Medications for Treating Alcohol Use Disorder

Treatment for drugs and alcohol was primarily focused on the 12-Step Program. This focus is, however, changing with the advancement in medicine. As a result of this progress, medications now have a significant role to play. Medications for addictions vary and depend on the type of substance. Using medicines for addiction is known as Medication-Assisted Treatment (MAT). This modality of treatment is now more common as acceptance continues to increase. People with alcohol use disorder can benefit from specific medications.

There are quite a few medications that help with treating alcohol use disorder. Many people do not know this, however. Also, lots of primary care doctors did not receive training to use these medications. As a result, less than 10% of people who could benefit from these medications get them.

Indeed, medications for alcohol use disorder are quite beneficial. There are only three medications that have approval from the Food and Drug Administration (FDA). These are naltrexone (and Vivitrol), disulfiram (Antabuse), and acamprosate (Campral). There are also a few other non-FDA medications that are helpful in treatment.

 

Statistics for Alcohol Use Disorder in the United States

A 2017 survey conducted by the National Survey on Drug use and Health (NSDUH) revealed the following:

  • 14.1 million adults ages 18 and older had alcohol use disorder.
  • This includes 9.0 million men and 5.1 million women.
  • About 6.5 percent of adults who had alcohol use disorder in the past year received treatment.
  • 443,000 adolescents ages 12-17 had alcohol use disorder.
  • About 5.2 percent of youth who had alcohol use disorder in the past year received treatment.
  • An estimated 88,000 people die from alcohol-related causes annually.
  • Alcohol is the third leading preventable cause of death in the United States. The first is tobacco, and the second is poor diet and physical inactivity.

The above statistics shed more light on the importance of treating this disorder. Let us begin with the three medications approved by the FDA.

 

1. Disulfiram (Antabuse)

This medication serves as a drinking deterrent. The FDA approved it in 1951 for alcohol use disorder. It was the first medication to receive such approval for alcohol use disorder.

Drinking alcohol when you are taking disulfiram causes a severe reaction. This response is called disulfiram-ethanol reaction. Because of this reaction, you are likely to stay away from drinking. In addition, sobriety is more likely when counseling is a part of your treatment.

 

How Does Disulfiram (Antabuse) Work?

Antabuse inhibits a chemical in the body known as aldehyde dehydrogenase. This reaction increases the blood levels of a substance known as acetaldehyde. It is this substance that causes an unpleasant reaction when people drink.

The symptoms and signs of a disulfiram-ethanol reaction include:

  • Nausea
  • Vomiting
  • Sweating
  • Dizziness
  • Warmness and flushing of the skin
  • Increase in heart rate
  • Palpitations
  • Low blood pressure
  • Blurring of vision
  • Shortness of breath
  • Confusion

This response usually goes away without treatment after about 30 minutes. Disulfiram helps reduce the frequency of drinking. For it to be effective, though, this medication must be taken regularly. Supervision may be an essential element in ensuring people take this medication. The disulfiram-ethanol reaction can occur even up to two weeks from the last ingestion of Antabuse. Thus, this needs to be pointed out to people receiving treatment for alcohol use disorder.

 

Side Effects of Disulfiram (Antabuse)

Even though this medication is helpful, it can present with side effects. These include:

  • Metallic taste
  • Rash
  • Drowsiness
  • Headache
  • Impotence
  • Acne
  • Fatigue
  • Severe disulfiram-ethanol reaction
  • Psychosis
  • Depression
  • Liver damage
  • Peripheral neuropathy (nerve damage)
  • Optic neuritis (damage to the eyes)

Damage to the eyes is rare. However, it is essential to monitor regularly for visual changes. Due to possible damage to the liver, regular monitoring of liver enzymes is advised.

With disulfiram, the higher the dose, the more likely you are to develop side effects. Thus, the dose has been limited to 250 to 500 mg/day for people with alcohol use disorder. The advice is to abstain from alcohol for at least 48 hours before taking this medication.

