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By Boris M | 12 April, 2020 Published in Alcohol Withdrawal Symptoms
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Alcoholism is a worldwide major problem. In a 2018 study conducted by the National Survey on Drug Use and Health (NSDUH) 26.5 percent of people aged 18 or older participated in binge drinking in the past month. [1]

According to the National Crime Victimization Survey (NCVS), in 2007, 26 percent of violent crime victims reported that the offender used drugs or alcohol. [2] Every year about 88,000 people die from alcohol-related causes. Alcohol is the third-highest preventable cause of death in the US. [3]

Unfortunately, alcohol-dependent patients have been left half-treated for generations. More than half of all American adults have dealt with alcohol abuse in their families.

A staggering 10 percent of American adults at least 18 years old claim they are in recovery from some substance abuse. [4]

How can Pharmacotherapy Help?

Programs like Alcoholics Anonymous have provided support for recovering alcoholics by supplying a community, but more treatment is necessary. In the 1990s there was a noticeable lack of prescription medicine utilized for alcohol addiction treatment, even though these drugs had been FDA-approved for decades. [5]

It took many studies showing their efficacy before health care professionals agreed that a combination of medicine and some form of counselling was the most effective treatment for alcohol addiction.

Only as recently as 2005 had the National Institute on Alcohol Abuse and Alcoholism (NIAAA) finally updated their clinical manuals with recommended medicine for the treatment of alcohol dependency.

Pharmacotherapy means treating a disorder or disease with medicine. Pharmaceuticals have been shown to alleviate dependency in alcohol use disorder (AUD).

Together with other therapies like Cognitive Behavioural Therapy (CBT), pharmacotherapy can help people suffering from alcohol use disorder can learn to abstain for good.

Medical professionals have become much more comfortable prescribing medicine to patients today.

What is the criteria for determining alcohol use disorder?

To accurately determine alcohol dependency, a number of factors must be considered. Does the person: [6]

  • Use alcohol to feel secure or to relax
  • Resort to alcohol when feeling sadness
  • Fail to stop or limit drinking habits
  • Lie about or hide their drinking habits
  • Experience withdrawal symptoms when not drinking
  • Cause physical or financial problems for yourself or others due to drinking habits
  • Ignore interpersonal issues caused by drinking
  • Operate dangerous machinery while drinking
  • Have a high tolerance to alcohol [7]

If you or a loved one exhibits two or more of these trends, it is highly likely due to alcohol dependence or addiction.

Do patients have to agree to abstain before starting a course of medication?

Most patients who have a long history of alcohol use disorder may find cutting off alcohol disconcerting at first. They will instead opt to reduce their alcohol intake gradually.

Luckily some medications help to lower the number of daily drinks and binge drinking. Complete abstinence will lead to a better alcohol detox outcome for people receiving medication, but it is not necessary for treatment.

What medications are most common for treating alcohol use disorder?

Below we have listed some of the most common medications used to tackle alcohol addiction. Each one is subjective to each user, and every medication must be administered by a medical expert following a clinical assessment.

The medications include:

Better known as campral, this medication is effective at stabilizing neural networks fried by AUD and withdrawal symptoms. It is best used in tandem with other behavioral therapies.

Acamprosate is viable for patients with liver cirrhosis, though it may cause diarrhea and irritable gut. Abstinence is required for acamprosate.

Disulfiram, also known as antabuse deters alcohol use via painful results. When ingested orally, it will cause a patient to grow uncomfortably sick if alcohol is consumed.

Disulfiram is suggested for self-motivated patients since it does not actually block any physiological urges to drink. It can cause drowsiness, headache and a metallic taste.

Naltrexone (revia, vivitrol) blocks the pleasure of drinking. It is best for patients who particularly find binge drinking thrilling. Naltrexone can be taken orally or via intramuscular injection.

Side effects may include a negative reaction to the injection, nausea, headaches, and weakness. Patients must abstain while taking naltrexone.

How effective is each medicine?

Research has been conducted into the effectiveness of medication for the treatment of alcohol use disorder. These are discussed below:

1. Naltrexone

Naltrexone is effective at curbing alcohol cravings. It has been proven to reduce the rate of drinking in heavy drinkers by up to 60 percent. In addition, it reduces the rate of relapse in the short term (less than 12 weeks). With CBT, naltrexone can significantly improve AUD.

2. Acamprosat (antabuse)

Acamprosate has decreased the number of drinks per day for over 1.5 million patients in 28 countries. It is very effective at assisting the brain in returning to its natural state.

Acamprosate has proven well in maintaining abstinence in the long term. It is a cheaper option than naltrexone and disulfiram, but it may cause incontinence.

3. Disulfiram

Disulfiram prevents alcohol from being metabolized in the body, which causes unpleasant symptoms. Disulfiram is usually a back-up medication for patients having difficulty abstaining.

The major issue with its use is that patients may continue to drink alcohol under its influence if the urge is strong. Thus they develop headaches, dizziness, nausea, and high blood pressure.

