Alcoholism, like other forms of addiction, is a chronic brain disorder that, like other physical and mental disorders, does not have a cure. Still, medical and addiction treatment researchers continue to find ways to treat alcoholism, help people manage the disorder and achieve recovery, and prevent relapse. One main object of this research is the use of medications that make treatment and recovery easier and decrease the person’s desire to use alcohol.
There are a number of medicines available for this purpose, but it can be confusing to know what works, what doesn’t, and whether or not these medications are able to help the person continue to be abstinent in the long-term. Also, there are often concerns that the person is just transferring the dependence from alcohol to some other substance, with the end result being continued addiction of another kind. Knowing how these medications are used – and whether they really help – can clear up some of the confusion around using them to treat alcoholism.
Treating Alcoholism with Medication
Some of the medications that are available for treating alcoholism itself are discussed in a document by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). These include some medicines that are specifically designated to treat alcoholism, such as:
Other medications that are used for alcohol addiction treatment are prescription drugs meant to be used for other purposes, like antidepressants or anticonvulsants, that have demonstrated some usefulness in treating alcoholism, so they are used off label for that purpose. Along with these, there are numerous other medications being studied and used to treat alcoholism. The major medications used for detox and for treating alcohol use disorders are discussed in more detail below.
Because alcohol detox can have serious health consequences, some medications are used to ease the withdrawal process and minimize the incidence of these symptoms, as discussed in an article from the Journal of Clinical & Diagnostic Research.
For example, benzodiazepines and barbiturates are drugs that have a similar action in the body to alcohol. Known as sedatives or central nervous system depressants, these medications can take the place of alcohol in the body, enabling a smooth taper off the drug, which has been shown to minimize some of the more dangerous withdrawal symptoms. Anticonvulsants have also been shown to support the withdrawal process.
Disulfiram is one medication that is prescribed to support abstinence from alcohol, and it has been in use for multiple decades for that purpose. As related by a study from Pharmacopsychiatry, the drug works chiefly by causing a negative reaction if the person consumes alcohol; nausea, heart palpitations, and other uncomfortable symptoms will occur if these substances are consumed together. As such, disulfiram is prescribed to make alcohol unattractive, encouraging abstinence through negative experiences.
Of course, this only works if the individual is faithfully taking the medication. While disulfiram has been shown to be more helpful in maintaining abstinence than some of the below medications, it also works better when the person is still in treatment than it does when the individual does not have the benefit of monitoring or guidance. Also, while it may serve as a deterrent, disulfiram does not reduce the person’s cravings for alcohol.
The Substance Abuse and Mental Health Services Administration explains how acamprosate differs from disulfiram. Rather than serving as a deterrent for alcohol use, it simply helps to reduce cravings for alcohol. The mechanism through which this occurs is not well understood, but acamprosate seems to work through certain neurotransmitter systems to reestablish normal brain activity after alcohol use, resulting in the person not feeling cravings for alcohol that arise from a neurotransmitter imbalance.
Nevertheless, because acamprosate is not a deterrent, there’s nothing to prevent the individual from drinking alcohol regardless of cravings. Because of this, it requires that the person taking it already be committed to recovery from alcohol abuse. It will not help someone who doesn’t want to be abstinent.
Similar to acamprosate, naltrexone helps to reduce cravings for alcohol. However, it works differently, by blocking the opioid neurotransmitters that create a euphoric response when drinking. By removing this pleasurable response, naltrexone reduces the person’s cravings to achieve that feeling through drinking.
An article in Psychology Today explains that naltrexone’s effectiveness for treatment depends on how the person takes it. In some studies, naltrexone showed no benefit over placebo. But in others, particularly based on work by a doctor in Scandinavia, it has been shown that having the individual use naltrexone only before drinking will, over time, remove the attraction to the alcohol and result in the person stopping drinking. Still, the medication can’t always be relied on, especially if the person does not have proper guidance from a treatment professional.
Nalmefene is also an opioid antagonist, with a broader action than naltrexone. In a study from Substance Abuse and Rehabilitation, the medicine was shown to work even better than naltrexone in helping people control alcohol intake, especially when taken right before drinking occurred.
The study also points out that nalmefene did not really do much to help people completely stop drinking. However, it did result in decreased intake both during a specific drinking event and overall. This is not considered to be a stable recovery model, leading to frequent relapse.
Topiramate and Other Anticonvulsants
Some drugs that are normally prescribed for other conditions are sometimes used off label to treat alcohol abuse and alcoholism. Anticonvulsant medications, usually used for seizure conditions like epilepsy, are often prescribed for this purpose. For example, topiramate – an anticonvulsant medication described in an article from Social Work in Public Health – has had some reported success in helping people who drink alcohol to decrease abuse. Similar to naltrexone, this medication appears to reduce the euphoric response to alcohol, making it less attractive to drink.
Topiramate has a negative effect on the brain, impairing thinking. Because of this and the fact that the medication is not always helpful to stop a person’s drinking, this tradeoff may not be worth it. In addition, more research is needed to better understand whether it does enough to deter drinking.
SSRIs and Antidepressants
Sometimes, through treating an underlying condition that is dominant to the alcoholism, such as depression or anxiety, treatment for alcoholism can be supported. As a result, serotonin-specific reuptake inhibitors (also known as SSRIs) and other, similar antidepressant medications are also sometimes used off label in alcoholism treatment, as discussed in another document from NIAAA. These include substances like:
However, these medicines are not helpful in treating alcoholism on their own. In fact, a study from The International Journal of Risk & Safety in Medicine indicates that some people treated for alcoholism using SSRIs show a tendency for increased alcohol consumption.
Psilocybin is a component of certain mushrooms that are sometimes used as hallucinogenic or psychedelic drugs. However, a study from the Journal of Psychopharmacology shows that administering psilocybin to people in treatment, along with motivational therapy, can promote abstinence from alcohol.
Other types of hallucinogenic drugs have also shown this effect, with seemingly little risk. However, these substances can also be addictive, leading to further issues later without guidance from treatment professionals.
The Challenges of Using Medications to Treat Addiction
The main issue with many of these alcoholism treatment medications is that they, too, are highly addictive, requiring close observation and monitoring by a treatment professional to avoid transferring the addiction to these drugs. For example, benzodiazepines used in alcohol detox can also become the object of an addiction, making it important to have professional guidance when using them and then work toward tapering off the drugs completely.
Even if addiction doesn’t result, it can be frustrating to become dependent on a medication to support alcohol abstinence. No medication can guarantee that the individual won’t relapse to alcohol use, sometimes making it seem pointless to keep using these treatment medications. Participation in a complete, well-rounded treatment program, supported by these treatment medications when helpful, makes it more likely that the individual will stop drinking alcohol and stay in recovery for the long-term.
Comprehensive Treatment for Alcohol Use Disorders
Comprehensive alcoholism and alcohol abuse treatment includes more than just medication. Through therapy, peer support, nutritional and exercise guidance, and education, individuals can learn to manage the chronic condition of alcoholism. Through this type of treatment, the person becomes able to lessen cravings, and to respond to triggers or cravings that do arise with activities other than drinking.
Working with a professional, research-based treatment program can provide an individual with access to this type of comprehensive treatment. This includes the development of a personalized plan that may or may not involve treatment medications, but that does provide the skills and tools needed to achieve and prolong abstinence from alcohol.