Medication For Alcohol Use Disorder: Types, Benefits & Side Effects

Medications can be an effective part of treatment for Alcohol Use Disorder (AUD) and related conditions. Medication-Assisted Treatment (MAT) is a form of therapeutic intervention employed for individuals struggling with Alcohol Use Disorder (AUD). This method integrates medication with counseling and behavioral therapies to manage AUD and maintain recovery. Medication can be very helpful to treat alcohol use disorder when taken in conjunction with other forms of treatment, such as therapy and lifestyle changes. The benefits of medication in this context include:

• Stabilizing the mental state by eliminating the peaks and troughs induced by alcohol.
• Liberating the mind from constant thoughts about alcohol.
• Alleviating the issues related to alcohol cravings.
• Facilitating focus on lifestyle modifications that steer towards healthier living.

The use of medication for AUD should be viewed similarly to the use of medication for any other medical condition. It does not equate to replacing one drug with another. When used appropriately, the medication does not foster a new addiction.

What is Medication Assisted Treatment For Alcohol Use Disorder?

MAT stands for Medication-Assisted Treatment. It is a comprehensive approach used to treat substance use disorders, particularly opioid use disorders and alcohol use disorders. MAT combines the use of FDA-approved medications (like methadone, buprenorphine, and naltrexone for opioid addiction, and disulfiram, acamprosate, and naltrexone for alcohol addiction) in conjunction with counseling and behavioral therapies.

In the context of Alcohol Use Disorder (AUD), Medication-Assisted Treatment (MAT) refers to the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Medication-Assisted Treatment (MAT) for Alcohol Use Disorder (AUD) is a comprehensive approach to alcohol misuse, that combines FDA-approved medications with counseling and other behavioral therapies to treat alcohol dependence. The goal of MAT is not only to reduce alcohol consumption but also to improve quality of life and functional health outcomes.

Is Medication Assisted Treatment For Alcohol Use Disorder Effective?

Individuals who consume alcohol and find it challenging to cease their drinking habits may find medications designed to curb alcohol cravings beneficial. Studies have shown that MAT was associated with significant improvements in clinical outcomes in the 12 months following initiation versus the non-MAT comparison group, including larger reductions in mental health hospitalization and emergency department visits, and larger improvements in psychotropic medication adherence.

MAT was, associated with strong beneficial changes in treatment utilization. The odds of mental health hospitalizations were significantly decreased for the MAT group versus the comparison group. The odds of emergency department/crisis visits after initiating the index treatment episode also decreased for the MAT group.

National Library Of Medicine

According to the National Survey on Drug Use and Health in 2018 an estimated 14.8 million people aged 12 or older had an alcohol use disorder, corresponding to 5.4% of the population. Individuals diagnosed with the disease of alcohol use disorder should be recommended treatment.  One available treatment option is the use of medications.  Medications used in the treatment of alcohol use disorders can be provided in the primary care setting or specialty medicine setting. Most often the use of medication is done in conjunction with psychosocial treatments such as 12 step programs, individual therapy, and/or group addiction counseling. Medications are not a cure but a tool some individuals benefit from. Individuals with alcohol use disorder are at risk for alcohol withdrawal and may require medical management of withdrawal prior to initiating treatment.  Your doctor can work with you to determine what setting (outpatient or inpatient) is appropriate.

What Medications Are Used To Treat Alcohol Use Disorder?

Healthcare professionals and providers use medications that have been approved by the Food and Drug Administration (FDA) to aid in alcohol use disorder and symptom management for mental illness, chest pain, treat seizures, and alcohol cravings that result in more effective treatment. These medications can help reduce cravings, manage withdrawal symptoms, help with muscle cramps, and in conjunction with therapy, can rewire the brain’s response to alcohol. Here’s a look at four such medications that could be part of your recovery toolkit:

What is Disulfiram?

Disulfiram, marketed under the brand name Antabuse, is a medication used in the treatment of chronic alcoholism. Disulfiram was the first medication approved for the treatment of alcohol abuse or alcoholism and is considered a second-line agent (naltrexone and acamprosate are first-line).  Disulfiram causes negative physical symptoms when alcohol is consumed.

