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
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