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Fighting Alcoholism With Medications

Drugs combined with support can help alcoholics kick alcohol addiction.

Antabuse

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.

With no enzyme to break it down, acetaldehyde builds up in the body after even a small amount of alcohol is ingested, resulting in extremely unpleasant side effects that can include flushing, nausea, and palpitations.

"The big limitation for a medicine like Antabuse is that what people do instead of deciding that alcohol's a bad thing to take, they think that Antabuse is a bad thing to take and they stop taking it," Volpicelli tells WebMD."Antabuse doesn't take away your craving, and if you drink you still get the effects of alcohol you would normally in terms of the pleasure, until you reach the point where you start feeling sick."

Antabuse is most effective when its use is monitored, say in an alcoholism clinic or at home by a spouse or family member, experts say.

Volpicelli has at least one patient who uses Antabuse as a kind of "chaperone" when she's in social situations. When she starts to feel that her face is flushing, she knows that she has to stop drinking or will get very sick, he says. But for the vast majority of patients the best way to prevent relapse is to stop drinking altogether, specialists in alcoholism treatment caution.

Naltrexone

Naltrexone helps to both reduce the pleasure that alcoholics receive from drinking and the cravings that compel them to seek out more alcohol. It does so by blocking receptors (docking sites) in the brain for endorphins, proteins produced by the body that help to elevate mood. The same receptors also accept narcotics such as morphine and heroin. The drug can be taken as a once-daily pill or in a recently approved once-monthly injectable form.

"Naltrexone sort of gets at the core of what addiction is," Volpicelli says. "The way I like to describe it is that addiction is a condition in which when you do something, you want to do more and more of it. So when people have one or two drinks, instead of stopping after a few drinks they want to have three, four, five, 10 drinks. What we found is that naltrexone breaks that positive feedback loop, so that people can have one or two drinks and they don't feel like having any more."

In clinical trials, oral naltrexone was shown to reduce the amount of relapses to heavy drinking (defined as four or more drinks per day for women, five or more for men). Compared with patients who took a placebo (dummy pill), alcoholics who took naltrexone had 36% fewer heavy drinking episodes over a three-month period.

In the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) study, sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), naltrexone was found to be as effective as up to 20 sessions of alcohol counseling by a behavioral specialist, when either was administered under a doctor's close supervision.

Naltrexone is now available in a once-monthly injectable form called Vivitrol. The advantage of this formulation is that patients are more likely to stick with a drug they only need to take once a month, and it appears to work very well, says Herman.

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