for over 29 years and currently serves as a director on the TAAP State Board.

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