One reason many people with alcohol use disorder – a.k.a. alcoholism – keep drinking when they want to stop is fear of alcohol withdrawal symptoms. They know that within a few hours of their last drink, they can expect to experience a range of mild to severe symptoms. Mild symptoms may include mood swings, shakiness, nausea, insomnia, depression, and fatigue. Severe symptoms may include fever, hallucinations, seizures, extreme agitation/confusion, and a dangerous neurological disorder known as Wernicke-Korsakoff syndrome.
In the context of alcohol withdrawal, the word mild is relatively misleading. Mild withdrawal is extremely uncomfortable – people going through mild withdrawal would probably not describe their experience as mild. Medical experts use the word mild to describe that first set of symptoms because they pale in comparison to the second set we list, some of which are extremely dangerous. In some cases, the more severe symptoms of alcohol withdrawal can be life-threatening.
That’s a fact a lot of people don’t know. Among substances of misuse and abuse, withdrawal from alcohol is the most dangerous. It’s more dangerous than withdrawal from drugs most people consider harder than alcohol, such as opioids, cocaine, or methamphetamine.
However, a recent study conducted at Yale University reveals that a medication in use around since the mid-70s – a high-blood pressure drug called prazosin hydrochloride, commercial name Prazosin – is effective in reducing relapse rates for people diagnosed with AUD who experience severe alcohol withdrawal symptoms.
About the Study
Researchers recruited 100 people diagnosed with alcohol use disorder (AUD) who reported varying degrees of alcohol withdrawal symptoms, from mild to severe. Participants were divided into two groups. One received a placebo (a pill with no therapeutic effect) and the other received the blood pressure medication Prazosin.
Over a 12-week period, researchers measured the following outcomes:
- Self-reported drinking days
- Self-reported heavy drinking days
- Average drinks per day
- Average daily mood (depressive state)
- Presence/absence of anxiety
- Presence/absence of cravings
- Sleep quality
After collecting and analyzing the data, the research team published their results in The American Journal of Psychiatry. Here’s what they found.
- Over the 12-week period, participants with severe withdrawal symptoms reported:
- 7 heavy drinking days
- 27 drinking days
- Reduced depression
- Reduced anxiety
- Fewer cravings
- Over the 12-week period, participants with no withdrawal symptoms or mild withdrawal symptoms reported:
- 58 drinking days
- 25 heavy drinking days
- No improvements in depression or anxiety
- No reduction in cravings
Those results beg the following question. Why does the medication reduce heavy drinking days, drinking days, depression, anxiety, and cravings for people who experience severe symptoms, but not for people whose symptoms are mild?
Withdrawal and Stress
Previous research on Prazosin at Yale showed the medication works on the areas of the brain related to stress. These areas overlap with brain areas related to craving. Additional research conducted by the Yale team shows that alcohol withdrawal disrupts brain function in brain areas related to stress. This disruption is more pronounced in people who report severe withdrawal symptoms and intense cravings than people who do not. The disruptions fade over time, but their intensity in early withdrawal often leads to relapse – and that’s where this new medication might help.
Rajita Sinha, director of the Yale Stress Center, speaking to Science Daily, said:
“There has been no treatment readily available for people who experience severe withdrawal symptoms, and these are the people at highest risk of relapse and are most likely to end up in hospital emergency rooms.”
This new (old) medication may serve to help those with the most severe withdrawal symptoms make it through the period of disrupted brain function – characterized by stress, anxiety, and cravings – without relapse. Once their brain function returns to a less disrupted state, which means less stress, anxiety, and cravings, they may have a better chance at avoiding relapse and achieving sobriety.
Whenever we talk about medication that helps recovery, we need to remember – and remind our readers – that an overwhelming amount of data indicates that treatment for alcohol use disorder (AUD) should be integrated, patient-specific, and involve individual therapy, group therapy, community support, and lifestyle/behavioral change.
In other words, addiction professionals caution against hoping for a magic pill of some kind that will cure addiction.
This medication offers hope because it has the potential to help people in treatment make it through the first few days of abstinence, when cravings are the most intense and the risk of relapse is highest. When they make it past this challenging period and their brains and bodies begin to re-establish homeostasis (balance) in the absence of alcohol, they can begin to fully participate in the type of treatment activities that lead to sustainable sobriety and lifelong recovery.