Medications Used in Alcohol Treatment

Many individuals struggling with alcohol use disorder (AUD) benefit from the comprehensive treatment protocols used in modern treatment. One such treatment approach involves a combination of pharmacotherapy (the use of medication to treat alcoholism) and behavioral therapies.

Using Medications to Decrease Drinking Behavior

A review article published in the journal The American Family Physician outlines many of the medications for alcoholism—including drugs approved by the FDA and others that are used on an off-label basis—commonly utilized in the treatment of alcohol use disorders. The goal of pharmacotherapy (pharmaceutical treatment for alcoholism) in these situations is to reduce continued alcohol use and increase abstinence rates.

FDA approved medications for alcohol dependence: 1-4

  • Naltrexone
  • Acamprosate (Campral)
  • Disulfiram (Antabuse)

Naltrexone for Alcohol Cravings

This medication is an opioid antagonist, meaning that it functions to block the effects of opioid drugs at a brain receptor level. It was originally used to diminish the reward of continued opioid use in the treatment of opioid use disorder, but research has indicated that it can also increase abstinence rates in individuals recovering from alcohol use disorders through its opioid receptor blockade activity and the associated decrease in drinking reward and craving. Naltrexone for alcohol cravings is available in several formulations, including oral capsules/tablets and, as Vivitrol, as an extended-release injectable solution that is administered once per month.

Acamprosate (Campral) for Alcohol Dependence

The mechanism by which Campral works isn’t entirely clear, but acamprosate for alcohol dependence treatment is thought to help restore a balance between excitatory and inhibitory neurotransmitter systems that had previously been upended by consistent drinking behavior. In doing so, it diminishes the adverse effects associated with protracted alcohol withdrawal, to encourage continued abstinence. It is safe for individuals who have liver damage but may require some caution in administering it for individuals with kidney issues.

Disulfiram (Antabuse) and Alcohol Reaction

The medication with the longest history of approved use in treating alcohol use disorders is Antabuse. The drug has been used for decades. Antabuse interferes with the body’s ability to metabolize alcohol.4 When an individual on Antabuse drinks (even a small amount of alcohol) there is a buildup of a toxic alcohol-related compounds due to the blocked breakdown of alcohol. This produces a pronounced adverse reaction to alcohol that includes unpleasant symptoms like headaches, upset stomach, nausea and vomiting, hot sweats, flushed skin, and heart palpitations. Evidence to support the effectiveness of disulfiram for alcoholism treatment is more inconsistent than that of either naltrexone or acamprosate.

Though they don’t have specific FDA approval for the treatment of AUD, nor is there consistent evidence to support their use at this point, there has been some investigation into the potential therapeutic utility of several additional pharmacologic agents.1,2,5,6

Additional medications for alcoholism include:  

  • Topiramate (Topamax) / Valproic Acid (Depakote) / Gabapentin (Neurontin): These medications are primarily used as anticonvulsant medications and, in some instances, for neuropathic or migraine pain management. However, they are sometimes used, off-label, in the treatment of alcohol use disorders. While their individual mechanisms of action in helping treat AUD are somewhat unclear, there is some evidence, mostly in the form of findings from case studies, that indicates these drugs may help reduce cravings and increase abstinence.
  • Ondansetron (Zofran) This drug is used primarily to manage nausea and vomiting associated with chemotherapy or anesthesia. It is believed to block the effects of serotonin at a specific receptor subtype, which is associated with a reduction in alcohol-induced reward. There is some clinical evidence that suggests this drug can decrease drinking behavior and increase the number of abstinent days in individuals recovering from alcohol use disorders.
  • Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs): Results from various clinical studies suggests that certain antidepressant medications, including the SSRIs Prozac (fluoxetine) and Zoloft (sertraline), may be useful in augmenting the treatment of those in recovery from alcohol use disorders to increase abstinence rates. However, these drugs are not FDA-approved for this purpose. In some cases, MAOIs, may also be effective in decreasing alcohol use in individuals with an alcohol use disorder and co-occurring depression.
  • Baclofen: Baclofen is a skeletal muscle relaxant that has received some research support regarding a potential role to reduce cravings for alcohol. The drug is not approved by the FDA nor is it not one of the drugs listed in the article by the American Family Physician; however, a number of sources suggest that this drug can be an aid for increasing abstinence from alcohol, perhaps through a mechanism that involves craving reductions, in individuals with alcohol use disorders.

Vitamin B and Alcohol

In addition to pharmaceutical interventions, some individuals may receive vitamin supplements, such as B vitamins, as an important part of the medical care associated with their treatment for alcohol use disorder. For example, vitamin B1 (thiamine) deficiency may occur in individuals with severe alcohol use disorders who also chronically neglect their diet. This can result in a very serious syndrome known as Wernicke-Korsakoff syndrome.7

If caught early enough, progression of the disease can be slowed or stopped with vitamin B1 replacement. Wernicke-Korsakoff syndrome is associated with a range of symptoms that include profoundly altered mental status (e.g., confusion, memory problems), ocular disturbances (e.g., nystagmus), and problems with ambulation or walking (e.g., ataxia).7

Treatment of a Co-Occurring Alcohol Use Disorder and Other Medical/Mental Health Issues

In some instances, individuals with substance use disorders have other co-occurring mental health issues or comorbid physical conditions. Integrated approaches for the simultaneous treatment of all conditions often necessitate additional medications being administered to manage these concurrent, or dual diagnosis issues.8

Is Medication for Alcoholism Enough?

Despite some drugs having FDA approval for the medical treatment of alcoholism (alcohol use disorder) and others being very effective at treating the complications that occur during withdrawal from alcohol, drugs alone do not address the many issues associated with substance use disorders. While professional organizations and treatment providers maintain that substance use disorders represent diseases, medical treatments alone are not sufficient to assist one in recovering from a substance use disorder, such as an alcohol abuse issue.

Individuals recovering from an alcohol use disorder may benefit from the use of medication; however, they will also require intensive substance use disorder therapy and may require other forms of support, such as participation in 12-step groups, psychoeducation, and other behavioral interventions.

The use of prescription medication for alcohol abuse can decrease the likelihood of relapse and help manage other pertinent medical and mental health issues. However, over the long run, individuals need to be involved in a treatment program that:

  • Addresses the issues that led to the development of an alcohol use disorder
  • Promotes stress management and trigger avoidance
  • Teaches ways to evaluate and reform dysfunctional coping strategies

Following their initial rehabilitation, many individuals will maintain their recovery through long-term aftercare that can include ongoing counseling, outpatient programming, and regular participation in 12-step meetings or other social support groups. These efforts often continue for many years after they’ve quit drinking.

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