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Alcohol dependency can ruin people’s lives. It impacts everything from finances, to relationships, to work.

Alcohol is also the single most popular drug in the UK. It is legal, and widely available. It is also relatively cheap.

There are a huge number of people in the UK who are dependent on alcohol. In fact, at the last count, there are 586,780 of them. Only 18% of this number are in treatment. [1]

Given the shocking rates of alcohol dependency and its damaging consequences, it is little surprise that there are lots of people wanting to get clean.

Unfortunately, it is difficult to quit drinking alcohol once you are dependent. It can even be dangerous. If you go ‘cold turkey’, your body will experience severe withdrawal symptoms.

In a rehab setting, these symptoms can be managed. However, you will still experience cravings. Cravings refer to the desire for a substance when you have quit or are in the process of quitting.

That’s where anti-craving medications come in, and that’s the subject of this page. Anti-craving meds help to block the desire for another drink. They can be very effective.

Controlling an alcohol dependency problem

Before we go into more detail on anti-craving medications, let’s talk about controlling alcohol dependency. Is it possible to control a condition like this?

Noeline Latt points out that ‘only 5% of dependent drinkers are able to return to controlled drinking’. [2] This statistic shows how difficult it is for a dependent drinker to go back to normal levels of drinking.

The only reliable way, therefore, for dependent drinkers to control their habit is to stop drinking. This normally requires treatment. Even with treatment, relapses are common. The path to sobriety is often a long and windy one.

In practical terms, it is not always possible for patients to become abstinent overnight. This is especially true outside of a rehab setting.

As a doctor, you may want to set a more achievable target for your patient in the short-term. For example, you could advise them to stay clean for a month.

Tell them to come back after a month. If they are still clean, see if they can extend this period. It can be easier to think of abstinence in stretches of weeks and months rather than simply ‘forever’.

We could think of this as the very first step in treatment. In reality, lots of steps are needed before an alcohol-dependent person gets clean.

We’ve listed some steps in treatment for alcohol abuse below:

What are pharmacotherapies and anti-craving medications?

Pharmacotherapies are medications which lessen the need for alcohol. They can do this in a number of ways. They can stop cravings (anti-craving medications).

Furthermore, they can make drinking less rewarding. Finally, in the case of one drug called disulfiram, they can make drinking cause an unpleasant reaction. This acts as negative reinforcement.

Doctors and medical professionals will only give out these medications after the initial period of intense withdrawal is over. This is because these medications can cause symptoms such as nausea.

Doctors need to be able to tell whether symptoms are caused by the medication or by withdrawal. That is why they leave a gap of time (normally 7 days) between the last drink and prescribing medication.

Without further ado, let’s take a look at some of these medications.

Naltrexone and nalmefene: opioid antagonists

Naltrexone and nalmefene are opioid antagonists, which means that they interfere with mu-opioid receptors in the brain. Normally, when someone drinks alcohol, endorphins act on these opioid receptors, which gives a feeling of pleasure. Under the influence of naltrexone and nalmefene, they will not feel the same amount of pleasure. They will also have less cravings for alcohol.

In short, naltrexone and nalmefene do two things. They make drinking less pleasurable, and they reduce cravings.

One study, quoted in Latt, found that ‘50 mg/day of naltrexone for 3 months significantly cut relapse rates by up to 50%’, if used alongside psychological therapies. [3]

So what is the difference between naltrexone and nalmefene? Naltrexone only lasts for 24 hours, whereas nalmefene lasts for weeks or months. Nalmefene, therefore, makes it more difficult for the patient to relapse.

As mentioned above, these medications are normally taken after the first 7 days of withdrawal. This allows doctors to identify which symptoms are caused by alcohol withdrawal and which by the medication.

Symptoms of naltrexone can include diarrhoea and nausea.

Both naltrexone and nalmefene should be taken as part of a broad treatment regime. This should include therapy, detox, support groups and so on.

Acamprosate

Acamprosate is an anti-craving medication. We do not know exactly how it works, but scientists think it may antagonise glutamate at the NMDA receptor. [4]

In other words, it helps to rectify a problem with the reward system in the brain. This problem is caused by heavy drinking.

The side effects of acamprosate are mild. It can be prescribed for up to a year after someone gives up alcohol.

Studies of acamprosate have had mixed results, although meta-analyses have shown that it does have a positive effect.

Disulfiram

Perhaps one of the more controversial pharmacotherapies, disulfiram causes an extremely unpleasant reaction when someone on the medication drinks alcohol.

Mixed with disulfiram, alcohol creates acetaldehyde. This is a toxic compound. It causes headaches, nausea, hot flushes, palpitations, hypotension and more. The effects last for between 1 and 2 hours.

Even a few drops of alcohol are enough to set off this reaction. It can be caused by sauces, ingredients in food, and even cough mixture.

Though it provides a clear deterrent to drinking, disulfiram clearly comes with some disadvantages. First off, it is very important that someone taking disulfiram be mentally sound.

If someone were to forget they were on the medication, and drink alcohol, the results would be very disconcerting and unpleasant. The ability to consent is crucial due to the nature of disulfiram. This medication should be approached with some caution.

Those with psychosis, heart disease, hepatic disease, or cognitive impairment should not take disulfiram.

Patients also need to go without alcohol for one day before taking disulfiram, and a week after the end of treatment.

Other medications

There are a few other medications which are either less common, or still under study. We’ll take a look at some of them here.

Topiramate. Topiramate is an anticonvulsant. There have been a few studies into its effects. They have shown it to be relatively good at helping people to stop drinking.

However, more research is needed. It is also not widely available at this point. Its side effects are drowsiness and loss of balance. It also leads to weight loss, which can be a risk in malnourished people.

Ondansetron. This is an anti-emetic. Initial studies have shown it to be effective for males. More research is needed before it can be rolled out.

Baclofen. This medication reduces withdrawal symptoms and cravings. It has shown promise in studies with alcohol-dependent people with cirrhosis. Again, more research is needed.

SSRIs. These drugs are useful in patients who are depressed as well as alcohol dependent. However, they should not be used for patients who do not have depression.

Final thoughts

In this page, we’ve looked at some main anti-craving drugs and pharmacotherapies for alcohol dependency. We’ve seen that these medications come in various shapes and sizes.

You can have medications that simply block cravings, medications that make alcohol less pleasurable, and medications that train you not to drink by producing an unpleasant reaction when combined with alcohol.

All of these medications can be useful for helping people get clean. Dealing with cravings is one of the hardest parts of recovery.

References

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

[2] Noeline Latt, Katherine Conigrave, John B. Saunders, E. Jane Marshall and David Nutt, Addiction Medicine, Oxford University Press, (Oxford, 2009), p. 124.

[3] Latt, Addiction Medicine, 2009, p. 125.

[4] Latt, Addiction Medicine, p. 126.

boris

Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process.