What are the effects of Disulfiram?

Disulfiram is most effective when taken in a monitored environment or at home with the help of a loved one to ensure adherence.  It produces a severe reaction when combined with alcohol, which helps deter individuals from drinking. The mechanism by which Disulfiram works is by inhibiting an enzyme involved in metabolizing alcohol, causing unpleasant effects when alcohol is consumed. These effects include flushing, nausea, and palpitations among others.

How to take Disulfiram

Take this medication by mouth with or without food or drink as directed by your doctor, usually once daily in the morning. If this medication causes drowsiness, take it at bedtime. The dosage is based on your medical condition and response to treatment.

What Are The Side Effects of Disulfiram?

Typical aversive symptoms can include a fast heart rate, skin flushing, low blood pressure, nausea, and vomiting.

Why is Disulfiram Important?

It’s important to note that it doesn’t cure alcoholism, but it can support the treatment process by deterring alcohol consumption.

What is Naltrexone?

Naltrexone is a prescription medication used to treat alcohol and opioid use disorders. It helps users to either stop drinking or using these substances and remain abstinent. it is available as an oral tablet and a long-acting injection (monthly).  Naltrexone works by inhibiting or blocking the brain’s mu-opioid receptor. It is not an opioid and is not addictive.  Naltrexone is used for both alcohol use disorders and opioid use disorders.  It is best to start Naltrexone when abstinent from alcohol or when symptoms of alcohol withdrawal have subsided.  By blocking the brain’s opioid receptors, the pleasurable effects of alcohol are diminished or not felt. Naltrexone can help to maintain sobriety, reduce cravings for alcohol and reduce the amount consumed if a relapse occurs.  Individuals with severe liver disease are not good candidates for Naltrexone.

What are the Positive Effects of Naltrexone?

Naltrexone is an opioid antagonist, meaning it blocks the mu-opioid receptor, thereby blocking the effects of alcohol and opioid medications, and preventing the intoxication these substances cause. It also modifies the interaction between the hypothalamus, pituitary gland, and adrenal gland to suppress the amount of alcohol consumed. Naltrexone works by inhibiting or blocking the brain’s mu-opioid receptor. It is not an opioid and is not addictive.

How to take Naltrexone

Naltrexone comes as an extended-release intramuscular injection and as oral tablets. According to the Mayo Clinic, Naltrexone treatment is started after you are no longer dependent on narcotics so you must have narcotic substances completely out of your system or you will experience negative side effects. Naltrexone can be taken orally via tablet or capsule. Dosages are different depending on age and the substance that is being abused.

For oral dosage form (tablets):

• For alcoholism:
  • Adults—50 milligrams (mg) once a day.
  • Children—Use and dose must be determined by your doctor.
• For narcotic addiction:
  • Adults—At first, 25 milligrams (mg) (one-half tablet) for the first dose, then another 25 mg 1 hour later. After that, the dose is 350 mg per week. Your doctor will direct you to divide up this weekly dose and take naltrexone according to one of the following schedules:
    • 50 mg (one tablet) every day; or
    • 50 mg a day during the week and 100 mg (two tablets) on Saturday; or
    • 100 mg every other day; or
    • 150 mg every 3 days.

What Are The Side Effects Of Natrexone?

Naltrexone can cause serious side effects including risk of opioid overdose, severe reactions at the site of the naltrexone injection, sudden opioid withdrawal, and liver damage or hepatitis.

Why is Naltrexone important?

Naltrexone plays a significant role in managing alcohol and opioid use disorders, which can have devastating effects on a person’s health, relationships with family, and quality of life.

What is Acamprosate?

Acamprosate, also known as Campral, is a medication primarily used to treat alcohol dependence. Acamprosate is a prescription medication that is used for the treatment of alcohol dependence. It is most beneficial in those who have abstained from alcohol and wish to continue abstaining. It has been shown to reduce cravings and withdrawal distress.  It’s used as part of a comprehensive recovery management program that includes psychosocial support. Available research suggests interaction with the glutamate neurotransmitter system.  Acamprosate has been shown to reduce post-acute or protracted withdrawal symptoms such as insomnia and anxiety.  Individuals with severe kidney disease are not good candidates for Acamprosate.

