Medications Used in Alcohol Treatment

Many individuals struggling with alcohol use disorder (AUD) benefit from the comprehensive treatment protocols used in modern treatment. One such treatment approach involves a combination of pharmacotherapy (the use of medication to treat alcoholism) and behavioral therapies.

Using Medications to Decrease Drinking Behavior

A review article published in the journal The American Family Physician outlines many of the medications for alcoholism—including drugs approved by the FDA and others that are used on an off-label basis—commonly utilized in the treatment of alcohol use disorders. The goal of pharmacotherapy (pharmaceutical treatment for alcoholism) in these situations is to reduce continued alcohol use and increase abstinence rates.

FDA approved medications for alcohol dependence: 1-4

  • Naltrexone: This medication is an opioid antagonist, meaning that it functions to block the effects of opioid drugs at a brain receptor level. It was originally used to diminish the reward of continued opioid use in the treatment of opioid use disorder, but research has indicated that it can also increase abstinence rates in individuals recovering from alcohol use disorders through its opioid receptor blockade activity and the associated decrease in drinking reward and craving. Naltrexone for alcohol cravings is available in several formulations, including oral capsules/tablets and, as Vivitrol, as an extended-release injectable solution that is administered once per month.
  • Acamprosate (Campral): The mechanism by which Campral works isn’t entirely clear, but acamprosate for alcohol dependence treatment is thought to help restore a balance between excitatory and inhibitory neurotransmitter systems that had previously been upended by consistent drinking behavior. In doing so, it diminishes the adverse effects associated with protracted alcohol withdrawal, to encourage continued abstinence. It is safe for individuals who have liver damage but may require some caution in administering it for individuals with kidney issues.
  • Disulfiram (Antabuse): The medication with the longest history of approved use in treating alcohol use disorders is Antabuse. The drug has been used for decades. Antabuse interferes with the body’s ability to metabolize alcohol.4 When an individual on Antabuse drinks (even a small amount of alcohol) there is a buildup of a toxic alcohol-related compounds due to the blocked breakdown of alcohol. This produces a pronounced adverse reaction to alcohol that includes unpleasant symptoms like headaches, upset stomach, nausea and vomiting, hot sweats, flushed skin, and heart palpitations. Evidence to support the effectiveness of disulfiram for alcoholism treatment is more inconsistent than that of either naltrexone or acamprosate.

Though they don’t have specific FDA approval for the treatment of AUD, nor is there consistent evidence to support their use at this point, there has been some investigation into the potential therapeutic utility of several additional pharmacologic agents, including:1,2,5,6

  • Topiramate (Topamax) / Valproic Acid (Depakote) / Gabapentin (Neurontin): These medications are primarily used as anticonvulsant medications and, in some instances, for neuropathic or migraine pain management. However, they are sometimes used, off-label, in the treatment of alcohol use disorders. While their individual mechanisms of action in helping treat AUD are somewhat unclear, there is some evidence, mostly in the form of findings from case studies, that indicates these drugs may help reduce cravings and increase abstinence.
  • Ondansetron (Zofran): This drug is used primarily to manage nausea and vomiting associated with chemotherapy or anesthesia. It is believed to block the effects of serotonin at a specific receptor subtype, which is associated with a reduction in alcohol-induced reward. There is some clinical evidence that suggests this drug can decrease drinking behavior and increase the number of abstinent days in individuals recovering from alcohol use disorders.
  • Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs): Results from various clinical studies suggests that certain antidepressant medications, including the SSRIs Prozac (fluoxetine) and Zoloft (sertraline), may be useful in augmenting the treatment of those in recovery from alcohol use disorders to increase abstinence rates. However, these drugs are not FDA-approved for this purpose. In some cases, MAOIs, may also be effective in decreasing alcohol use in individuals with an alcohol use disorder and co-occurring depression.
  • Baclofen: Baclofen is a skeletal muscle relaxant that has received some research support regarding a potential role to reduce cravings for alcohol. The drug is not approved by the FDA nor is it not one of the drugs listed in the article by the American Family Physician; however, a number of sources suggest that this drug can be an aid for increasing abstinence from alcohol, perhaps through a mechanism that involves craving reductions, in individuals with alcohol use disorders.

