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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 medications) and behavioral therapies.

Using Medications to Decrease Drinking Behavior

A review article in the journal The American Family Physician outlines many of the medications—for both FDA-approved use and those used on an off-label basis—commonly utilized in the treatment of alcohol use disorders. The goal of pharmacotherapy in these situations is to reduce continued alcohol use and increase abstinence rates.

FDA-approved treatment medications include:1,2,3

  • 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 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 it 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, and when individuals on Antabuse drink alcohol, they have a pronounced adverse reaction, which may include nausea, stomach upset, vomiting, hot/flushed skin, sweating, and heart palpitations. Evidence to support the effectiveness of disulfiram 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:1,2,4,5

  • 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 as a result of case studies, that indicates that 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 . The drug has some clinical evidence to suggest that it 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): There is some clinical evidence 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 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 increasing abstinence, perhaps through a mechanism that involves craving reductions, for alcohol in individuals with alcohol use disorders.

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 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 caught early enough, progression of the disease can be slowed or stopped with B1 replacement. Wernicke-Korsakoff syndrome is associated with a range of symptoms including profoundly altered mental status (e.g., confusion, memory problems), ocular disturbances (e.g., nystagmus), and problems with ambulation or walking (e.g., ataxia).6

Detox Medications for the Treatment of Alcohol Withdrawal

Individuals attempting to quit drinking often need additional medical treatments. 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 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 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 drove the development of their substance use disorder, promotes stress management, trigger avoidance, 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 initial rehabilitation, many individuals continue with long-term aftercare efforts, such as ongoing counseling, outpatient programming, regular 12-step meeting attendance or other social support groups, for years after they’ve quit drinking.

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. 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.
  5. de Beaurepaire R. (2012). Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patientsFrontiers in psychiatry3, 103.
  6. Akhouri S, Newton EJ.(2019) Wernicke-Korsakoff Syndrome. Treasure Island (FL): StatPearls Publishing.
  7. 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.
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