Fighting Alcoholism With Medications
Drugs combined with support can help alcoholics kick alcohol addiction.
There is no magic pill or one-size-fits-all treatment that can banish an alcoholic's need or desire to drink.
But a handful of FDA-approved medications, when used in combination with psychological and social interventions such as 12-step programs, can help a significant number of alcohol-dependent patients reduce their insatiable cravings and cut back substantially on the number of heavy drinking days, say experts in alcohol abuse and dependence.
"For me, the biggest issue is not whether these medicines work, it's why they're not being used more often," says addiction specialist Joseph Volpicelli, MD, PhD, associate professor of psychiatry at the University of Pennsylvania School of Medicine.
Despite the current understanding that alcoholism is a tenacious disease, there are lingering prejudices that cause some people to view alcohol abuse and dependence as moral failings that can be overcome simply by willpower, Volpicelli tells WebMD.
But as he and other specialists in addiction note, medications are not substitutes for drinking, but can instead help make the difference between an alcoholic's successful recovery or relapse.
"I think medications are very important and effective and work best when they're used with psychosocial modalities," agrees Merrill Herman, MD, director of psychiatric services for Montefiore Medical Center's substance abuse treatment program and president of the New York Society of Addiction Medicine in New York City.
Roger D. Weiss, MD, a professor of psychiatry at Harvard Medical School in Boston and clinical director of the alcohol and drug abuse treatment program at McLean Hospital in Belmont, Mass., notes that "medications can sometimes reduce the desire to drink. They can attenuate [weaken] the response that people get to alcohol, to make it less reinforcing, and they can, depending on which medication you're talking about, help reduce protracted, longer-term withdrawal distress."
There are three drugs approved by the FDA for the treatment of alcoholism; a fourth drug has shown promise in recent clinical trials. The following is a summary of the drugs and how they work.
Antabuse was approved for the treatment of alcoholism more than 50 years ago, making it the oldest such drug on the market. It works by interfering with the body's ability to absorb alcohol -- specifically by inhibiting production of an enzyme that would otherwise allow the body to absorb an alcohol breakdown product called acetaldehyde.