Vitamin B and Alcohol

In addition to pharmaceutical interventions, some individuals may receive vitamin supplements, such as B vitamins, as an important part of the medical care associated with their treatment for alcohol use disorder. For example, vitamin B1 (thiamine) deficiency 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 caught early enough, progression of the disease can be slowed or stopped with vitamin B1 replacement. Wernicke-Korsakoff syndrome is associated with a range of symptoms that include profoundly altered mental status (e.g., confusion, memory problems), ocular disturbances (e.g., nystagmus), and problems with ambulation or walking (e.g., ataxia).6

Drugs Used to Treat Alcohol Withdrawals

Individuals attempting to quit drinking often need additional medical treatments such as the use of alcohol cessation drugs. A person with significant physiological alcohol dependence in the early stages of recovery may require relatively intensive medical management of the acute withdrawal syndrome as it is sometimes associated with potentially life-threatening complications. Medical detox approaches often include benzodiazepines—such as diazepam (Valium) and chlordiazepoxide (Librium)—as the standard of care for managing alcohol withdrawal. 3 When administered under the care of the treatment team, benzodiazepines help to manage certain unpleasant symptoms of withdrawal and serve as prophylaxis against withdrawal seizures. As seizure risks diminish over the course of detox, these medications can be systematically tapered down by the prescribing physician to slowly wean the individual off the medication.7

Treatment of a Co-Occurring Alcohol Use Disorder and Other Medical/Mental Health Issues

In some instances, individuals with substance use disorders have other co-occurring mental health issues or comorbid physical conditions. Integrated approaches for the simultaneous treatment of all conditions often necessitate additional medications being administered to manage these concurrent, or dual diagnosis issues.

Is Medication for Alcoholism Enough?

Despite some drugs having FDA approval for the medical treatment of alcoholism (alcohol use disorder) and others being very effective at treating the complications that occur during 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 prescription medication for alcohol abuse can decrease the likelihood of relapse and help manage other pertinent medical and mental health issues. However, over the long run, individuals need to be involved in a treatment program that:

  • Addresses the issues that led to the development of an alcohol use disorder
  • Promotes stress management and trigger avoidance
  • Teaches ways to evaluate and reform dysfunctional coping strategies

Following their initial rehabilitation, many individuals will maintain their recovery through long-term aftercare that can include ongoing counseling, outpatient programming, and regular participation in 12-step meetings or other social support groups. These efforts often continue for many years after they’ve quit drinking.

People Also Ask

What causes aversion to alcohol?

Antabuse (disulfiram) is a drug that conditions the mind and body to develop an aversion to alcohol. If someone is taking Antabuse and drinks alcohol, they will experience severely unpleasant side effects that can include headaches, hot sweats, nausea, and vomiting.

Is Antabuse still used?

Yes, the prescription drug Antabuse (disulfiram) is currently one of the three medications approved by the FDA for the treatment of chronic alcoholism.4

How is alcohol use disorder diagnosed?

A psychologist, psychiatrist, or licensed alcohol and drug counselor can diagnose someone with an alcohol use disorder after an evaluation of the patient and an assessment of their condition. A diagnosis of alcohol use disorder is based on specific criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a publication from the American Psychiatric Association. More specifically, an individual must exhibit two or more of the eleven symptoms that are listed for alcohol use disorder in order for a diagnosis to be made.9

Can your doctor help you stop drinking?

Yes, your doctor can prescribe you a medication used for the treatment of alcohol use disorder. There are currently three drugs that have been approved by the FDA, and several other drugs that have been successfully used on an off-label basis. If needed, your doctor can also refer you to an addiction treatment center for rehab services.

Is alcohol use disorder a disease?

Yes, alcohol use disorder is a disease. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol use disorder is “a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.”10

What is severe alcohol use disorder?

The severity of an alcohol use disorder is determined by the number of symptoms (listed under this condition in the DSM-5) that are exhibited by an individual.9 Mild alcohol use disorder is defined by the presence of 2 to 3 symptoms, moderate alcohol use disorder is defined by the presence of 4-5 symptoms, and severe alcohol use disorder is defined by the presence of 6 or more symptoms.

What causes alcohol use disorder?

The causes of alcohol use disorder are complex. This condition can result from the interaction of several contributing factors that include genetics, environment, and life experiences. Several studies have shown that an individual’s genetic variations are the most important contributor to the risk for alcohol use disorder.11 Nongenetic factors that play a critical role in the development of alcohol use disorder include:12

  • Depression and other psychiatric disorders
  • Certain psychological traits (such as impulsivity and low self-esteem)
  • Stress
  • Being around others who abuse alcohol
  • Easy access to alcohol

Can a blood test detect alcohol use?

