Medications To Help Stop Drinking

Understanding Alcohol Use Disorder

Alcohol use disorder is a chronic condition characterized by a problematic pattern of alcohol consumption that leads to significant distress or impairment. It affects individuals both physically and emotionally, and can have a profound impact on their overall well-being.

Impact of Alcohol Use Disorder

Alcohol use disorder can have devastating consequences on various aspects of a person's life. It not only affects their physical health but also takes a toll on their mental and social well-being. The impact of alcohol use disorder can include:

• Physical Health: Prolonged and excessive alcohol consumption can lead to a range of physical health problems, such as liver disease, cardiovascular issues, gastrointestinal disorders, and increased risk of certain types of cancer. It can also weaken the immune system, making individuals more susceptible to infections.
• Mental Health: Alcohol use disorder is often associated with mental health disorders, such as depression, anxiety, and increased risk of suicide. Alcohol can exacerbate existing mental health conditions or contribute to the development of new ones.
• Relationships and Social Life: Alcohol abuse can strain relationships with family, friends, and significant others. It can lead to conflicts, isolation, and a breakdown in communication. Social activities and responsibilities may be neglected, and individuals may experience a decline in their overall quality of life.
• Work and Finances: Alcohol use disorder can impact an individual's ability to perform effectively at work or maintain consistent employment. Absenteeism, decreased productivity, and conflicts with colleagues may arise. Financial difficulties can also arise due to spending a significant portion of income on alcohol or experiencing job loss.

Importance of Treatment

Seeking treatment for alcohol use disorder is crucial for individuals struggling with this condition. Treatment aims to help individuals achieve and maintain sobriety, improve their overall well-being, and regain control over their lives. It typically involves a combination of behavioral therapies, support groups, and, in some cases, medication.

The use of medications in the treatment of alcohol use disorder has shown promise, particularly in conjunction with psychotherapy. Medications can help individuals reduce their alcohol consumption, manage cravings, and alleviate withdrawal symptoms, increasing the chances of successful recovery.

It is important to note that medication-assisted treatment should be undertaken under the guidance of a healthcare professional experienced in addiction medicine. They can assess the individual's specific needs and determine the most appropriate medication and treatment plan.

By seeking treatment for alcohol use disorder, individuals can take an important step towards reclaiming their lives and achieving long-lasting recovery. Through a comprehensive approach that addresses the physical, mental, and social aspects of the disorder, individuals can regain their health, rebuild relationships, and create a brighter future for themselves.

Pharmacotherapy for Alcohol Use Disorder

When it comes to treating alcohol use disorder (AUD), pharmacotherapy plays a significant role in helping individuals on their journey to recovery. Medications, when used in conjunction with other treatment approaches, have shown to be effective in addressing this disorder.

Role of Medications

Medications prescribed for AUD work by targeting specific mechanisms in the brain that are involved in addiction. These medications can help reduce cravings, manage withdrawal symptoms, and decrease the pleasurable effects of alcohol. By addressing these aspects, medications can assist individuals in reducing or abstaining from alcohol consumption.

It's important to note that medications alone may not be sufficient for complete recovery. Psychotherapy, such as counseling or support groups, is often recommended alongside pharmacotherapy to address the psychological and behavioral aspects of AUD. Combining these approaches has been shown to yield better outcomes compared to using medications or psychotherapy alone.

Combination Therapy Benefits

Research has demonstrated the added value of combining psychotherapy and pharmacotherapy in the treatment of AUD. Multiple randomized controlled trials (RCTs) have shown that the combination of psychotherapy and pharmacotherapy is more effective in preventing relapse to drinking compared to either approach alone. The combination therapy approach offers a comprehensive approach to address both the physical and psychological aspects of alcohol addiction.

In a study comparing combined therapy to psychotherapy alone, 10 out of 19 RCTs indicated the added value of combining therapy approaches in the treatment of AUD. Another study showed that out of nine RCTs comparing combined therapy with pharmacotherapy, three demonstrated the potential benefit of combining therapy in the treatment of AUD.

By combining medications with psychotherapy, individuals with AUD can receive comprehensive support that addresses both the physiological and psychological aspects of their condition. This integrated approach increases the chances of successful recovery and long-term sobriety.

In the next sections, we will explore specific medications commonly used in the pharmacotherapy of AUD. These medications, such as Naltrexone, Acamprosate, and Disulfiram, have demonstrated efficacy in helping individuals reduce alcohol consumption and maintain sobriety.

