Effective Treatments for Alcohol Use Disorders

It may turn out that you’re a good candidate for one of three federally approved medications on the market. Scaling back alcohol use, however, can be difficult for many, including the more than 14 million U.S. adults with alcohol use disorder (AUD), which is defined as an impaired ability to stop or control alcohol use despite its known consequences. A variety of factors can play into people’s drinking patterns, including genetics, depression, anxiety and stress. And stigma often keeps people who are affected by alcohol from seeking help, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Naltrexone was first developed in 1963 to treat addiction to opioids. In 1984, it was approved by the FDA for the treatment of use of drugs such as heroin, morphine, and oxycodone. At the time, it was marketed by DuPont under the brand name Trexan. An extended-release, monthly injectable form of naltrexone is marketed under the trade name Vivitrol.

Is medication for alcohol use disorder effective?

One of the strengths of acamprosate is its side-effect profile; the most common side effects are gastrointestinal in nature. Acamprosate can be used in patients with moderate liver disease but is contraindicated in patients with severe renal impairment, and dose reductions are recommended for those with mild-to-moderate levels of renal impairment. Your doctor may suggest a medicine to help treat your alcohol use disorder. Medicines are usually used together with talk therapy and support groups. If you have alcohol use disorder, medication may help you stop drinking while you take it. Keep in mind medication can’t help change your mindset or lifestyle, though, which are just as important during recovery as stopping drinking.

“The steroid hormone aldosterone and its related mineralocorticoid receptor regulate fluid and electrolyte homeostasis,” according to the study authors. Based on preliminary research that suggests aldosterone and MR may contribute to alcohol seeking and consumption, the authors were interested in spironolactone since it can possibly reduce that desire. One of the main reasons researchers studied spironolactone is because the medication is in the mineralocorticoid receptor (MR) antagonist drug class.

What should I know before starting treatment with naltrexone?

Two other drugs, gabapentin and topiramate, also interact with GABA and glutamate systems. The FDA approved them to treat seizures, but health care professionals sometimes prescribe them “off-label” for alcohol use disorder. Many people don’t know it, but there are medications that treat alcohol use disorder,  the term for the condition that you may know of as alcoholism and alcohol abuse.

Naltrexone is most effective when taken in concert with other forms of treatment, including other medications, therapy, counseling, and 12-step programs. One area where Naltrexone has proven especially useful is in the treatment of alcoholics who have relapsed. Treatment response was similar at the end of 10 weeks, with 84.1 percent (74 of 88) of the PCM patients and 86.5 percent (77 of 89) of the CBT patients avoiding persistent heavy drinking. Among those who responded to a primary care model, continued treatment with naltrexone for 6 months significantly helped sustain gains. Among those receiving CBT, maintenance of response remained relatively high and continued naltrexone did not improve this outcome significantly over placebo. There has been considerable enthusiasm about the potential of rimonabant, a cannabinoid receptor 1 antagonist, based on preclinical research showing that it reduced alcohol drinking.

Optimizing Outcomes by Patient–Treatment Matching

Because benzodiazepines work on the same receptors of the brain as alcohol, these drugs are often administered during the acute detoxification phase. Oftentimes, the individual is immediately given sober house the drug to mitigate the dangerous withdrawal symptoms of alcoholism and then slowly tapered off. Typically, benzodiazepines are only administered during the initial alcohol detoxification phase.

In fact, a recent study published in the American Journal of Psychiatry found that naltrexone helped to significantly reduce binge drinking among men with mild to moderate alcohol use disorder. It also reduces alcohol cravings and has helped patients curb overeating and smoking. Campral (acamprosate) is the most recent medication approved for the treatment of alcohol dependence or alcoholism in the U.S. It works by normalizing alcohol related changes in the brain, reducing some of the extended physical distress and emotional discomfort people can experience when they quit drinking (also known as post-acute withdrawal syndrome) that can lead to relapse.

VIVITROL and counseling has been proven to reduce the number of heavy drinking days* in patients with alcohol dependence1,2

Heavy drinkers may need hands-on medical care and monitoring, or a proper “detox” in a health care facility, to manage their symptoms. Thanks to years of research, doctors and health professionals now have a full menu of options to treat alcohol use disorders. Building on this progress, scientists continue to work on new medications and discover new ways to improve the effectiveness, accessibility, quality, and cost-effectiveness of treatment for people who have alcohol use disorders. Early studies with the selective serotonin reuptake inhibitors (SSRIs) have been disappointing. Two fairly good studies used tricyclic antidepressants (ie, desipramine, imipramine), which showed some short-term benefit. SSRIs probably do not benefit patients who are not depressed but might benefit those who are depressed.

Extended-release naltrexone, a formulation that only requires a monthly injection, holds the potential to minimize problems with medication adherence. In a 6-month trial, 64 percent of participants received all 6 months of double-blind medication, translating into daily coverage for the entire treatment period (Garbutt et al. 2005). Naltrexone was significantly more effective in reducing the rate of heavy drinking than placebo, an effect most pronounced in those who had achieved abstinence prior to receiving the first injection. In the subset of those who were abstinent for at least 4 days prior to random assignment, extended-release naltrexone also significantly improved continuous abstinence rates (O’Malley et al. 2007). Specifically, 32 percent of those receiving extended-release naltrexone (380 mg) remained abstinent over 6 months compared with 11 percent of those receiving placebo. Individual and group therapy are key components of medication-assisted treatment programs for alcohol addiction.

Research is needed to address the optimal use of medication therapy for the treatment of alcohol use disorders and for treating the broader spectrum of unhealthy alcohol use, from non-dependent risky drinking to alcohol dependence. This is especially true given the major scientific advances in pharmacotherapy that have been made over the past 60 years. To improve access to effective medication therapy, research also should explore the use of these medications in a range of health care settings. To optimize medication treatment outcomes, practitioners need to assess both the appropriate level of counseling (from minimal to more intensive) and the appropriate methods to enhance medication adherence for individual patients. The development of medications to address the spectrum of unhealthy alcohol use across the broad range of health care settings has the potential to maximize benefits for future patients. Primary care providers are well suited to address a wide variety of behavioral problems in their patients and routinely manage chronic diseases with a combination of counseling and medication management.