Yes, various laboratory blood tests can be used to determine if you are drinking alcohol. Tests that detect ethanol levels in the serum provide the most accurate determination of an individual’s blood alcohol level. Other useful diagnostics for acute, short-term alcohol ingestion include tests that detect ethyl glucuronide (EtG) and ethyl sulfate (EtS), direct products of ethanol breakdown that can be detected in the blood for up to 36 hours following alcohol consumption. The sensitivity of these tests is highest in heavy drinkers, and results from EtG tests and EtS test do not accurately correlate with the amount or frequency of alcohol use.13

The carbohydrate-deficient transferrin (CDT) test is an FDA-approved alcohol biomarker test that detects CDT, an indirect product of alcohol metabolism that is found in the serum.14 CDT levels correlate well with an individual’s drinking pattern, and for this reason a CDT test can detect if someone is a binge drinker or a daily heavy drinker. CDT tests are also used for long-term abstinence monitoring to determine if someone in recovery has had a relapse.13

The phosphatidylethanol (PEth) test is a useful alcohol biomarker test that detects PEth, an indirect product of alcohol metabolism. PEth levels closely correlate with alcohol consumption, as the formation of PEth is totally dependent on the presence of ethanol. PEth tests can detect longer term alcohol exposure (within 1-2 weeks or longer) and are used to monitor alcohol consumption, identify early signs of harmful alcohol consumption, and track cases of alcohol use disorder or dependence.13

What happens if you drink alcohol while taking naltrexone?

Naltrexone is a medication that suppresses the euphoria and pleasurable sensations associated with alcohol. If you drink while taking naltrexone you will not experience these feelings of intoxication. Therefore, you will have less of an urge to drink and will likely reduce your alcohol intake. However, naltrexone will not reduce your body’s physical response to alcohol. Consequently, you will still experience functional impairments like loss of coordination, decreased response time, and poor judgment if you drink while taking this drug.15

 

References

  1. Winslow, BT, Onysko, M, Hebert, M. Medications for Alcohol Use Disorder. (2016) American Family Physician. 2016 Mar 15;93(6):457-465.
  2. Salisbury-Afshar, E. Pharmacotherapy for Adults with Alcohol Use Disorder. (2016) American Family Physician. 2016 Jul 15, 94(2):155-7.
  3. Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism, Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. HHS Publication No. (SMA) 15-4907. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
  4. National Alliance on Mental Illness. (2018). Disulfiram (Antabuse).
  5. Carpenter, J. E., LaPrad, D., Dayo, Y., DeGrote, S., & Williamson, K. (2018). An Overview of Pharmacotherapy Options for Alcohol Use DisorderFederal practitioner: for the health care professionals of the VA, DoD, and PHS35(10), 48–58.
  6. de Beaurepaire R. (2012). Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patientsFrontiers in psychiatry3, 103.
  7. Akhouri S, Newton EJ.(2019) Wernicke-Korsakoff Syndrome. Treasure Island (FL): StatPearls Publishing.
  8. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse. Treatment Improvement Protocol(TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131.
  1. National Institute on Alcohol Abuse and Alcoholism. (2016).
  2. (National Institute on Alcohol Abuse and Alcoholism. (2016). Alcohol Use Disorder.
  3. Edenberg, H.J., & Foroud, T. (2013). Genetics and alcoholism. Nature Reviews Gastroenterology and Hepatology, 10(8), 487-494.
  4. Genetics Home Reference. (2019). Alcohol use disorder.
  5. Nanau, R.M., Neuman, M.G. (2015). Biomolecules and biomarkers used in diagnosis of alcohol drinking and in monitoring therapeutic interventions. Biomolecules, 5(3): 1339-1385.
  6. Fleming, M., & Mundt, M. (2004). Carbohydrate-Deficient Transferrin: Validity of a New Alcohol Biomarker in a Sample of Patients with Diabetes and Hypertension. The Journal of the American Board of Family Medicine, 17(4), 247-255.
  7. National Institute on Alcohol Abuse and Alcoholism. (2008). Prescribing Medications for Alcohol Dependence.
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More