Medications for Alcohol Use Disorder

In general, treatment goals of AUD are to reduce and manage symptoms and improve health and functioning. The implementation and widespread use of medications to treat alcohol problems faces a unique set of barriers in primary care. Although primary care providers are proficient at prescribing a wide variety of medications, they generally are unfamiliar with medications for treating alcohol problems other than those used to treat alcohol withdrawal. Indeed, a growing body of research to support basic screening methods, brief interventions, and especially medication therapy has yet to have a major impact on how primary care providers care for individuals at risk for or with alcohol problems (D’Amico et al. 2005).

But it wasn’t a foregone conclusion that it would also be effective in humans, Ray said. Side effects from the drug, which included nausea and some abdominal pain, were mild, and none of the participants dropped out of the study. The research is published online by Neuropsychopharmacology, and will appear later in in the journal’s print edition. UCLA researchers have found that an anti-inflammatory drug primarily used in Japan to treat asthma could help people overcome alcoholism. UCLA research shows that the drug, ibudilast, reduces people’s craving for alcohol and appears to improve their ability to recover from a stressful situation.

What is an alcohol use disorder?

Research is being done in an attempt to identify predictors of patient response to FDA–approved treatments. In a secondary analysis of a U.S. acamprosate trial, patients with a strong commitment to abstinence benefited from acamprosate (Mason et al. 2006). However, several hypothesized predictors of acamprosate response, including high physiological dependence, late age-of-onset, and serious anxiety symptoms, did not predict differential response in a pooled analysis of data from seven placebo-controlled trials. In the COMBINE study, people with “Type A” alcohol dependence (i.e., fewer co-morbid psychiatric and substance abuse disorders) responded well to naltrexone (Bogenschutz et al. 2009). Because primary care providers may feel more comfortable managing less complicated patients, this is an encouraging finding. In the end, the promise of personalized medicine will depend on the identification of reliable predictors of differential treatment response.

• Two other drugs, gabapentin and topiramate, also interact with GABA and glutamate systems.
• Heavy drinkers may need hands-on medical care and monitoring, or a proper “detox” in a health care facility, to manage their symptoms.
• Without limiting the foregoing, Alkermes does not warrant or represent that the Provider Locator or any part thereof is accurate or complete.
• Detox encompasses the period of time when someone is first coming off of a drug.
• At the end of four to six months of treatment with the Sinclair Method, 80 percent of people who had been overusing alcohol were either drinking moderately or abstaining entirely.

During further exploration of the drug in animal trials, researchers found that the drug had an equal ability to decrease alcohol consumption. This discovery led to human clinical trials in the early 90’s  that resulted in the approval of Vivitrol for alcohol treatment. Nalmefene is another opioid antagonist, and it blocks delta, kappa, and mu receptors; naltrexone acts primarily on mu receptors. One randomized trial with 100 patients using 10 mg PO bid has been completed, and nalmefene appears to have efficacy similar to naltrexone (reduces relapse to heavy drinking in patients who sample alcohol). At present, the drug is approved only for intravenous use for opiate addiction. Most studies are of short duration, and more long-term trials are needed.

Other Medications

Patients are reminded of the risks of adverse effects when tempted to drink. Disulfiram causes nausea, vomiting, and dysphoria with coincident alcohol use. If a patient asks for disulfiram and thinks it will help, it might be worth considering. 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.

Therefore, the individual must undergo a complete detoxification from alcohol before beginning naltrexone treatment. Just as with all other medications used in MAT, naltrexone works best when administered in conjunction with psychotherapy and a comprehensive treatment plan. Naltrexone, sober house which blocks endorphins and reduces the euphoria of intoxication, was approved in the United States for the treatment of alcohol dependence nearly 30 years ago. But it is typically prescribed for patients with more severe alcohol disorders to take daily to abstain from drinking.

Medication Use in the Treatment of Unhealthy Alcohol Use in Primary Care Settings

Even when medication therapy has a clear evidence base in a given clinical situation, patients and their providers may identify a variety of reasons why a specific therapy may or may not be used. Beyond this, research often demonstrates that there are certain patient subgroups for whom a specific therapy may or may not be particularly effective. These subgroups may be identifiable based on clinical, demographic, genetic, or social features that all may play a major role in the decision process regarding medication use. With the availability of several FDA-approved medications, a provider may recommend a trial with a new medication should an individual patient not respond to the first medication tried. The spectrum of unhealthy alcohol use can be addressed in a variety of health care settings, including primary care, specialty practice, and alcohol treatment programs. Medication use in these nonspecialized settings and in a spectrum of patients including nondependent individuals is a recent phenomenon.

Many alcohol-dependent individuals also smoke cigarettes, and researchers have investigated the potential role of the nicotinic acetylcholine receptor (nAChR) system as a factor in both addictive behaviors (for a review, see Chatterjee and Bartlett 2010). Nicotinic compounds, including agonists, partial agonists, and antagonists, currently are under investigation for the treatment of alcoholism. Laboratory studies also have shown that varenicline, a partial agonist approved for smoking cessation, can reduce craving and drinking in smokers who drink heavily (McKee et al. 2009). A preliminary study among smokers receiving varenicline for smoking cessation found that it significantly reduced heavy drinking (compared with a placebo) during an extended pretreatment period (Fucito et al. in press). Studies are ongoing to evaluate the efficacy of these two compounds in clinical trials of alcohol-dependent patients.

Medications for the Treatment of AUD

Initially, disulfiram was discovered in the early 1930s when some workers in the rubber industry became sick from drinking alcohol after exposure to tetraethylthiuram disulfide. This discovery led to a series of different trials and research studies that ultimately led to the production of brand name medication Antabuse in the 1940s. While these can play a factor in the development of the disease, it can also come from simply drinking too much. Alcohol is an addictive substance, so over time too much exposure can cause dependency. Stay away from alcohol if you have family history, mental health conditions, or find yourself emotionally reliant on it.

The medication can help you have fewer days when you drink heavily as well as drink less overall. Yet medications for alcohol use disorder can work well for people who want to stop drinking or drink a lot less. 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. The most recent Federal data indicate that non-medical personnel, many of whom possess personal 12-step recovery histories, deliver the majority of alcoholism treatment in this country in specialty care settings. These treatment programs differ widely in organizational structure, source of payment, services offered, leadership characteristics, staff credentials, presence of medical personnel, program size, and patient characteristics.