What are the positive effects of Acamprosate (Campral)?

While the exact workings of acamprosate aren’t completely understood, it’s thought to change chemical signals in the brain that would otherwise be unbalanced in a person who is addicted to alcohol. Acamprosate works by restoring this balance. According to WebMD, This medication is used along with counseling and support to help people who are alcohol dependent not drink alcohol. Acamprosate works by restoring the natural balance of chemicals in the brain (neurotransmitters).

How To Take Acamprosate (Campral)?

Acamprosate is taken orally three times a day, two pills, ideally at the same time each day. Administer the medication orally, either with or without meals, as advised by your physician, typically three times daily. Do not alter the tablet’s form by crushing or chewing it. Your dosage depends on your health status and how you react to the treatment. To maximize the medication’s effectiveness, ensure consistent usage. It should only be taken after the substances which have been removed are completely out of your system.

What Are The Side Effects Of Acomprosate?

The side effects of acamprosate can include diarrhea, nausea, vomiting, gas, upset stomach, loss of appetite, constant feeling of tiredness or weakness, dizziness, and difficulty sleeping. These are usually mild and temporary, but if they persist or worsen, medical advice should be sought.

Why Is Acomprosate Important?

Acamprosate can significantly improve the ability of a person who has alcohol dependence to not drink alcohol or abstain from drinking. The medication can help to maintain alcohol abstinence by reducing the craving for alcohol.

What Is Topiramate?

Topiramate (brand name Topamax) is an anticonvulsant that is primarily used to control seizures and to prevent migraine headaches. It has also been found effective in the treatment of alcohol dependence. Topiramate works by calming the nerves in the brain that are overactive in withdrawal and alcohol dependence, which can help reduce cravings. Topiramate has also been used as an off-label treatment for alcoholism. It has been shown to reduce cue reactivity, suppress alcohol cravings and enhance recovery outcomes among those experiencing substance use disorders.

What Are The Positive Effects of Topiramate?

Topiramate stimulates the activity of GABA, a neurotransmitter in the brain that inhibits brain activity. This effect can decrease the excitability of neurons in the brain, thus reducing the alcohol craving, for alcohol. According to GoodRX, Topamax prevents brain cells from working too fast, which can cause seizures.

How To Take Topiramate

Topiramate comes as a tablet and a sprinkle capsule (a capsule that contains small beads of medication that can be sprinkled on food or put into drinks) to take by mouth. It is usually taken with or without food twice a day in the morning and the evening. Your doctor will probably start you on a low dose of topiramate and gradually increase your dose, not more than once every week.

What Are The Side Effects Of Topiramate?

Topiramate can cause side effects, including tingling of the arms and legs, weight loss, loss of appetite, taste change, diarrhea, nausea, dizziness, sleepiness, trouble with memory, and confusion. In rare cases, Topiramate can cause vision problems and decreased sweating, and increased body temperature. If you experience any severe or persistent side effects, it’s important to consult your healthcare provider immediately.

Why Is Topiramate Important?

Topiramate represents another tool in the arsenal against alcohol dependence. It is particularly useful for individuals who haven’t responded well to other treatments. It’s also an example of how medications originally intended for other purposes, like controlling seizures, can have secondary uses in treating substance abuse disorders.

Please note that while Topiramate is a commonly prescribed medication for alcohol dependence, it is essential to discuss all potential treatment options with a healthcare provider to ensure that the chosen medication is suitable and safe for your individual health circumstances.

What Drugs are similar to Topiramate?

Topiramate is an antiepileptic drug, and other drugs in this category include:

• Gabapentin
• Pregabalin
• Carbamazepine
• Valproic acid
• Phenobarbital

These drugs may also have effects on alcohol dependence, but the evidence varies, and they should not be used for this purpose without the guidance health care of a healthcare professional.

Please note that the information about related drugs is based on their categorization as antiepileptic drugs, and this doesn’t necessarily mean that they are used or effective in treating alcohol dependence​.

What Medications Help With Alcohol Withdrawal Symptoms?

