Medication for Alcoholism
Medications can be used together with behavioral therapies to treat different substance use disorders, including alcohol use disorder (AUD). As part of a medication-assisted treatment plan, you may be prescribed certain medications during the course of treatment in both inpatient and outpatient settings to help you reduce drinking behavior and stay on track in your recovery.
While all these medications are intended to assist in sobriety and recovery, they do so via very different mechanisms.
Read on to learn about:
- FDA-approved medications for alcoholism.
- How these drugs to treat alcoholism work.
- Some risks of drugs that treat alcoholism.
- Behavioral therapies used alongside of medications for the treatment of alcohol use disorder.
How Medical Treatment for Alcoholism Works
Currently, three medications are approved by the Food and Drug Administration (FDA) for treating alcoholism.1 How these three medications work are quite different but can be utilized in combination with each other as well as in tandem with behavioral therapy to help people decrease their drinking.
Disulfiram helps to discourage alcohol consumption by giving rise to aversive reactions—such as sweating, skin flushing, and vomiting—if drinking takes place while on the medication.2
Acamprosate is thought to work by changing brain chemistry that was previously disrupted by longstanding alcohol use.3
Naltrexone helps to decrease drinking by diminishing the rewarding properties of alcohol, should it continue to be consumed while on treatment.4
In addition to these FDA-approved medications, other medications may be incorporated into an alcohol treatment plan (potentially for off-label uses) to additionally address specific symptoms that may occur in the recovery process and aid overall in reducing problematic drinking.
Disulfiram, also available under the brand name Antabuse, is a medication taken in tablet form once a day. Disulfiram changes how the body processes alcohol, resulting in distinct symptoms intended to make the person not want to drink alcohol to avoid them.2
Disulfiram may be useful for treating some people in recovery for alcoholism by triggering unpleasant symptoms if drinking continues. These effects start about 10-30 minutes after one drinks alcohol, and they can last for over an hour. The idea is to discourage an individual from drinking because of the potential for such a reaction.2, 5
The symptoms of an Antabuse reaction may include:5
- Blurry vision.
- Fast breathing.
Disulfiram should not be taken with anticoagulants such as warfarin. Physicians should also know whether the person taking disulfiram has diabetes; kidney, liver, or thyroid disease; or brain damage. Patients should also tell the physician if they are pregnant or plan to have surgery before they take disulfiram.2
Naltrexone is the generic name of a medication sometimes prescribed as Vivitrol. This medication helps to reduce the risk of relapse for people struggling with AUD but is also an effective treatment drug for people with opioid use disorders. It’s thought to work by blocking some of the positive, reinforcing sensations in the brain associated with drinking alcohol.3
Naltrexone does not give rise to aversive or unpleasant symptoms should alcohol be used like Antabuse does. Should a person drink while taking naltrexone, they will not experience physical illness, but they will also not experience the rewarding effects that make alcohol desirable for many.6 Some people additionally report a decrease in cravings for alcohol while taking the medication.3, 6
Naltrexone is an opioid receptor antagonist. It is able to bind to opioid receptors but does not itself activate them. By blocking activation of opioid receptors, naltrexone is thought to reduce the reinforcement of continued use of alcohol and opioids, as well as cravings for these substances.6
Campral is a previous brand formulation of acamprosate, a medication thought to restore some balance within specific neurotransmitter systems in the brain that have been disrupted from regular alcohol use. Though it is not thought to have any effect on acute withdrawal symptoms, it is able to decrease drinking behavior in people attempting to remain sober.4
Acamprosate is believed to alter brain chemistry by increasing activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and decreasing the opposing activity of the neurotransmitter glutamate. Before taking acamprosate, a person must have undergone detox and stopped drinking as studies do not show it being effective in people who continue to drink. The medication, combined with behavioral therapy in a rehabilitation program, can help reduce the risk of relapse.7
Anticonvulsants for Alcoholism Treatment
Anticonvulsant medications are traditionally used to help treat seizures. However, some of them have been studied for off-label purposes to augment other more standard treatments for alcohol use disorder. Though these drugs may work somewhat differently from one another, they may also play a beneficial role in AUD treatment by normalizing some of the alcohol-related disruptions to the inhibitory and excitatory brain signaling coming from the GABA and glutamate neurotransmitter systems, respectively.7
Although there are not any anticonvulsants currently approved by the FDA for treating alcohol use disorders, several studies have shown promising results. Some of the anticonvulsants studied for this indication include:7
- Carbamazepine, which showed increased time to the first heavy drinking day, reduced number of drinks and drinking days, and the number of consecutive days of heavy drinking.
- Topiramate, which showed significantly greater reductions than did placebo-treated patients in drinks per day, drinks per drinking day, drinking days, and heavy drinking days.
- Gabapentin, which may reduce heavy drinking, increase abstinence, improve sleep, and reduce acute/protracted withdrawal syndromes.
Effectiveness of Alcohol Abuse Medications
The research evidence demonstrating the effectiveness of the three FDA-approved treatment medications, as well as the off-label uses of drugs like topiramate and gabapentin has been somewhat mixed and/or is still somewhat preliminary.8
Medications alone should not be looked to as comprehensive addiction treatment; however, they may be helpful when used in conjunction with other evidence-based treatments. For instance, though acamprosate and naltrexone may modestly reduce alcohol consumption and increase alcohol abstinence rates, they work best when combined with other therapeutic approaches, including behavioral modification and supportive therapy.8
The effectiveness of any medication may also be a function of individual differences—for example, the severity of their addiction, their history with addiction recovery, their unique medical history, and any co-occurring mental health issues.
If the person being treated has any co-occurring medical or mental health issues that require medication, any possible interactions will be considered before medication is prescribed for addiction recovery.
Treatment Types for Alcohol Abuse
If you’re asking yourself “how can I stop drinking so much?” know that there are several evidence-based therapies that help people recover from alcohol addiction. These therapy options can be used in conjunction with medications for alcohol cessation.
Your precise mix of therapeutic options may depend on several things, including the type of substance use disorder you have and how severe the addiction is. Below is a handful of treatment types you can find at many facilities like River Oaks:
- Cognitive Behavioral Therapy helps individuals identify, understand, and change certain thoughts and behaviors, such as those related to drug and/or alcohol use. CBT focuses on what individuals are feeling during therapy, not necessarily what cause the reliance on substances.
- Contingency Management Interventions helps identify if clients with substance use disorders believe they need help with their substance abuse, or and how serious the implications of their behaviors are.
- Family Behavior Therapy creates opportunities for loved ones of a client to work through their feelings together in order to minimize enabling and strengthen relationships.
- Group Therapy allows patients with similar experiences to discuss their feelings and experiences with other individuals going through similar ones.
- Individual Therapy focuses on developing a treatment plan, creating recovery goals, and dealing with co-occurring disorders.