Fighting Alcoholism With Medications
Drugs combined with support can help alcoholics kick alcohol addiction.
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.
Campral, taken by mouth three times daily, acts on chemical messenger systems in the brain. It appears to reduce the symptoms that alcoholics may experience when they abstain from booze over long periods. These symptoms can include insomnia, anxiety, restlessness, and unpleasant changes in mood that could lead to relapse. In European clinical trials and in pooled data from several studies, Campral increased the proportion of alcoholics who were able to refrain from drinking for several weeks or months.
However, in the COMBINE trial and another U.S. study, there was no apparent benefit to the use of Campral, either alone or in combination with naltrexone. Patients in the European trials tended to be more severely alcohol dependent than those in the U.S. studies, and most patients in European studies had been abstinent for longer periods before starting Campral, two factors that could account for the difference in the findings, according to the NIAAA.
"We use medicines to help detoxify people, but even after detoxification occurs the neurochemistry is still not in very good balance, and probably even more importantly, when your brain thinks it's going to get alcohol, that elicits these compensatory neural changes so that the body goes through the equivalent of a little mild withdrawal, and [Campral] blocks that," Volpicelli explains.