For More Information On Detox & Treatment For Alcohol Withdrawal, Visit the Alcohol Detox Center page

Benzodiazepines

Benzodiazepines are sedative medications and can be helpful to treat alcohol withdrawal symptoms. The benzodiazepine medications which are used most frequently to treat anxiety and seizures during withdrawal are:

• chlordiazepoxide (Librium)
• diazepam (Valium)

Benzodiazepines that are specifically FDA-approved to manage acute alcohol withdrawal syndrome include:

• Chlordiazepoxide (e.g., Librium)
• Clorazepate (e.g., Tranxene)
• Diazepam (e.g., Valium)
• Oxazepam (e.g., Serax)

Anticonvulsant

In addition to benzodiazepines, medical professionals may also prescribe other anticonvulsant medications to help manage symptoms of acute alcohol withdrawal syndrome during severe alcohol withdrawal. Some of these medications include:

• Carbamazepine (e.g., Tegretol)
• Gabapentin (e.g., Neurontin)
• Oxcarbazepine (e.g., Trileptal)
• Valproic Acid (e.g., Depakene)

For individuals experiencing alcohol withdrawal, the use of seizure medications may vary, either as a replacement for benzodiazepines or in conjunction with them. One advantage of these anticonvulsants is that they have a lower risk of abuse compared to benzodiazepines. However, it’s important to note that they may not necessarily prevent DTs or grand-mal seizures.

Barbiturates

Barbiturates are another type of medication that may be used to manage alcohol withdrawal symptoms in cases where benzodiazepines are not effective. Their use in emergency departments and intensive care units for severe cases of alcohol withdrawal has shown potential. However, further research is necessary to fully understand the role of barbiturates in the treatment of alcohol withdrawal syndrome. Barbiturates that are commonly prescribed by medical professionals for alcohol withdrawal include the following:

• Amobarbital. This can treat insomnia, but it’s only effective in the short term. It can also help with certain neurological (brain function) tests.
• Butalbital. This medication is part of many combination medications, including aspirin, acetaminophen, caffeine, and codeine. Depending on the combination, it can treat migraines and tension headaches.
• Methohexital. This medication is useful for anesthesia in short diagnostic and treatment procedures. It’s very helpful in procedures like electroconvulsive therapy.
• Pentobarbital. This medication is useful for pre-anesthesia. It can also stop seizures as they’re happening.
• Phenobarbital. This medication is also useful for preventing seizures or stopping them when they’re happening. This is the most commonly prescribed barbiturate for alcohol withdrawal.
• Primidone. This medication prevents convulsions, making it useful for preventing seizures.

Integrating Medication Into an AUD Treatment Plan

For an individualized AUD treatment plan, a healthcare provider must assess the person’s medical history, drinking behavior, and comorbid conditions. Medication can help manage symptoms, lessen cravings, and prevent relapse in combination with therapy and support groups.

The FDA has approved three medications for AUD: naltrexone, acamprosate, and disulfiram.

• Naltrexone blocks brain reward pathways, making alcohol less enjoyable.
• Acamprosate balances brain chemicals that were altered due to heavy drinking, and reduces withdrawal and cravings.
• Disulfiram causes a nasty reaction when alcohol is consumed, like nausea, vomiting, and flushing, which can discourage relapse.

Before using medication, it’s important to consult a healthcare provider. Medication isn’t enough to conquer AUD. An integrated treatment plan contains medication, behavior therapies, support groups, and lifestyle changes.

Safety and Side Effects of AUD Medications

Treating Alcohol Use Disorder (AUD) can involve medication. It’s important to know the benefits and side effects.

Most AUD meds lower the pleasure from alcohol or cause an unpleasant feeling when consumed. They have been effective, but can cause nausea, sedation and digestive issues.

Discussing AUD meds with a doctor can help decide if it’s the right choice. Weigh the potential side effects with the benefits, such as reduced cravings and improved mental health.

Seeking help for AUD is essential. Talking to a doctor can be the first step to finding the right treatment plan.

Medication Initiation and Duration

Medication for Alcohol Use Disorder (AUD) involves managing withdrawal symptoms, reducing cravings, and preventing relapse.

Benzodiazepines, such as diazepam, are used to reduce symptoms like anxiety, insomnia, and seizures. Yet, they can be habit-forming, and have a high risk of abuse. So, they must be used carefully and with close medical supervision.

