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Medications for Alcoholism

In our quick-fix society, it’s tempting to look for a medication to cure just about any health problem, from a runny nose to an addiction to alcohol. But even with medication to help you get sober, recovery from alcoholism is anything but fast or easy. Medications like disulfiram, naltrexone and acamprosate can’t undo years of addictive behavior, but they can help you concentrate on the work of recovery and ease the long-term physical effects of alcohol withdrawal.

What Medications Are Approved for Treating Alcoholism?

The National Institute on Drug Abuse notes that only three medications have been approved by the FDA for treating alcoholism: disulfiram (Antabuse), naltrexone (ReVia) and acamprosate (Campral). But these drugs are not the only medications that can be used to help an alcoholic get through detox and recovery. Additional medications are often prescribed on an off-label or investigational basis to help recovering alcoholics. Anticonvulsants may be used to prevent seizures during withdrawal, and antidepressants or anti-anxiety drugs may be prescribed to help an alcoholic handle the emotional triggers of drinking.

Medications for alcoholism should be taken only with a doctor’s prescription. These drugs will not be effective unless they’re used regularly according to a doctor’s orders:

  • Disulfiram. Disulfiram, which goes by the brand name Antabuse, is the oldest of the FDA-approved anti-alcoholism medications. When you take Antabuse, your body no longer breaks down a compound in alcohol called acetaldehyde. As a result, if you drink while you’re taking Antabuse, this compound will build up in your system and cause extremely unpleasant side effects, like nausea, vomiting, sweating and headaches. The more extreme side effects of drinking alcohol while taking Antabuse may include heart attacks, breathing problems, coma and death.

Antabuse creates a reaction to alcohol that’s so violently unpleasant that an alcoholic supposedly won’t want to drink. However, alcoholism is a powerful disease, and many alcoholics end up drinking even if they’re taking Antabuse. Because Antabuse has a high rate of noncompliance, doctors may be reluctant to prescribe the drug to their alcoholic patients, especially in primary care clinics. However, a review of clinical trials published in Current Pharmaceutical Design indicates that Antabuse can be an effective part of a treatment program for alcoholism, provided that it’s combined with psychotherapy.

Disulfiram is not recommended for people with heart or liver disease. Antabuse can cause liver toxicity, and people who take this drug may need regular blood tests to check their liver function. Drinking heavily while taking Antabuse can be fatal.

  • Naltrexone. Naltrexone is marketed under several different brand names, including ReVia and Vivitrol. This drug is an opiate antagonist, which interferes with the way your brain reacts to alcohol. Naltrexone blocks the receptors in your brain that respond to alcohol, minimizing the pleasant effects of this chemical. Instead of feeling happy, relaxed or buzzed when you drink after taking naltrexone, you may feel nothing.

Naltrexone can be taken by mouth as a tablet (ReVia) or as an intramuscular injection (Vivitrol). When taken by mouth, naltrexone must be taken exactly as directed in order for the drug to work. When taken as an injection, the drug can usually be taken once a month. The injectable form of naltrexone may encourage compliance by eliminating the need to remember a daily pill. However, the injectable drug can pose problems of its own, like pain, infection or tissue death at the injection site. Naltrexone can cause side effects like headaches, nausea, fatigue or weakness. Taking too much naltrexone may result in liver damage, according to the U.S. National Library of Medicine.

  • Acamprosate. Acamprosate, which goes by the brand name Campral, is the newest of the drugs to be approved for treating alcohol dependence. Like naltrexone, acamprosate works by altering your brain’s response to alcohol so that you’re less likely to experience cravings. Acamprosate may also alleviate some of the long-term physical effects of withdrawing from alcohol, like edginess, sleep disturbances and depression. A review of clinical studies published in the Journal of Clinical Psychiatry indicates that alcoholics who took acamprosate had lower relapse rates and a higher number of abstinent days than those who didn’t take the medication. Naltrexone and acamprosate can be prescribed together to make treatment even more effective.

People with kidney problems or advanced liver disease should not take Campral, but alcoholics who have minor liver dysfunction may be able to take the medication safely. Campral can cause side effects like nausea, vomiting, gas, diarrhea and headaches.