 

2. Naltrexone and Vivitrol

The FDA approved naltrexone for the treatment of alcohol use disorder in 1994. Besides alcohol treatment, it is also beneficial for treating opioid use disorder. Naltrexone is a tablet that is taken by mouth. It, however, also comes as an extended-release, monthly injectable. This injection is called Vivitrol.

 

How Does Naltrexone Work?

Naltrexone blocks opioid receptors in the brain. It decreases the “high” and pleasure that people experience when they drink alcohol. Thus, it helps to prevent relapse to heavy drinking.

In addition to decreasing the cravings for alcohol, naltrexone also decreases the pleasure of drinking. Research shows that this medication works best when you stop drinking for at least four days before treatment. By this time, you should be past the severe withdrawals from alcohol.

You can take naltrexone daily as a tablet. For the injection, though, this is given once a month in a doctor’s office. Both the pill and injection can help you have fewer days of heavy drinking. It can also help you drink less alcohol overall. The usual dose for naltrexone is 50 mg daily. Vivitrol injection is 380 mg once a month. Because of its long duration, Vivitrol is also called extended-release naltrexone.

Note, however, that medications like naltrexone work better when there is ongoing counseling. Given this, it is essential to engage with a therapist to help your recovery process. The combination of medications and counseling goes a long way in maintaining sobriety. As you know, relapses are frequent in people with alcohol use disorder.

It is not advisable to drink alcohol when you take any medication. Studies do not show any risk of consuming alcohol with naltrexone, though.

 

Side Effects of Naltrexone

The adverse effects of naltrexone include:

  • Nausea
  • Vomiting
  • Difficulty sleeping (insomnia)
  • Headaches
  • Abdominal pain
  • Anxiety
  • Body pains
  • Dizziness
  • Rash
  • Fatigue
  • Constipation
  • Decrease in appetite
  • Liver damage
  • Depression
  • Suicidal ideations

The side effects of naltrexone tablets and Vivitrol are similar. With the injection, pain, and swelling at the injection site can also occur. People with alcohol use disorder may, however, benefit more from the monthly injections as compliance is not an issue. Also, the injections tend to provide better availability of the drug in the body.

 

3. Acamprosate (Campral)

The FDA approved Acamprosate in 2004 for the treatment of alcohol use disorder. It is even more helpful for this disorder when you have ongoing counseling.

 

How Does Acamprosate Work?

This medication works by interacting with two chemicals in the brain –

  1. Gamma-aminobutyric acid (GABA)
  2. Glutamate

The interaction of acamprosate with these two brain chemicals helps to reduce relapse on alcohol. Additionally, for those who relapse, this medication helps to decrease the quantity and frequency of drinking.

The dosage for Campral is 1,998 mg/day. The tablets, however, only come in 333 mg. This dosing means you have to take two 333 mg tablets three times per day. Such dosing can be tricky for some people due to the frequency and number of pills.

Similar to naltrexone, acamprosate works best for people who stop drinking for about four to five days before treatment.

 

Side Effects of Acamprosate

Campral has some side effects:

  • Nausea
  • Diarrhea
  • Bloating
  • Itching
  • Depression
  • Anxiety
  • Excessive sweating
  • Tingling sensation
  • Dizziness
  • Dry mouth

Side effects of acamprosate tend to be mild and go away quickly.

 

Other Medications For Treating Alcohol Use Disorder

Disulfiram, naltrexone, and acamprosate all have FDA approval for treating alcohol use disorder. There are, however, some other non-FDA approved medications that help with this disorder. They include:

 

4. Topiramate (Topamax)

This medication acts on GABA and glutamate. It reduces drinks per day, drinks per drinking day, and drink days. It also decreases the number of heavy drinking days.