Naltrexone for Alcoholism

Naltrexone is a medication commonly used to treat alcoholism and assist individuals in their journey to stop drinking. It is available under the brand names ReVia or Vivitrol. This medication plays a crucial role in reducing the desire for alcohol and helping individuals stay sober for an extended period.

Mechanism of Action

Naltrexone works by blocking the parts of the brain responsible for creating pleasure and intoxication when alcohol is consumed. By doing so, it reduces the need to drink alcohol, making it easier for individuals to stop drinking. Importantly, naltrexone does not induce sickness if alcohol is consumed.

This medication acts as a competitive opioid antagonist, suppressing the reward system associated with alcohol consumption. By reducing the pleasure experienced after drinking alcohol, naltrexone assists in breaking the cycle of alcohol dependence and craving. It has been approved by the FDA for the treatment of alcoholism and has shown effectiveness in reducing heavy drinking and alcohol craving.

Effectiveness and Usage

The efficacy of naltrexone in treating alcoholism is dependent on consistent and long-term use. The most effective treatment involves taking naltrexone for more than 3 months, typically for 12 weeks or more. For individuals who prefer not to take a daily pill, a shot form of naltrexone is available. This monthly injection provides the same effect as the pill form [2].

Studies have shown that naltrexone, whether taken as a daily pill or a monthly injection, can significantly reduce the number of heavy drinking days and overall alcohol consumption. It can be an effective tool in the treatment of alcohol use disorder, assisting individuals in achieving and maintaining sobriety.

It is important to note that naltrexone should be used as part of a comprehensive treatment plan for alcoholism, which may include counseling, behavioral therapies, and support groups. Consulting with a healthcare professional is essential to determine the appropriate dosage and duration of naltrexone treatment, tailored to the individual's specific needs.

Naltrexone offers hope and support to individuals struggling with alcoholism by reducing the desire to drink and promoting sobriety. With its mechanism of action and proven effectiveness, it can be a valuable component of the treatment journey for those seeking to stop drinking.

Acamprosate and its Benefits

Acamprosate is a medication that has been approved by the FDA and EMA for the treatment of alcohol dependence. It is considered a first-line treatment for individuals aiming to maintain abstinence from alcohol. Acamprosate works by modulating glutamatergic transmission, affecting N-methyl-D-aspartic acid (NMDA) and metabotropic glutamate-5 receptors, and indirectly modulating GABA receptor transmission. This modulation helps to reduce alcohol craving and unpleasant withdrawal symptoms, making it an effective option for alcohol-dependent individuals.

Mode of Action

Acamprosate is a structural analogue of gamma-aminobutyric acid (GABA). While its exact mechanism of action is not fully understood, it is believed that acamprosate interacts with glutamate at the N-methyl-d-aspartate (NMDA) receptor. By doing so, it helps to stabilize the balance between glutamate and GABA neurotransmission, which can be disrupted by chronic alcohol use. This stabilization contributes to the reduction of alcohol cravings and the improvement of abstinence rates.

Efficacy in Treating Alcoholism

Several studies have demonstrated the efficacy of acamprosate in treating alcoholism. A systematic review that included 27 studies and 7,519 patients found that acamprosate had a number needed to treat (NNT) of 12 to prevent a return to any drinking. Additionally, a Cochrane review of 24 trials with 6,915 patients concluded that acamprosate reduced drinking compared to placebo (NNT = 9). It has also been shown to reduce heavy drinking days and prolong the time to relapse compared to placebo. Acamprosate is most effective in individuals who are not currently drinking alcohol.

Acamprosate is generally well-tolerated, with transient diarrhea being the most common adverse event. It does not have abuse potential and can be administered to patients with liver dysfunction. It is important to note that acamprosate should be avoided in patients with severe renal dysfunction. Overall, acamprosate has demonstrated its effectiveness in improving abstinence rates and treatment completion rates in alcohol-dependent individuals, making it a valuable option for those seeking help with alcohol cessation.

Disulfiram: The Deterrent Medication

Disulfiram is a medication used to help individuals overcome a drinking problem, acting as a deterrent to drinking rather than a cure for alcoholism. It works by interfering with the breakdown of alcohol in the body, leading to a buildup of a toxic substance called acetaldehyde. This buildup causes unpleasant symptoms when alcohol is consumed, discouraging the individual from drinking.

How Disulfiram Works?