*Why Effective Treatment Is Critical

Alcoholism is a widespread health problem in the United States, affecting our physical, emotional and economic health. If there were an easy solution for alcohol dependence, these numbers from the Academy of American Family Physicians wouldn’t be so disturbing:

  • Percentage of Americans who drink enough to be at risk of alcoholism: 33 percent
  • Number of deaths caused by alcohol-related injuries or illnesses each year: 100,000
  • Percentage of qualifying alcoholics who receive medication for alcoholism: 20 percent
  • Cost of alcoholism to the American economy in a given year: Over $180 billion

Why Add Medication to Your Recovery Program?

Counseling, behavioral modification and participation in self-help groups have traditionally been the front-line strategies for helping alcoholics lead sober lives. While these psychosocial strategies still play a central role in addiction treatment, the role of medication is becoming increasingly important. How can you benefit by adding medication to your recovery program? Medications for alcoholism may:

  • Curb the craving for alcohol. Every alcoholic who gets sober, whether it’s for 24 hours or 24 years, faces a risk of drinking again. As you’re doing the hard work of recovering from this disease, medications like ReVia and Campral can help you fight the urge to drink by making alcohol less appealing. Ondansetron (Zofran) and topiramate (Topamax) may also make it easier to stay abstinent.
  • Give you an incentive to stay sober. Although Antabuse does not have a high compliance rate, this drug has helped some alcoholics stay sober by making the experience of drinking extremely unpleasant, even dangerous.
  • Provide psychological support. Alcoholism is a tough addiction to fight, and you need more than one tool in your arsenal to stay sober over the long term. When you’re working your way through recovery, medication may give you a sense of reassurance that you’re using all the tools at your disposal.
  • Help you deal with the emotions underlying alcoholism. Fluoxetine (Prozac) is an antidepressant that’s often used to treat depression associated with alcohol dependence. Anti-anxiety medications may also be used to help recovering alcoholics cope with edginess and fear.

How Do I Get Medication for Alcoholism?

If you think you have a problem with alcohol, the first step is to reach out for help. Use the toll-free number above to contact an experienced addiction professional who can connect you with treatment resources in your area. When you develop a treatment plan with a doctor who’s authorized to prescribe medications for alcoholism, your doctor will consider a few factors to decide whether medication is right for you:

  1. Your physical health. If you have kidney or liver problems, heart problems or mood disorders, you may not be able to take certain anti-addiction drugs, or you may need to take a lower dose.
  2. Drug allergies and other medications. An allergy to any medication is a contraindication to taking that drug. You may also be advised not to take certain medications for alcoholism if you’re already taking other drugs that may have dangerous interactions.
  3. Your mental condition. Some anti-alcoholism medications are not recommended for people with mood disorders. If you suffer from depression or anxiety, your doctor may recommend that you take antidepressant medications to address these underlying psychological factors.
  4. Your level of motivation. Medications like Antabuse, ReVia and Campral don’t work unless you take them on a regular basis. If you’re not committed to sobriety, you aren’t likely to take a pill every day. Signs that you’re committed to getting sober include entering an intensive treatment plan, attending counseling sessions and displaying responsible behavior in your personal life and at work.

*Lapse Versus Relapse: Comparing Acamprosate and Naltrexone

Almost every alcoholic who’s tried to get sober understands the difference between a lapse and a relapse. A lapse could be defined as a temporary slip: having a glass of champagne at a wedding or sneaking a can of beer at a picnic. A relapse is a longer-term return to drinking, which may last for a night or for a lifetime.

In a meta-analysis of studies of the effects of acamprosate and naltrexone, researchers in Germany found that acamprosate was more effective at preventing an initial slip, or a lapse, while naltrexone was more effective at keeping a lapse from turning into a relapse. The study, published in a 2008 issue of the Journal of Psychopharmacology, suggests that an alcoholic’s level of motivation to stay sober might determine which drug would be more effective.

If I Take Meds, Am I Really Sober?

In some self-help groups, there’s a debate over whether you can officially call yourself “sober” if you take medication to reduce cravings, reduce anxiety or alleviate depression. Ultimately, the decision is yours. For some alcoholics, medication is ineffective or unnecessary. For others, a drug like ReVia or Prozac can literally save their lives. If you don’t have adequate support for your decision to use medication in your recovery program, the best solution is to find a treatment facility, doctor or support group that does support your choice.

The bottom line is that if you need medication to stay sober, those negative opinions don’t matter. Each alcoholic experiences recovery differently. If medication is what it takes to preserve your health, stay out of jail, keep your family or hold down a job, don’t let anyone else’s beliefs stand in your way.

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