Naltrexone is an alternative medication. It blocks the pleasurable effects of alcohol in the brain and helps to reduce cravings and prevent relapse. It is available as a daily pill or a monthly injection.

The duration of medication treatment for AUD differs for each individual. Benzodiazepines are usually short-term, for a few days to a week. Naltrexone treatment could last months or years. A healthcare professional must be consulted to determine the right medication initiation and duration for your particular needs.

Sex Differences in AUD and Response to AUD Pharmacotherapies

AUD occurs more often in men than women. But women develop AUD faster and with less alcohol. Meds used to treat AUD can reduce cravings and prevent relapse. Yet, men and women react differently to these meds. For example, naltrexone cuts the pleasure of drinking. It tends to work better in men than women. Acamprosate, which helps with withdrawal symptoms, is more effective in women than men. So, sex-specific treatments may be needed to treat AUD.

Pharmacogenetic and Pharmacometabolomic Predictors of Response

Pharmacogenetics and pharmacometabolomics are personalized approaches to treating alcohol use disorder (AUD).

Genetic testing studies how genetic variations influence a person’s reaction to medication. DNA testing can reveal if a certain medication is suitable for that individual.

Pharmacometabolomics examines the metabolism of an individual and its effect on medication. This info can show if the person processes meds faster or slower than the average.

Combining these methods helps to identify tailored, effective treatments for AUD. For instance, genetic testing may detect adverse effects from a certain medication. Thus, another med may be more suitable. By using pharmacogenetic and pharmacometabolomic predictors, healthcare providers guide patients towards personalized medication-based treatments for AUD.

Medications for Alcohol-Related Conditions

In addition to medications for AUD, there are also medications to treat conditions related to chronic alcohol use, such as stomach ulcers. These medications, such as proton pump inhibitors or H2 blockers, are designed to reduce stomach acid and promote healing. They are typically taken before meals or at bedtime, and they can start to relieve symptoms within a few days. However, they should not be used as a solution to continue drinking, and alcohol can worsen stomach ulcers and decrease the effectiveness of these medications.

What Are The Negative Effects of Medication Assisted Treatment For Alcohol Use Disorder?

While Medication-Assisted Treatment (MAT) for Alcohol Use Disorder (AUD) can be highly effective, it’s important to note that it can also have potential side effects or negative effects. These can vary depending on the specific medication used:

1. Naltrexone: Side effects can include nausea, headache, dizziness, fatigue, nervousness, insomnia, vomiting, and anxiety. In rare cases, naltrexone can cause more serious side effects such as liver damage, allergic pneumonia, and severe depression.
2. Acamprosate (Campral): Potential side effects include diarrhea, nausea, vomiting, gas, weakness, loss of appetite, and dizziness. In rare cases, acamprosate can cause allergic reactions, irregular heartbeat, and suicidal thoughts.
3. Disulfiram (Antabuse): When taken in conjunction with alcohol, disulfiram can cause a very unpleasant reaction that includes flushing, nausea, vomiting, and palpitations. Other side effects can include drowsiness, fatigue, headache, acne, and a metallic or garlic-like taste in the mouth. In rare cases, disulfiram can cause liver damage, nerve damage, and psychological reactions like psychosis.

It’s also important to note that these medications are not suitable for everyone. For example, naltrexone should not be used in people with acute hepatitis or liver failure, and disulfiram should not be used in people with severe heart disease or psychosis.

Furthermore, while these medications can help reduce cravings and support recovery, they are not a cure for AUD. They are most effective when used as part of a comprehensive treatment plan that includes counseling and psychosocial support.

Frequently Asked Questions About Medication For Alcohol Use Disorder

Is there a pill that stops the urge to drink?

Yes, there are FDA-approved medications that can help reduce the urge to drink. These include Naltrexone, Acamprosate, and Disulfiram. Each works differently and is prescribed based on individual circumstances. It’s essential to consult with a healthcare provider for the best treatment options.

What drug is commonly used to treat alcoholics?

