Individuals with moderate to severe alcohol use disorders require comprehensive treatment protocols in order to assess and overcome their issues with alcohol abuse. One of the potential forms of treatment capable of addressing a number of different issues in recovery is pharmacotherapy (the use of medications).
Medications to Eliminate or Curb Use of Alcohol
An article in the journal The American Family Physician reviewed the use of medicine in the treatment of alcohol use disorders and listed the most commonly used medications. The major medications used in the treatment of alcohol use disorders to address cravings and foster abstinence for individuals with alcohol use disorders include the following:
- Campral (acamprosate): This drug has been approved by the FDA to reduce cravings associated with recovery from alcohol use disorder. It is safe for individuals who have liver damage but may require caution for individuals with kidney issues. The mechanism by which Campral works is unknown, but it is believed to affect the neurotransmitter N-methyl-D-aspirate, a form of glutamate which is the most abundant excitatory neurotransmitter in the central nervous system. Of all FDA-approved medications for the treatment of alcohol use disorders, Campral has some of the most reliable research support.
- ReVia (naltrexone): This medication is an opioid antagonist, meaning that it is designed to block the effects of opioid drugs. It was originally used in the treatment of cravings for opiate drugs, but research has indicated that it can reduce cravings and increase abstinence in individuals recovering from alcohol use disorders. This drug was approved by the FDA and has very solid research to support its use.
- Antabuse (disulfiram): The medication with the longest history of approval for treatment of alcohol use disorders is Antabuse. The drug has been used for decades. Antabuse interferes with the body’s ability to metabolize alcohol, and when individuals on Antabuse drink alcohol, they become violently ill. This drug has a long history of physicians prescribing the drug to curb alcohol use in individuals who are in recovery; however, the research associated with its effectiveness is inconsistent because individuals can stop taking the drug if they decide they want to drink alcohol and can then drink after a couple of days of not using the drug. Nonetheless, the drug is FDA-approved for the treatment of alcohol use disorders.
- Topamax (topiramate) and Neurontin (gabapentin): These medications are primarily used as anticonvulsant medications and pain relievers. They are sometimes used in the treatment of alcohol use disorders. There is some evidence, mostly as a result of case studies, that indicates that these drugs may reduce cravings and increase abstinence. However, the drugs are not formally approved by the FDA for the treatment of alcohol use disorders.
- Zofran (ondansetron): This drug is used primarily to treat nausea. It is believed to work on a specific type of serotonin receptor. The drug has some clinical evidence to suggest that it can promote abstinence in individuals recovering from alcohol use disorders; however, it is not approved by the FDA for that purpose.
- Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs): There is some clinical evidence that certain antidepressant medications, particularly SSRIs Prozac (fluoxetine) and Zoloft (sertraline), may be useful in helping individuals in recovery from alcohol use disorders to remain abstinent. However, these drugs are not FDA-approved for this purpose. In some cases, MAOIs, such as Serentil (mesoridazine) and Zyvox (linezolid), may be useful in the treatment of individuals with an alcohol use disorder and co-occurring depression. However, MAOIs need to be used with caution because there are a number of serious side effects that can occur with their use as a result of interactions with the amino acid tyramine. People using MAOIs need to remain on strict diets that limit their intake of this amino acid. In addition, MAOIs are not approved by the FDA as a treatment for an alcohol use disorder.
- Flagyl (metronidazole): This drug is an antibiotic that may have some specific uses in promoting abstinence in individuals in recovery from alcohol use disorders. However, individuals need to be alcohol-free at least 12 hours before using the drug as there are a number of contraindications regarding its use.
- Lioresal (baclofen): Baclofen is a muscle relaxant that has received some research support regarding its efficiency to reduce cravings for alcohol. The drug is not approved by the FDA and not one of the drugs listed in the article by the American Family Physician; however, a number of sources suggest that this drug can aid in the reduction of cravings for alcohol in individuals with alcohol use disorders.
The majority of the drugs listed above, except for Antabuse, are most efficacious when the individual is already on a program of abstinence. Antabuse can be administered to individuals who are still drinking but wish to stop. In addition, individuals may receive vitamin supplements, such as B vitamins, in the treatment of alcohol use disorder. For example, vitamin B1 deficiency (thiamine) 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. If treated early enough in its course, it may be reversed by the use of vitamin B1. Wernicke-Korsakoff syndrome is associated with vision problems, problems with walking, and severe memory issues that also may leave the individual very confused.
Medications for the Treatment of Alcohol Withdrawal
Individuals who undergo the withdrawal process from an alcohol use disorder often need additional medical treatments. A person in the early stages of recovery from alcohol abuse in any withdrawal management program may be given any of the above listed medications in addition to a benzodiazepine to assist with abstinence. Benzodiazepines are the preferred medications used in physician-assisted withdrawal management from alcohol use disorders because they help to reduce the symptoms of withdrawal. They are also used in the control of seizures, which can occur in withdrawal from alcohol, and they can be slowly and systematically tapered down in their dosage by the prescribing physician in order to slowly wean the individual off the medication. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) protocol for withdrawal from alcohol, preferred benzodiazepines are Valium (diazepam) and Librium (chlordiazepoxide), although certainly other benzodiazepines are used for this purpose.
Treatment of a Co-Occurring Alcohol Use Disorder and Other Disorder
Alcohol use disorders rarely occur in isolation. Individuals with substance use disorders often have other co-occurring mental health disorders or comorbid physical conditions. Treatment for a substance use disorder should adopt a holistic approach, and these other conditions should also be treated. This can result in any number of medications being used to treat these co-occurring disorders.
Is Medication Enough?
Despite some drugs having FDA approval for the treatment of alcohol use disorders and others being very efficient at treating the complications that occur from 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 medications can assist these individuals in dealing with cravings to use alcohol; however, over the long run, individuals need to be involved in a treatment program that addresses the issues that drove their substance use disorder, teaches them positive coping skills, teaches them stress management, and helps them learn to evaluate and reform dysfunctional ways of coping with issues in their lives and the way they perceive the world.
Following formal therapy, many individuals still need to be involved in long-term aftercare programs, such as 12-Step groups or other social support groups, for years after they have discontinued using alcohol. Many individuals find that some form of continued participation in these groups is necessary even after being abstinent for decades.