The effectiveness of disulfiram depends on the patient’s willpower, proper supervision, and support from a trusted individual.

Non FDA-approved drugs for alcohol addiction

Below, we have listed some of the lesser-known drugs that can be used to combat alcohol addiction. These include:

1. Topiramate

Topiramate (Topamax, Trokendi, Qudexy) is an anti-seizure medication that can aid with emotional and mental instability. This oral medicine is for patients cutting down on alcohol, so abstinence is not necessary. Topiramate eases pain, but it can cause moderate brain fog.

Nevertheless, a study on its benefits by Paparrigopoulos et. al has shown topiramate medication to be effective at improving depression and anxiety, lowering obsessive-compulsive drinking, and preventing relapse. [8]

2. Gabapentin

Gabapentin is another anti-seizure medication for patients wishing to slow down (but not cease) their alcohol intake. A study funded by the National Institute of Health (NIH) found that the group that took gabapentin was twice as likely to forego heavy drinking and four times as likely to quit drinking entirely as the control group.

Taken either as a solid or liquid pill, gabapentin is one of the few medications for alcohol use disorder known to improve sleep. However, it can cause dizziness, drowsiness, and possibly weight gain. [9]

Off label medications for treating alcohol abuse

There are a number of ‘off-label’ medications that can be used to treat alcohol addiction. This means that they are not medically created to treat alcohol use disorder entirely, but they can be cross-used to help combat some of the side-effects and symptoms associated with the conditions.

These medications include:

Topiramate and gabapentin are anticonvulsants, medical agents used for treating epilepsy and seizures. When paired with psychotherapy, topiramate can successfully limit the number of binge drinking days and drinks per day for those who are addicted to alcohol.

Gabapentin is effective at augmenting abstinence. Both medications are shown to prevent relapse in the short term.

Antidepressants are very effective at dealing with alcohol dependency. Depressed patients are more likely to relapse, while treated patients are more involved in the abstinence process.

Selective antidepressants, especially "selective serotonin reuptake inhibitors" (or "SSRI's"), are effective in treating depression in alcoholic patients because they can be taken safely by people who continue to drink and have few side effects.

Ondansetron (Zofran) prevents the sensation of nausea and vomiting. It can be taken with naltrexone and or CBT to decrease cravings for alcohol, to regulate mood changes, and to decrease the number of drinks per day for patients.

Ondansetron is specifically effective for adults under age 25, whose brains are predisposed to alcohol use disorder.

How long should medications be maintained?

Because chances of relapse are very high after the first 6 to 12 months following release, the NIAAA recommends a minimum initial period of 3 months for pharmacotherapy.

Most patients remain on medication for about a year or longer if they respond positively to treatment. After medical treatment, medical personnel will monitor the outpatient vigilantly to ensure they maintain long term abstinence.

Which medication is most effective?

There are several medicines available for alcohol-dependent patients, but which is the best one?

The simple answer is that it depends on the patient’s situation. Some people may have different medical conditions that favour using one drug over another. For example, a patient with liver cirrhosis may be recommended acamprosate.

The side effects of the medication must be included as well. Taking acamprosate may help with alcohol use disorder but will simultaneously cause bouts of diarrhoea. Disulfiram is useful for reinforcing abstinence, but can cause complications for the patient if they decide to drink anyway.

Further research is needed to determine how truly effective medication can be on alcohol use disorder patients. Studies of effectiveness typically combine medication with CBT or other therapies, making it harder to clarify which medication is working best.

Head-to-head trials are sparse and cannot offer much advice either. Conclusively, a medical professional will recommend the best drug for his patient given the circumstances.

The importance of counselling and therapy alongside pharmacotherapy

Alcohol dependence is a tough enemy to fight. Utilizing counselling, therapy, and pharmacotherapy together will battle the addiction from multiple angles.

Medicines help with the physiological changes taking place in the brain; counselling tackles the social and supportive aspect of rehab; and therapy works psychologically to adopt ideals for an alcohol-free lifestyle.

Using any of these methods alone is not sufficient to beat alcohol use disorder or prevent relapse. In addition, most studies of medication have implemented some form of therapy and/or counselling in some fashion.

A mere 15-20 minute weekly medical briefing can be quite effective combined with prescribed medicine in early treatment. Patients need guidance and accountability for taking their medication regularly.

Ready to get help?

We offer high-quality rehabilitation & detoxification services tailored to your individual needs.

To discover your road to recovery, call us today on 0800 140 4690.

References

[1] https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetTabsSect2pe2018.htm#tab2-1b

[2] https://www.cdc.gov/features/costsofdrinking/

[3] https://www.bjs.gov/content/dcf/duc.cfm

[4] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

[5] https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics

[6] https://www.webmd.com/mental-health/addiction/features/fighting-alcoholism-with-medications#3

[7] https://www.drinkaware.co.uk/research/data/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062593/

[9] https://www.nih.gov/news-events/news-releases/nih-funded-study-finds-gabapentin-may-treat-alcohol-dependence

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