Disulfiram acts as an inhibitor of an enzyme called aldehyde dehydrogenase, which is responsible for breaking down acetaldehyde in the body. When an individual takes Disulfiram and consumes alcohol, acetaldehyde accumulates in the bloodstream, leading to a range of unpleasant symptoms. These symptoms may include:

• Facial flushing
• Nausea and vomiting
• Headache
• Sweating
• Rapid heartbeat
• Hyperventilation

These symptoms can be highly uncomfortable and serve as a deterrent to drinking alcohol. The effects of Disulfiram can last for several hours to days, depending on the individual's metabolism and the dosage of the medication.

Considerations and Side Effects

While Disulfiram can be an effective medication for treating alcohol use disorder, there are important considerations and potential side effects to be aware of. It is crucial to follow the prescribing doctor's instructions and consult with them regarding any concerns or questions.

One essential consideration is the avoidance of any alcohol consumption while taking Disulfiram and for up to 14 days after stopping the medication. Consuming alcohol during this period can lead to severe reactions or complications, including heart attack, unconsciousness, seizures, and even death [7].

Common side effects of Disulfiram may include drowsiness or decreased alertness. If these side effects occur, it is important to avoid activities that require alertness, such as driving, operating machinery, or engaging in tasks that could pose a risk.

Disulfiram can interact with other medications that slow down the nervous system (CNS depressants), such as antihistamines, sedatives, pain medications, muscle relaxants, and anesthetics. These interactions can increase the risk of experiencing increased drowsiness. It is crucial to inform the prescribing doctor about all the medications being taken to avoid potential complications.

To prevent accidental alcohol consumption, individuals taking Disulfiram should read product labels carefully to check for alcohol content in foods and other products. It is important to avoid alcohol-containing foods like sauces and vinegars that may trigger the unwanted effects of Disulfiram.

It is crucial to have open and honest communication with a healthcare professional when considering Disulfiram as a medication for alcohol use disorder. They can provide guidance, monitor progress, and address any concerns or potential interactions to ensure the safe and effective use of the medication.

Other Medications for Alcohol Use Disorder

In addition to the commonly known medications like naltrexone, acamprosate, and disulfiram, there are other medications that have shown potential in helping individuals with Alcohol Use Disorder (AUD) reduce alcohol consumption. Two such medications are gabapentin and topiramate, and the use of antidepressants in treatment.

Gabapentin and Topiramate

Gabapentin and topiramate, although FDA-approved for seizures, have shown promising results when used "off-label" to treat AUD. These medications interact with the GABA and glutamate systems, which are involved in alcohol addiction. They have demonstrated efficacy in helping individuals avoid drinking or drink less.

Gabapentin, also known by the brand name Neurontin, is an anticonvulsant that has been found to decrease alcohol consumption in patients with AUD. A study with 150 patients showed higher abstinence rates in those taking gabapentin compared to placebo, along with lower rates of heavy drinking, improved mood, fewer cravings, and improved sleep [5]. Another study involving 60 males with a high average alcohol consumption found that those treated with gabapentin had fewer heavy drinking days and consumed less alcohol during the trial period.

Topiramate, another anticonvulsant, has shown robust therapeutic effects in treating AUD. Multiple trials have demonstrated that topiramate decreases the number of drinking days, heavy drinking days, and drinks per day [5]. It has been found to be beneficial for individuals with comorbid psychiatric disorders as well.

Antidepressants in Treatment

While antidepressants are not effective in decreasing alcohol use in individuals without coexisting mental health disorders, they can be helpful for patients with AUD who also have depression or other mental health conditions. In a study involving patients with alcohol dependence and depression, a combination of cognitive behavior therapy and sertraline (Zoloft) or naltrexone resulted in higher abstinence rates and longer delays before relapse to heavy drinking compared to placebo or either medication alone. Fluoxetine (Prozac) has also shown promising results in reducing drinking, drinking days, and heavy drinking days in patients with AUD and major depression.

It is worth noting that the use of medications like gabapentin and topiramate for AUD is considered "off-label," meaning they are not FDA-approved specifically for this indication. However, their potential benefits in reducing alcohol consumption have been observed and studied extensively.

While these medications can be effective in helping individuals with AUD, it is important to consult with a healthcare professional experienced in addiction medicine to determine the most appropriate treatment plan. The choice of medication should be personalized based on the individual's specific needs and medical history.

References

[1]: https://www.ncbi.nlm.nih.gov/pmc

‍[2]: https://familydoctor.org/naltrexone-for-alcoholism/

‍[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915396/

‍[4]: https://www.webmd.com/mental-health

‍[5]: https://www.aafp.org/pubs/afp/issues

‍[6]: https://www.samhsa.gov/medications-substance-use-disorders

‍[7]: https://www.mayoclinic.org/drugs-supplements