Medication For Alcohol Use Disorder

The U.S. Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. ¹ Binge drinking and heavy drinking are both forms of risky or hazardous drinking. Binge drinking is defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) as consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.  NIAAA defines heavy alcohol use as more than 4 drinks on any day for men or more than 3 drinks for women. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines heavy alcohol use as binge drinking on 5 or more days in the past month. ²   Binge drinking and heavy drinking can increase an individual’s risk of developing an alcohol use disorder.

What Medications Are Used To Treat Alcohol Use Disorder?

For many individuals grappling with alcohol dependence, the journey toward recovery can be fraught with challenges. Yet, it’s important to know you’re not alone, and there’s a bevy of resources at your disposal. Among these, certain medications have been approved by the Food and Drug Administration (FDA) to aid in alcohol cessation. These medications can help reduce cravings, manage withdrawal symptoms, and rewire the brain’s response to alcohol. Here’s a look at four such medications that could be part of your recovery toolkit:

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.

How it works:

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 it:

Take this medication by mouth with or without food 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.

Side Effects:

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

Why It’s Important:

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

Naltrexone

Naltrexone is a prescription medication used to treat alcohol and opioid use disorders. It helps users to stop 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 brains 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.

How it works:

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 it:

Naltrexone comes as an extended-release intramuscular injection and as oral tablets.

Side effects:

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 it’s important:

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

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​¹​.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.

How It Works

While the exact workings of acamprosate aren’t completely understood, it’s thought to affect chemical signals in the brain that would otherwise be unbalanced in a person who is addicted to alcohol. Acamprosate works by restoring this balance.

How To Take It

Acamprosate is taken orally three times a day, ideally at the same time each day.

Side Effects

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 It’s Important

Acamprosate can significantly improve the ability of a person who has alcohol dependence to abstain from drinking. The medication can help to maintain alcohol abstinence by reducing the craving for alcohol.

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.

How it works

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 craving for alcohol.

How To Take It

Topiramate comes as a tablet and a sprinkle capsule (capsule that contains small beads of medication that can be sprinkled on food) 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​³​.

Side Effects

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​⁴​.

Why It’s 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.

Related Drugs

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 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​⁵.

What is Medication Assisted Treatment For Alcohol Use Disorder?

Medication-Assisted Treatment (MAT) for Alcohol Use Disorder (AUD) is a comprehensive approach 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.

According to the National Survey on Drug use and Health 2018 an estimated 14.8 million people aged 12 or older had an alcohol use disorder, corresponding to 5.4% of the population.³ 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 Help With Alcohol Withdrawal Symptoms?

Please note, this information is taken from the article https://theridgeohio.com/alcohol-abuse/detox/withdrawal/

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.

Final Thoughts On Medication-Assisted Treatment For Alcoholism

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

Alcohol abuse affects individuals physically, emotionally, and spiritually therefore treatment and medications should target all three areas.  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.