For nearly 20 years, William C. Moyers led two lives. There was the successful journalist, dedicated family man and churchgoer. And there was the alcoholic and cocaine addict. He'd struggled with substance abuse since he was a teenager. He'd walked away from a couple jobs when the drinking got too bad.
He'd seek treatment, stay sober for a while and then, like many alcoholics, falter. In 1994, he suffered a near-fatal relapse, failing to show up for his job as a writer and producer at CNN for four days.
Instead of firing him, his CNN supervisors, who were aware of his past drinking problems, told him: Go get treatment and you can keep your job.
"CNN stood right with me," says Moyers, the son of broadcast journalist Bill Moyers. "They held me accountable by saying, 'Moyers, you better go to treatment; you better stay sober when you get back here.' "
After a nearly four-month stay at a rehabilitation center in suburban Atlanta, Moyers returned to his job. Eleven years later, he has remained sober and now works as a vice president for the Hazelden Foundation, a substance-abuse treatment center in Minnesota. He credits his former employer with saving his life and career.
But success stories like Moyers' are surprisingly uncommon in America today.
Even as scientists have gained a better understanding of the nature of alcoholism and more effective treatments have become available, fewer people are getting help. Fewer than one in 10 of the more than 20 million alcoholics in the United States are diagnosed each year, according to a recent study by researchers at George Washington University Medical Center.
Of those who are diagnosed, fewer than half receive any type of treatment. The number of Americans entering alcoholism treatment programs has been declining steadily, dropping by more than 23% between 1993 and 2003, the latest year for which federal statistics are available.
The costs of underdiagnosis and lack of treatment are staggering. Beyond the incalculable toll on the personal lives of alcoholics and their families, there is the hefty tab for U.S. employers: an estimated $40 billion a year from absenteeism, lower productivity, healthcare and other costs, according to an analysis of federal data by Ensuring Solutions to Alcohol Problems, a research group at George Washington University.
Yet, recent research shows that roughly half of alcoholics who undergo treatment will remain sober one year later -- a success rate that compares favorably with treatments for such common chronic conditions as asthma, diabetes and high blood pressure. Based on genetic and neural imaging studies, scientists believe they understand the causes and mechanisms of alcoholism better than ever.
Research has shown alcoholism to be linked to several genes, which interact with the environment in complex ways, according to Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism.
The disease is thought to be caused by roughly 60% genetic factors and 40% environmental ones. Researchers also have begun to document changes that occur in an alcoholic's brain, especially in parts of the brain that govern motivation and emotion.
With this knowledge, some scientists, including Willenbring, believe that treatment for alcoholism could improve dramatically during the next 10 years.
For decades, the only drug available to help alcoholics was Antabuse, which produces unpleasant side effects, including headache, vomiting and chest pain, when patients drink alcohol. But two newer drugs are helping many alcoholics. Both act on the mechanisms of addiction, rather than simply deterring people from drinking, as Antabuse does. Naltrexone, approved by the Food and Drug Administration in 1994, reduces the craving for alcohol and the desire to drink more if an alcoholic has a relapse. Acamprosate, approved in 2004, is thought to normalize some of the chemical imbalances in the brain caused by prolonged alcohol abuse.
And researchers are investigating the drug topiramate, an anti-seizure medication, for the treatment of alcoholism. In preliminary research, scientists at the University of Texas in San Antonio have found that topiramate reduced the amount of drinking among recovering alcoholics and increased the number of days of total abstinence from alcohol by 26.2%, as compared with a placebo group. The National Institute on Alcohol Abuse and Alcoholism is also conducting clinical trials on topiramate for alcoholism.
As new drugs are developed and treatment improves, why are fewer people getting help?
The answer to that question is complex. Certainly, the social stigma of alcoholism and patients' unwillingness, or denial, to acknowledge their drinking as a serious problem remain issues. But some more immediate factors are exacerbating the problem, experts said.