Can medication keep you sober? Probably not, but medication may help you stay sober, especially when medications approved for the treatment of alcoholism are combined with therapy.
While researchers have yet to find a real medication-based cure for alcoholism (and research continues in earnest), the U.S. Food and Drug Administration (FDA) has approved four medications for use in treating the disorder. These medications are all used to help people avoid relapse or decrease drinking.
The four medications approved by the FDA to treat alcoholism are:
- Oral naltrexone
- Injectable naltrexone
Why Use Medication?
Research shows that adding an approved medication for alcoholism to counseling or other forms of addiction treatment improves treatment outcomes. Alcoholism medications have been found to:
- Reduce enduring symptoms of withdrawal that can prompt relapse (acamprosate)
- Help minimize alcohol cravings
- Help recovering alcoholics who temporarily slip back into drinking to avoid complete relapse
- Prolong intervals between slips or relapses
- Increase the benefits of counseling or other alcohol treatments
Medication can help an alcoholic in early recovery stay sober long enough to develop sober living and social skills that provide a continuing base for further sobriety. These medications also reduce the severity of cravings and withdrawal symptoms.
Acamprosate helps restore brain function damaged by alcoholism, and in doing so helps alcoholics maintain abstinence.
Alcohol causes intense but relatively brief withdrawal symptoms, and much longer lasting but milder symptoms of withdrawal. Although milder, these enduring withdrawal symptoms (such as difficulty sleeping, irritability and anxiety) can lead to alcohol relapse.
Acamprosate helps motivated recovering alcoholics maintain abstinence by reducing the severity of these longer lasting withdrawal symptoms. Acamprosate is thought to reduce glutamate activity, but its exact means of action remains poorly understood.
How Well Does Acamprosate Work?
Some studies show that acamprosate can double durations of abstinence. Other studies have shown less impressive outcomes. Acamprosate seems to work best for people who are motivated to stay abstinent. It must be taken three times daily, so patient compliance is very relevant.
Advantages of Acamprosate
- Acamprosate is not metabolized in the liver, and so can be used by patients with liver damage or cirrhosis.
- It can be used by patients taking methadone or Suboxone, and by those who require opiates for pain control (unlike naltrexone).
- It causes no withdrawal symptoms and can be stopped suddenly if needed. It can also be taken safely with benzodiazepines.
- It cannot be abused and it is not dangerous, even at overdose quantities.
- Side effects are generally minimal, and those that occur are well tolerated.
Acamprosate becomes fully effective between five and eight days after treatment initiation.
Oral Naltrexone (ReVia)
Patients taking oral naltrexone experience reduced cravings for alcohol and, while taking the medication, drinking alcohol won’t produce as much pleasure. Since drinking doesn’t make people on naltrexone feel as good, people that slip while taking the medication tend to drink lesser amounts.
Oral naltrexone works by blocking receptor neurons in the brain’s natural opioid system. With these receptors blocked, consuming alcohol is not as pleasurable. Additionally, neurons in the mesolimbic system (the opioid system) are thought to be responsible, at least in part, for alcohol cravings. Blocking these receptors with naltrexone reduces craving intensity.
How Well Does Oral Naltrexone Work?
Oral naltrexone is effective at helping people maintain abstinence or drink less. Studies of oral naltrexone have shown that, compared to people taking a placebo, people taking the medication:
- Have lower rates of relapse
- If they do drink, drink less often and drink less in a sitting
Advantages of Oral Naltrexone
- It works well, particularly for people who experience heavy alcohol cravings and who are motivated to maintain abstinence.
- It is well tolerated, causing few side effects (the most common side effect is nausea).
- It has no abuse potential and causes no withdrawal symptoms.
Disadvantages of Oral Naltrexone
- It cannot be used by some people with liver problems.
- It cannot be used by anyone using methadone, Suboxone or requiring opiate pain medications.
- It may increase a person’s vulnerability to opiate overdose by decreasing opiate tolerance.
Most people begin oral naltrexone therapy within three to seven days after achieving alcohol abstinence. Naltrexone is FDA-approved for up to three consecutive months of treatment.
Injectable Naltrexone (Vivitrol)
Injectable naltrexone works in the same way as oral naltrexone to reduce alcohol cravings and decrease the pleasures of alcohol consumption. While oral naltrexone needs to be taken daily, intramuscularly injected naltrexone works for a continuous month. With a monthly injectable dose, everyday compliance is not an issue.
Studies that have examined the efficacy of naltrexone as a treatment for alcoholism have consistently encountered patient non-compliance as a barrier to successful treatment.
The advantages and disadvantages of injectable naltrexone treatment closely mimic those of oral naltrexone treatment. The main benefit of injectable naltrexone is increased patient compliance. Some points of concern include:
- The possibility of an injection site reaction.
- The duration of effectiveness means that any adverse reactions experienced will be experienced for 30 days.
Patients talking disulfiram cannot consume alcohol without becoming very ill. Patients taking this medication know this, and so avoid drinking alcohol while taking the medication. This helps people in recovery prolong abstinence and avoid relapse.
How Does Disulfiram Work?
Normally, alcohol is metabolized by the body into acetaldehyde and then into acetic acid. Disulfiram disrupts the final stage of this process (the metabolization of acetaldehyde into acetic acid), causing a much higher level of acetaldehyde in the body after any alcohol consumption.
High levels of acetaldehyde in the bloodstream lead to very uncomfortable reactions, such as the following:
- Nausea and vomiting
- Chest pains
- Muscle weakness
At higher doses, the combination of disulfiram and alcohol can lead to serious reactions that can include symptoms such as:
- Heart failure
- Respiratory depression
Disulfiram is no longer given in doses high enough to likely cause a very severe or dangerous reaction. In the past, disulfiram was given in high dosages to patients in combination with alcohol, but that is no longer accepted medical practice.
Does Disulfiram Work?
Studies have shown that disulfiram helps to reduce drinking days amongst the actively drinking, but does not seem to work better than placebo in supporting abstinence. Patients who are supervised while taking their medication (to ensure compliance) seem to do better than those who are left unsupervised.
Disulfiram is not an appropriate medication for people with any of the following:
- Mental illness
- Poor impulse control
- Cognitive impairments
No one should take disulfiram without a full understanding of the effects and potential consequences of the medication.
Medications Can Help Support Recovery
Medications can play a very supportive role as one of several pillars in a foundation of recovery. No medication yet available for the treatment of alcoholism works very well when offered as a standalone therapy — all must be combined with other therapies.
If you are interested in quitting drinking or reducing your consumption of alcohol, talk to your doctor about your suitability for any of the above medications. To find a doctor versed in alcoholism recovery, contact the National Resource Center at 877-975-1243. The center is a free service providing treatment specialists 24 hours a day to answer your questions and put you in contact with appropriate healthcare professionals in your area.