Medications Used with an Alcohol Use Disorder Treatment Program

Alcohol use disorder[i] is a condition that includes both alcoholism and the dysfunctional use of alcohol in non-addicted people. In the U.S., more than 15 million people currently meet the terms used to diagnose this condition[ii]. Medications play an important role in alcohol treatment and can help people in treatment attain sobriety and maintain an alcohol-free lifestyle.

Types of Medications

Doctors and other medical professionals classify the FDA-approved medications used in alcohol treatment according to the effects they produce in the brain and body. The three main types of medications[iii] used to treat alcoholism are:

• Glutamate receptor blockers (e.g., acamprosate)
• Aldehyde dehydrogenase inhibitors (e.g., disulfiram)
• Opiate/opioid antagonists (e.g., naltrexone)

Glutamate receptor blockers get their name because they interfere with the release of the brain chemical glutamate. This chemical plays an essential role by speeding up the pace of interaction between the brain’s primary nerve cells. Glutamate receptor blockers also encourage the release of a second brain chemical known as GABA (gamma-aminobutyric acid). GABA has the opposite effect of glutamate and slows down the pace of nerve cell interaction.

Aldehyde dehydrogenase inhibitors get their name because they block the activity of a natural human enzyme called aldehyde dehydrogenase. Normally, this enzyme prevents the buildup of acetaldehyde, a toxic chemical produced by the breakdown of alcohol inside the liver.

Opioid antagonists, such as naltrexone, are substances that prevent opioid drugs and medications from reaching the central nervous system (the brain and spinal cord). They do so by blocking access points in the brain and body called opioid receptors. Naltrexone is also used to treat alcohol use disorders as it helps decrease alcohol consumption.

H2 What Does Acamprosate Do?

Acamprosate (Campral)[iv] is the name of the glutamate receptor blocker employed in alcohol treatment. When used in combination with behavioral psychotherapy, it helps people enrolled in treatment avoid drinking for extended periods of time. The National Institute on Drug Abuse (NIDA) notes that use of acamprosate may also decrease the intensity of the symptoms sometimes found in people going through prolonged alcohol withdrawal. Examples of these symptoms include:

• A general sense of unease
• Sleeplessness
• Restlessness
• Anxiousness

People heavily affected by alcoholism may benefit from the use of this medication more than those with mild or moderate symptoms.

No one knows how acamprosate works. However, researchers have a theory. In a person affected by alcoholism, the normal levels of glutamate and GABA are thrown off. In turn, this imbalance supports the conditions that lead to the onset of addiction. It’s possible that acamprosate restores the brain’s glutamate/GABA balance, and thereby helps break addiction’s grip.

What Does Disulfiram Do?

Disulfiram (Antabuse) is the name of the aldehyde dehydrogenase inhibitor used in alcohol treatment. By interfering with the breakdown of alcohol inside the liver, this medication increases blood levels of acetaldehyde. Since acetaldehyde is toxic, its rising presence in the bloodstream produces symptoms of a mild form of poisoning, including such things as:

• Heart palpitations
• Facial flushing
• Confusion
• Blurry vision
• Nausea and vomiting
• Headaches
• A choking sensation
• Anxiousness
• Increased sweat output
• Breathing problems
• Chest pain

In combination, these symptoms can deter people enrolled in treatment from consuming alcohol. NIDA reports that disulfiram is most effective in program participants who have committed themselves to sobriety. It can also help someone avoid drinking on specific days or at specific events. The medication’s main benefit is a reduction in the overall number of days on which alcohol use occurs.

What Does Naltrexone Do?

Naltrexone (Vivitrol, ReVia) is the name of the opiate/opioid antagonist most often used in alcohol treatment. When given to a person in treatment, it partially blocks the pleasurable effects associated with intoxication. The medication also helps reduce the intensity of alcohol cravings. To avoid any risks for provoking withdrawal symptoms, doctors typically only given naltrexone to program participants a week or so after detoxification and the initial establishment of sobriety.

Another Medication Alternative: Topiramate

There is another potential option for people in treatment for alcohol problems: topiramate (Topamax, Trokendi XR). Topiramate has received FDA approval as a treatment for seizure disorders, but not as a treatment for alcoholism. Nevertheless, doctors sometimes adapt the medication for use in alcohol programs. Like acamprosate, topiramate appears to provide a benefit by correcting glutamate/GABA imbalances inside the brain. However, no one knows the details of this proposed mechanism. Potential benefits of the medication include:

• A higher number of non-drinking days in treatment
• Easier avoidance of heavy drinking in treatment
• Diminished alcohol craving

Medication’s Role in the Larger Course of Treatment

On its own, medication use can play an important role in substance use treatment. However, research shows that people who receive medication in combination with counseling or behavioral therapy have better treatment outcomes than people who only receive medication. The combined use of medications and counseling/behavioral therapy is known as medication-assisted treatment, or MAT[v]. Known benefits of MAT include:

• Lowered risks for treatment relapses
• Increased odds of finding work after receiving treatment
• Increased odds of staying employed after receiving treatment
• Lowered odds of dying from addiction-related causes

Medication-assisted treatment is also recommended for people recovering from opioid abuse/addiction. Counseling and behavioral therapy methods with proven usefulness for people recovering from alcohol use disorder including motivational enhancement therapy (MET), community reinforcement approach (CRA) plus vouchers, contingency management (CM) and cognitive behavioral therapy (CBT).

Getting Help for Alcohol Abuse and Addiction

Our Summit Detox facility provides medication assisted detox, if necessary, for drug or alcohol use disorders. Once detox is complete, and withdrawal symptoms have subsided, we will discuss your next steps for continuing care. If we recommend further treatment, such as a partial hospitalization program, we can transfer you to Transformations Treatment Center. We specialize in individualized and personalized care to help you recover and live a life free from drugs or alcohol.