Medications Used to Treat Alcoholism

Currently, alcohol is the fourth-leading preventable cause of death in the U.S.2 Various methods are used to treat alcohol use disorder (AUD), including behavioral treatments, support groups, and medications. In this article, we will explore AUD and medications for alcoholism.

Alcohol Use Disorder (AUD)

Problem drinking that escalates is given the medical diagnosis of alcohol use disorder (AUD). To date, around 15 million people in the United States have AUD, including 9.2 million men, 5.3 million women, and 401,000 adolescents ages 12–17.3

Practitioners refer to 11 basic criteria to assess whether you have AUD and to gauge its severity. Severity is based on the number of criteria you meet based on your symptoms:4

  • Mild (2–3 criteria)
  • Moderate (4–5 criteria)
  • Severe (6 or more criteria)

The 11 symptoms of alcohol use disorder are:

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol is present.
  5. Recurrent alcohol use that fails to fulfill major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which it is physically hazardous
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance, as defined by either a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol.
  11. Withdrawal, as manifested by either the characteristic withdrawal syndrome for alcohol or alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.4

Various evidence-based interventions are available to treat AUD. Treatment for AUD is not a one-size-fits-all solution and is most effective when tailored to you. In other words, what works for one person may not work for you.

Inpatient and outpatient treatment, support groups, or medication are all common approaches to treating AUD.1 For AUD and opioid dependence, pharmacotherapies are available that are safe and effective when used in a comprehensive treatment protocol, such as medication-assisted treatment.

If you or someone you know is suffering from alcoholism, call 800-839-1686Who Answers? to speak to a rehab specialist and discuss your options for treatment.

Medication-Assisted Treatment (MAT) for AUD

Medication-assisted treatment (MAT) uses medications in combination with counseling and behavioral therapies to provide a holistic approach to treating alcoholism. Medications for alcohol withdrawal or a medical detox may be a necessary first step in recovery if you are physically dependent on alcohol.5,6

Some people are better candidates for MAT than others.7 Additionally, each medication has a different mechanism of action and will work differently depending on how you respond to the particular medication and dose.7

People who may benefit from MAT include:

  • Those who don’t respond to psychosocial treatments alone
  • Those who have a goal of abstinence
  • Those who want a more comprehensive recovery approach
  • Those who suffer from intense cravings for alcohol

The role of medication-assisted treatment varies depending on the needs and goals of each patient. Common goals for the use of MAT include:5

  • Reduction in substance use
  • Overdose prevention
  • Withdrawal from dependence
  • Relapse prevention

FDA-Approved Medications for Alcoholism

Currently, only 3 medications have been approved by the FDA to treat alcoholism or AUD:5,6

  • Acamprosate
  • Disulfiram (Antabuse)
  • Naltrexone

Acamprosate

Acamprosate reduces alcohol withdrawal symptoms by normalizing the brain’s alcohol-related changes, which also reduces the potential for relapse to occur. It also may reduce insomnia, anxiety, restlessness, and dysphoria.

It’s available in oral form (taken 3 times daily).7 Acamprosate appears to be most effective in achieving complete sobriety from alcohol versus simply reducing how much alcohol is consumed.

Acamprosate is usually started 5 days after the last time you drank alcohol. However, it can be used safely in combination with alcohol (and benzodiazepines) and can be started during medically-supervised withdrawal in a detox setting.

You can usually see the medication’s effectiveness in 5 to 8 days, and it can be continued even if you revert to drinking alcohol.5 There are no significant drug interactions with acamprosate.5

Disulfiram (Antabuse)

Disulfiram, also called Antabuse, was the first medication approved by the FDA for the treatment of alcoholism. It is an alcohol aversive or alcohol-sensitizing agent, meaning it causes a toxic reaction 10 to 30 minutes after alcohol ingestion, making you not want to drink alcohol due to the effects you feel. Some people report feeling nauseous, dizzy, or weak and experiencing blurred vision on Antabuse. Although disulfiram doesn’t stop cravings for alcohol, it may motivate you to stay sober.5

Disulfiram is most effective when given in a monitored manner, such as in a clinic or by a spouse.7 You may be able to self-administer disulfiram, especially if you’re highly motivated to quit drinking. You may also use it periodically as “insurance” for high-risk social situations and holidays where alcohol is present.7

Disulfiram cannot be started until 12 hours after abstaining from alcohol or until your blood alcohol concentration level is zero. If you are on disulfiram, you may be monitored with tests such as those for breath or blood alcohol, and liver function.

