Stubborn and varied, alcoholism requires a treatment as comprehensive as the disease is powerful, and for most alcoholics, no one therapy or intervention induces complete abstinence. Recovery rates are highest when alcoholics use a variety of therapies and medications for relapse prevention and eventual sobriety.
Naltrexone, Acamprosate and Disulfiram…
The existing medications for use in the treatment of alcoholism all remain imperfect, and there does not yet exist a magic bullet solution for the disease. No medications will work well without additional psycho social therapies and education, and no medications will work without an internalized desire to change and strength of will against temptation. But although imperfect, existing medications used in the treatment against alcohol relapse do offer some assistance in cravings minimization and relapse avoidance, and clinical studies have shown that patients treated with comprehensive drug and alcohol therapies, and also using a combination of relapse preventing medications, have the best eventual recovery rates.
There are three primary medications used in the treatment of alcoholism, and all are used after detox and therapies, and are used to assist the recovering alcoholic resist the temptations to relapse. The three most widely used medications used in the treatment of alcoholism are Naltrexone, Disulfiram and Acamprosate.
The newest medication approved for the treatment of alcoholism, acamprosate works like naltrexone to reduce the intensity of experienced cravings. One major advantage of acamprosate over naltrexone is that it is not significantly metabolized in the liver, and as such can be effectively used even by patients with serious alcohol induced complications of the liver.
Acamprosate works through a mechanism of action within the glutamate systems of the brain. Chronic alcohol abuse leads to brain changes within the glutamanergic system, and disruptions within this system are one of the reasons why alcohol detoxification is so dangerous and can result in fatal convulsions. Acamprosate helps to stabilize glutamate activity in the brain for the first months after sobriety, allowing the brain to recover naturally and slowly, while reducing some of the discomforts of intermediate withdrawal symptoms.
Acamprosate has been found to reduce cravings to alcohol, and also seems to help people to sleep better during the first months of recovery (which is significant, as insomnia is a major contributor to relapse).
Acamprosate has been clinically proven effective, and some studies have shown that a combination of acamprosate and naltrexone offers the best protection against the cravings that lead to relapse and further abuse.
Often sold under the trade name Antabuse, patients taking disulfiram will feel extremely sick if they drink alcohol concurrently with the drug. Disulfiram motivates alcoholics to avoid alcohol out of a fear of experiencing intense and unpleasant symptoms, similar to a severe hangover.
Disulfiram inhibits the body's ability to effectively process alcohol, and when the body cannot break down the consumed ethanol there is a resultant increase in the enzyme acetaldehyde in the blood. Acetaldehyde is the enzyme that creates many of the symptoms of an experienced hangover, so when patients consume alcohol concurrently with disulfiram, the almost immediate sensation is one of a very strong and unpleasant hangover.
The drug is very well tolerated, but can remain active for as long as two weeks after consumption is curtailed, and there are some dangerous drug interactions. The biggest problem with disulfiram therapy for relapse avoidance is that if patients feel sufficient compulsions to drink, they can simply stop taking the medication and can again drink without sickness soon after. Disulfiram is less widely used today than other alternative medications.
Naltrexone is an opiate antagonist widely used in the treatment of both alcoholism and opiate addiction. Naltrexone reduces cravings and compulsions to drink through a mechanism of action within the dopamine mesolimbic pathways of the brain, also stimulated by alcohol.
Naltrexone reduces the pleasure associated with drinking, and also reduces cravings to use and abuse. The medication is very well tolerated by the vast majority of recovering alcoholics, and most people will not experience serious side effects after the first few days, during which time the body is becoming accustomed to the drug.
Naltrexone needs to be taken exactly as directed, and no opiates, even codeine containing cough syrups, can be taken concurrently with naltrexone. Most patients will use naltrexone for the first few months of sobriety, during which time the cravings back to use are strongest.
Naltrexone now has a long clinical history of efficacious use and numerous studies have shown that naltrexone, when used as a part of a more comprehensive alcohol treatment program, does increase the success rates of sobriety and long term abstinence.
No Medication is Enough Without Therapy
No one or even combination of medications seems to offer enough protection against relapse on their own, and any medication taken without accompanying therapy and education does not offer significant prevention against relapse. Taken as a part of a more comprehensive program of alcohol rehab and treatment though, these drugs do offer recovering alcoholics extra assistance in the battle towards abstinence and long term sobriety.
The difficulty in successfully overcoming alcoholism is such that any available tools in the arsenal of treatment need to be considered as worthy additions to a comprehensive program of recovery.
Page last updated 28/09/2015