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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.
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
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
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
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
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.
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.