Naltrexone, Acamprosate, and Disulfiram are commonly used to treat Alcohol Use Disorder. Naltrexone works by blocking the euphoric effects and feelings of intoxication, Acamprosate helps maintain sobriety, and Disulfiram causes unpleasant symptoms when alcohol is consumed. Treatment plans should always be personalized and guided by a healthcare provider.

What to do against alcohol craving?

There are several strategies to manage alcohol cravings. These include cognitive-behavioral strategies to cope with triggers, participation in support groups, regular exercise, stress management techniques, and taking FDA-approved medications like Naltrexone and Acamprosate. Consultation with a healthcare provider or a mental health professional can help tailor an effective approach for you.

Does Ozempic stop alcohol cravings?

Ozempic, a medication used primarily for managing type 2 diabetes, is not FDA-approved for reducing alcohol cravings. While some studies suggest potential links between certain diabetes medications and reduced alcohol consumption, it’s crucial to consult with a healthcare provider for appropriate treatment for alcohol cravings or Alcohol Use Disorder.

Which medication is best for alcohol dependence?

The “best” medication for alcohol dependence can vary greatly depending on individual circumstances, including the severity of dependence, personal health history, and other factors. FDA-approved options include Naltrexone, Acamprosate, and Disulfiram. An informed discussion with a healthcare provider will help determine the best treatment option.

Which of the following medications is used to decrease craving for alcohol use?

Without a provided list of medications, it’s difficult to answer precisely. However, Naltrexone and Acamprosate are two commonly prescribed medications used to decrease cravings for alcohol.

Is there a medication to curb alcohol consumption?

Yes, there are FDA-approved medications to curb alcohol consumption. These include Naltrexone, which can help reduce the urge to drink, and Disulfiram, which can deter drinking by causing unpleasant effects if alcohol is consumed. A healthcare provider can offer guidance on the most suitable option.

Which of the following drugs reduces the craving for alcohol?

Without a provided list of drugs, a precise answer can’t be provided. However, in a general sense, Naltrexone and Acamprosate are two drugs known to help reduce cravings for alcohol. It’s recommended to discuss with a healthcare provider to understand which medication would be most suitable.

Final Thoughts On Medication-Assisted Treatment For Alcoholism

Medications for alcohol and drug abuse during detox are broken down in the following categories according to research from The Mayo Clinic.

Anxiolytic

Relieves anxiety and tension. May promote sleep.

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Sedative

Causes drowsiness, calmness, and dulled senses. Some types may become addictive.

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Vitamin

Helps promote normal body function, growth, and development.

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Supportive Medication Includes:

IV fluids

Delivering fluids, medication, or blood directly into a vein.

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Medication-Assisted Treatment (MAT) for Alcohol Use Disorder (AUD) has emerged as a key component of comprehensive treatment approaches, demonstrating its potential in improving recovery rates and reducing the risk of relapse. It’s important to recognize that while medications like Naltrexone, Acamprosate, and Disulfiram can aid in the recovery process, they are most effective when used in combination with behavioral therapies and support networks.

MAT provides a valuable tool for managing cravings, reducing consumption, and mitigating the effects of alcohol abuse, but it’s not a standalone cure for AUD. It’s essential for healthcare providers to assess individual circumstances, health history, and severity of the disorder when prescribing these medications, and for patients to use them as part of an integrated treatment plan.

The success of MAT in treating AUD underscores the fact that alcoholism is not merely a lack of willpower or a moral failing, but a chronic disease that requires medical intervention alongside psychological and social support. Ultimately, addressing AUD involves not just controlling the physical aspects of the disease, but also changing behaviors, healing emotional wounds, and rebuilding lives.

As we continue to break down stigmas around AUD and promote access to treatments, Medication-Assisted Treatment will play an increasingly significant role in empowering individuals to reclaim control from addiction and move towards recovery.Alcohol abuse affects individuals physically, emotionally, and spiritually therefore treatment and medications should target all three areas.  Alcohol abuse also affects people differently based on their age. No single treatment approach is effective for everyone.  Medications can be considered in conjunction with therapeutic interventions or more extensive psychosocial treatments to have the best results.  Please speak to your doctor to discuss available treatment options and determine an individualized treatment plan to assist in your recovery goals or contact The Ridge to start an evaluation.