Patient education and ongoing supervision, as well as contingency management, are important when taking disulfiram.5

Naltrexone

Naltrexone blocks opioid receptors involved in the euphoric effects experienced after drinking alcohol and the craving for alcohol. Naltrexone is available in two forms:7

  • Oral (Depade & ReVia) once-daily dosing
  • Injectable (Vivitrol) extended-release, taken once a month as an injection.7

According to the National Institute on Alcohol Abuse and Alcoholism, “Naltrexone reduces the relapse risk during the first 3 months by about 36%.”7 Oral naltrexone is most effective when prescribed for patients who are highly motivated and/or supported with monitored daily dosing.5 Extended-release injectable naltrexone showed a 25% reduction in excessive drinking with better outcomes among males.7

Naltrexone is most effective if you have:5

  • A history of opioid use disorder and are seeking treatment for alcohol use disorder.
  • Intense craving for alcohol during treatment.
  • A family history of alcohol use disorders.
  • The Asp40 allele of the gene encoding the mu-opioid receptor (OPRM1).
  • Issues adhering to daily dosing and respond better to monthly, injectable naltrexone.

Other Medications Used in Alcoholism

Other drugs on the market may be used to treat AUD, but research on these drugs’ efficacy is lacking.8 These medications for alcoholism include:8

  • Topiramate (Topamax): May decrease alcohol intake in patients with alcohol use disorder.
  • Ondansetron (Zofran): May decrease alcohol intake in patients with alcohol use disorder.

Generally, the first 6 to 12 months after initiating abstinence is the hardest for most people, but sobriety gets easier over several years.7 From a clinical standpoint, a minimum of 3 months of pharmacotherapy is recommended initially. Some people may respond well and won’t need to continue taking medications, while others may need more time and support.7

Statistically, most people with AUD do recover, but it does take time.1 Seeking professional help, behavioral interventions, support groups, and therapy early on are beneficial.

Behavioral therapies can help you develop skills to get past triggers, such as stress, that might instigate increased alcohol use. Medications can help combat drinking during times when people may be at greater risk or provide an extra safeguard for triggering social situations.

A comprehensive plan where a combination of interventions is used is effective in treating AUD. In most circumstances, alcohol detox is recommended as the first step in treating alcohol addiction.

Alcohol Withdrawal: Detox and Treatment

If you have been drinking excessively and then suddenly stop, you may experience some uncomfortable side effects, known as withdrawal syndrome. Depending on how much and how long you have been drinking, withdrawal may occur anywhere from a few hours to a few days after the last alcohol intake. Acute alcohol withdrawal symptoms may include:9

  • Anxiety
  • Agitation
  • Insomnia
  • Irritability
  • Upset stomach
  • Nausea/vomiting
  • Tremors
  • Seizures

If you are on the severe spectrum of AUD, you may experience more severe and potentially life-threatening withdrawal symptoms such as:9

  • Fevers
  • Hallucinations
  • Grand mal seizures
  • Severe mental confusion

Depending on if your case is mild, moderate, or severe, you may need a medical detox to safely go through withdrawal followed by additional treatment at an inpatient or outpatient facility.

Medications Used to Treat Alcohol Withdrawal

Some doctors may suggest medications to ease the uncomfortable alcohol detox process. More than 90% of acute symptomatic seizures emerge within 48 hours of alcohol cessation, so it’s important to ensure you are taking the right precautions when you stop drinking.9

Primary medications used in alcohol detox are:

  • Benzodiazepines—diazepam and chlordiazepoxide
  • Barbiturates—phenobarbital to control seizures

Benzodiazepines help your body to remain in a calm state, reducing the agitation and anxiety that can occur during detox.9 This drug can also help to control seizures, much like barbiturates do. Both drugs should be used under medical supervision.

If you have a history of drug abuse, your doctor will need to evaluate if the use of medications is appropriate since these drugs can become addictive themselves. The last thing you need is to get sober from alcohol and develop another addiction.

After detox, you may need to assess if you require further treatment at an inpatient or outpatient facility. Medications used in conjunction with other therapies (CBT, group support, counseling, alternative approaches, etc.) provide a comprehensive recovery plan.

If you are struggling with AUD, ask your doctor about medications for alcoholism and other treatment options. For more information, you can also call our support specialists at (phone) for assistance. We are here to help guide you to appropriate treatment resources.

References

  1. National Institute on Alcohol Abuse and Alcoholism. (2020). Understanding alcohol use disorder.
  2. Grossman, E. R., Benjamin-Neelon, S. E., & Sonnenschein, S. (2020). Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults. International Journal of Environmental Research and Public Health, 17(24), 9189.
  3. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol use disorder.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  5. Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed Research International, 2015, 137020.
  6. Substance Abuse and Mental Health Services Administration. (2021). Medication-Assisted Treatment.
  7. National Institute on Alcohol Abuse and Alcoholism. (2008). Helping patients who drink too much: A clinician’s guide.
  8. Winslow, B.T., Onysko, M., & Hebert, M. (2016). Medications for alcohol use disorder. American Family Physician, 15;93(6), 457-65.
  9. Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta neurologica Scandinavica, 135(1), 4–16.

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