Medications For Alcohol Addiction

Medications Used In Alcohol Addiction Treatment

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), approximately 29.5 million Americans have an alcohol use disorder (AUD). AUD complications greatly affect a person’s physical health and impact various aspects such as mental health, interpersonal relationships, employment, and overall well-being. With so many people affected and with such great risks, treatment for AUD is vital.

One form of AUD treatment is medications targeted to help reduce alcohol cravings and consumption. The NIAAA highlights that these medications are not to be seen as a cure or alcohol substitute for someone dealing with AUD. However, these medications are beneficial in that they are non-habit forming and, in conjunction with counseling, have positive outcomes of reduced alcohol consumption. Currently, there are three medications used:

• Disulfiram
• Acamprosate
• Naltrexone

How Is Alcohol Addiction Treated?

The main goal of AUD treatment is to help people reduce drinking and eventually avoid alcohol entirely (abstinence). There are several treatment strategies to help achieve that goal.

Treatment approaches often involve a combination of medications and nonpharmacological options. Nonpharmacologic methods include motivational interviewing, motivational enhancement therapy, and cognitive behavioral therapy that may involve peer support groups.

Medications Used To Treat Alcohol Addiction

Currently, the US Food and Drug Administration (FDA) has approved three medications for use in alcohol addiction treatment: Disulfiram, Acamprosate, and Naltrexone.

Disulfiram

In 1951, disulfiram became the first FDA-approved drug intended to treat alcohol use disorder. The chemical name of disulfiram is bis(diethylthiocarbamoyl) disulfide, an alcohol antagonist drug.

One proposed way disulfiram works is by inhibiting an enzyme called acetaldehyde dehydrogenase that breaks down alcohol in the body. Inhibition of this enzyme leads to the accumulation of acetaldehyde. Acetaldehyde is a toxic substance in the body, and buildup can result in unpleasant symptoms that include:

• Headache
• Nausea
• Vomiting
• Flushing
• Dizziness
• Increased heart rate

Disulfiram relies on the aversion reaction of experiencing these uncomfortable symptoms when taken with alcohol to deter use.

Disulfiram is taken by mouth and is gradually absorbed in the gastrointestinal tract and eliminated slowly from the body. Disulfiram should not be given until the person has abstained from alcohol for at least 12 hours. The initial dosing regimen is a maximum dose of 500 mg daily, given in a single dose for one to two weeks, typically taken in the mornings. The average maintenance dose is 250 mg daily, not exceeding 500 mg daily. The medication is used as an aid for people who want to remain sober so that supportive and psychotherapeutic treatment options may be applied.

Without appropriate motivation and supportive therapy, disulfiram is unlikely to lead to substantive effects on the drinking patterns of chronic alcoholism. Daily therapy with disulfiram must be continued until the person fully recovers and permanent self-control is established. The duration of maintenance therapy with disulfiram may be required for months or years, depending on the individual.

Naltrexone

The second drug approved by the FDA to treat alcohol addiction was naltrexone in 1994.

Naltrexone has also been shown to help reduce alcohol cravings and has reduced the frequency and average of drinking days while increasing the number of abstinence days. Naltrexone for the treatment of alcoholism has a recommended dose of 50 mg by mouth once a day for up to 12 weeks. Side effects include:

It’s important to note that naltrexone is referred to as an opioid receptor antagonist, meaning it impacts the opioid receptors and blocks the effects of ingested opioids. This can immediately throw the person into opioid withdrawal and set off severe withdrawal symptoms, so it’s essential that anyone using naltrexone to treat AUD does not concurrently take any opioid medication.

Acamprosate

In the US, acamprosate was approved to treat AUDs in 2004. This drug acts on different neurotransmitters (glutamate and GABA) in the brain, leading to reduced alcohol intake. The most common side effects of acamprosate are:

• Diarrhea
• Nausea
• Vomiting
• Headache
• Stomachache
• Dizziness

Acamprosate is not known to cause alcohol aversion after alcohol ingestion.

The recommended dose of acamprosate is two 333 mg tablets taken orally three times a day, though some people can still benefit from a lower dose. Acamprosate is intended for maintaining abstinence in people with alcohol dependence who are sober at the start of therapy. Acamprosate should be used as part of a comprehensive management program that involves psychosocial support.

Clinical studies used for acamprosate approval ranged from 90 days to 360 days of therapy. Acamprosate should be avoided by those with severe kidney problems and people who may be allergic to any of its ingredients. Using acamprosate does not eliminate or diminish alcohol withdrawal symptoms.

Naltrexone Injection

In 2006, the FDA approved an extended-release intramuscular injection formulation of naltrexone. This formulation aims to improve adherence to the original oral tablet. The naltrexone injection is for the treatment of alcohol dependence in those who are unable to abstain from alcohol in an outpatient setting before treatment initiation. People should not actively drink alcohol at the time of initial administration.

The naltrexone injection has a recommended dose of 380 mg, given intramuscularly as a gluteal injection. The injection can be administered once every 30 days or once a month by a healthcare provider. The most common side effects were injection site reactions, nausea, abdominal pain, drowsiness, and dizziness.

Find Treatment

Excessive alcohol use or alcohol addiction can hold you back from living the life you want to live. However, with proper treatment, many people recover from alcohol use disorder.

If you are struggling with limiting your alcohol use, help is available. If you have questions or are interested in learning more about the rehab options available, contact a treatment provider to discuss further.