Fighting Alcoholism with Medications

As of now there is no single drug that can cure alcoholism or that can kick out an alcoholic’s "need" to drink. However, there are a number of FDA-approved drugs alcohol abuse experts claim that when used along with psychological and social interventions (counseling and treatment, AA and the 12-step program), can help a considerable number of alcoholic patients decrease their cravings and their alcohol consumption.

Addiction specialist Joseph Volpicelli, MD, PhD and associate professor of psychiatry at the University of Pennsylvania School of Medicine says that "for me, the biggest issue is not whether these medicines work, it’s why they’re not being used more often."

Though alcoholism is now accepted as a disease, there are still those who view alcohol dependence and abuse as moral failings and believe that it can be overcome simply by willpower, adds Volpicelli. But as he and other experts point out, medications are not substitutes for alcohol. They help improve people’s chances of recovering.

Merill Herman, MD, director of psychiatric services for Montefiore Medical Center’s substance abuse treatment program and president of the New York Society of Addiction Medicine in New York City agrees that "…medications are very important and effective and work best when they’re used with psychosocial modalities."

Roger D. Weiss, MD, a professor of psychiatry at Harvard Medical School in Boston and clinical director of the alcohol and drug abuse treatment program at McLean Hospital in Belmont, Mass., notes that "medications can sometimes reduce the desire to drink. They can attenuate [weaken] the response that people get to alcohol, to make it less reinforcing, and they can, depending on which medication you’re talking about, help reduce protracted, longer-term withdrawal distress."

At present there are three FDA-approved drugs that are used for the treatment of alcoholism. A fourth medication is still being clinically tried but has already shown promising results. Below is a summary of these drugs and their effects:

Antabuse

  • approved for the treatment of alcoholism 50 years ago.

  • works by interfering with the ability to absorb alcohol.

  • inhibits production of the enzyme that breaks down acetaldehyde which builds up in the body after even a small amount of alcohol is ingested.

  • resulting side effects include flushing, nausea and palpitations.

  • best used when closely monitored in a clinic, or by a spouse or relative.

The desired effect is that when a patient uses antabuse, he/she will stop drinking when he/she feels any of the side effects, thus significantly lessening their alcohol intake. For most people, the best way to prevent relapse is to stop drinking altogether.

Vopicelli says a big limitation for a medicine like Antabuse is that instead of deciding that alcohol is a bad thing to take, people think that Antabuse is a bad thing to take and they stop taking it. Antabuse doesn’t take away your craving, and if you drink you still get the effects of alcohol you would normally in terms of the pleasure, until you reach the point where you start feeling sick."

Naltrexone

  • Helps reduce pleasure alcoholics get from drinking and the cravings that drive them to get more.

  • Works by blocking endorphin receptors in the brain. Can be taken once day in pill form, or once a month injectable form (Vivitrol).

  • Clinical trials have shown that naltrexone reduces the amount of relapses to heavy drinking. Heavy drinking is defined as four or more drinks per day for women, and five or more drinks for men.

  • Alcoholics who took naltrexone had 36% fewer heavy drinking episodes over a three-month period, compared to those who took placebo (dummy pill).

  • In a study conducted by Combining Medications and Behavioral Interventions for Alcoholism (COMBINE), sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), naltrexone has proven to be as effective as up to 20 sessions of alcohol counseling by a behavioral specialist, when either was administered under a doctor’s close supervision.

Volpicelli says "Naltrexone sort of gets at the core of what addiction is. "The way I like to describe it is that addiction is a condition in which when you do something, you want to do more and more of it. So when people have one or two drinks, instead of stopping after a few drinks they want to have three, four, five, 10 drinks. What we found is that naltrexone breaks that positive feedback loop, so that people can have one or two drinks and they don’t feel like having any more."

Campral

  • It acts on chemical messenger systems in the brain.

  • Campral is taken orally three times a day.

  • Reduces the symptoms – which include insomnia, anxiety, restlessness and unpleasant mood swings – that alcoholics experience when they abstain from drinking for long periods of time. These symptoms can lead to relapse.

  • European clinical trials, plus other combined data from other studies, show that Campral increased the proportion of alcoholics who were able to were able to stop drinking for several weeks or months.

  • However, combine trials and another US study showed that there was no apparent benefit from using Campral either on its own or with naltrexone.

  • According to NIAAA however, European patients are more severely alcohol dependents than US patients. Also, most patients in European studies have been abstaining for longer periods before taking Campral. NIAAA says that these two factors could be the reason behind the difference in the results of the studies.

"We use medicines to help detoxify people, but even after detoxification occurs the neurochemistry is still not in very good balance, and probably even more importantly, when your brain thinks it’s going to get alcohol, that elicits these compensatory neural changes so that the body goes through the equivalent of a little mild withdrawal, and [Campral] blocks that," Volpicelli explains.

Topamax

FDA approved for seizures, not for alcoholism treatment.

Works similarly with Capral and may likewise help patients reduce or avoid the symptoms of associated with abstinence.

In a study published in The Journal of the American Medical Association in October 2007, US and German researchers reported that Topamax was better than placebo at reducing heavy drinking day percentage over a 14 week-period.