Medications for alcohol use disorder
Did you know there are medications to maintain alcohol sobriety?
Alcohol use disorder, or the loss of control of alcohol consumption and associated consequences, is the most common substance use disorder. Sadly, it remains undertreated with only 15-25% of people with the disorder seeking medical treatment according to the National Institute on Alcohol Abuse and Alcoholism. It seems that only a small percentage of people are aware that there are FDA-approved medications to treat alcohol use disorder and help maintain sobriety.
There are currently three prescription medications with FDA approval for the treatment of alcohol use disorder. The medication most commonly known is disulfiram/Antabuse. This medication works by
disrupting the body's normal metabolism of alcohol. It halts the chemical processes and produces an excess of a metabolite that leads to noxious symptoms in the body. Simply put, individuals who take this medication and then drink alcohol find themselves very sick with nausea, vomiting, diarrhea. The idea of this medication is to cause a negative consequence of drinking and discourage the individual from ongoing consumption. This medication is swallowed in pill form and needs to be taken daily.
Another treatment option is naltrexone/Vivitrol. Naltrexone affects the craving system in the brain through a mechanism not fully understood by binding to the opiate receptors. When an individual is on this medication it should adjust the neurochemicals involved in cravings and reward. This leads to a clinically significant decrease in cravings for alcohol. Also, if the patient were to drink while on the medication, the reward or good feeling of consuming alcohol should be blunted making the experience less desirable. Naltrexone comes in a once-a-day pill or a once-a-month extended-release injection. This medication should be avoided by individuals with advanced liver disease and people on chronic opioid therapy.
The third medication option is acamprosate/Campral. This works similarly to naltrexone, though through a different, poorly understood mechanism. This medication does not bind to the opiate receptors and thus is a good option for patients also on opiate therapy. This medication is metabolized through the kidney making it an alternative treatment option for the patient with advanced liver disease. Acamprosate is swallowed in pill form. It is dosed three times per day to maintain the therapeutic benefit.
The length of therapy with any of these medications depends on the individual patient. They are generally recommended for at least three consecutive months, with six to twelve months being preferable. It is possible to continue the medication for a longer period in consultation with your physician.
There are several other medical therapies available off-label for alcohol use disorder and much research being conducted on other treatment modalities coming in the future. Please discuss your treatment options with your doctor.