Side effects of Topamax include:

  • Numbness and tingling
  • Change in taste
  • Fatigue
  • Dizziness
  • Loss of appetite
  • Nausea
  • Diarrhea
  • Weight loss
  • Difficulty concentrating
  • Memory issues
  • Word finding difficulties
  • Kidney stones

 

5. Gabapentin

Gabapentin is an antiseizure medication. It is also useful for treating nerve pain. Studies have shown that it helps maintain abstinence from alcohol. It is also used in alcohol detox to ensure safe and comfortable withdrawal. Due to the benefits in alcohol use disorder, it is an option for treatment.

Side effects of gabapentin include:

  • Dizziness
  • Fatigue
  • Nausea and vomiting
  • Tremors
  • Headaches
  • Constipation
  • Depression
  • Memory problems
  • Weight gain
  • Rash
  • Unstable gait
  • Dry eyes

 

6. Carbamazepine

This medication also acts on GABA and glutamate. It is also an antiseizure medication. Carbamazepine helps to decrease the number of drinking days. Even though it is not commonly used in alcohol use disorder, it is an option.

Side effects of this medication include:

  • Drowsiness
  • Unsteady gait
  • Nausea and vomiting
  • Constipation
  • Itching
  • Dry eyes
  • Speech disturbance
  • Tremor
  • High blood pressure
  • Blood disorder
  • Liver damage
  • Inflammation of the pancreas

 

7. Divalproex

Divalproex has been shown to reduce the risk of relapse to heavy drinking. It also decreases irritability that can arise when people stop drinking. Divalproex is not a common choice for alcohol use disorder. Despite this, studies show some benefits.

Side effects of Divalproex include:

  • Headaches
  • Nausea and vomiting
  • Diarrhea
  • Fatigue
  • Liver damage
  • Inflammation of the pancreas
  • Blood disorder
  • Weight gain
  • Bleeding
  • Rash
  • Psychosis
  • Polycystic ovarian syndrome
  • Suicidality

 

8. Baclofen

Baclofen also acts on GABA in the brain. It helps with treating muscle spasms. Even though it is not approved by the FDA, studies show it helps with abstinence from alcohol. There are, however a few issues with this medication. Misuse, overdose, and withdrawal reactions are some problems with using this drug. Given the negatives of this drug, it is not common for treating alcohol use disorder.

In addition, baclofen has the following side effects:

  • Drowsiness
  • Weakness
  • Nausea
  • Confusion
  • Headache
  • Difficulty sleeping
  • Constipation
  • Itching
  • Fatigue
  • Breathing difficulty
  • Unsteady gait
  • Seizures
  • Psychosis

More research needs to be done with baclofen to ascertain its importance in treating alcohol use disorder.

 

Other Considerations for Treating Alcohol Use Disorder

When treating alcohol use disorder, it is also important to consider underlying mental illnesses such as depression, anxiety, post-traumatic stress disorder, bipolar disorder, and schizophrenia. These disorders and several others may contribute to self-medication with drugs and alcohol.

Treating underlying mental illnesses in people who abuse illicit substances (co-occurring disorders) goes a long way in helping with recovery. This treatment may be done using medications variously categorized as antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics.

 

Alcohol use disorder

Alcohol use disorder

Conclusion

Medications for addiction are helpful in the recovery process. They can help get off illicit substances and maintain sobriety. Utilizing medications for addictions is known as Medication-Assisted Treatment (MAT). Counseling is also an active component of MAT.

Despite the positives of medications for addictions, not all illicit drugs require MAT. The three main groups of addictive substances which benefit from MAT are opioids, alcohol, and nicotine.

There are three medications with approval from the FDA for treating alcohol use disorder. These are naltrexone (and Vivitrol), disulfiram (Antabuse), and acamprosate. Some other medications may also be beneficial for maintaining sobriety. Examples of the non-FDA approved drugs are topiramate, gabapentin, carbamazepine, divalproex, and baclofen.

Besides medications, it is essential to have counseling, as well. Studies show a combination of counseling with medications works better for alcohol use disorder. In addition, it is important to treat underlying mental disorders. Self-medication with alcohol is common, hence the need to prevent this.