The right drug can help you overcome the desire for alcohol and help body and mind cope with the physical effects of withdrawal, which could otherwise be life-threatening. Not all primary care doctors are familiar with medications to treat alcohol addiction. Here are the options to talk about with your doctor for withdrawal and long-term sobriety.
Why Medication Is Needed for Addiction Treatment
“Medications are very important during alcohol withdrawal, the period called cold turkey. Long-term abuse of alcohol has a sedative effect on the body. When you withdraw alcohol suddenly, there is a phase of excitability that can be deadly without the use of a medication to take the place of alcohol,” says Michael Weaver, MD, professor in the department of psychiatry and behavioral sciences and medical director of the Center for Neurobehavioral Research on Addictions at the University of Texas Health Science Center at Houston. “Sudden withdrawal of alcohol can cause a spike in blood pressure, rapid heart rate, and extreme excitability.” This can lead to delirium tremens — tremors and delirium. “In extreme cases, untreated alcohol withdrawal can lead to seizures, heart attack, or stroke,” Dr. Weaver warns.
Medications for Alcohol Withdrawal
The medications most commonly used for alcohol withdrawal are benzodiazepines, sedatives that calm anxiety and nervous system excitability by slowing down nerve impulses. Short-term side effects may include drowsiness, dizziness, and dry mouth. “You want to use a benzodiazepine that is not too long-acting or too short-acting. The most common choices are lorazepam or diazepam. These drugs can be given orally or intravenously. They can be tapered down slowly until the danger is past,” Weaver explains.
Medications for Maintenance
These medications are approved for treating alcohol dependence long-term to maintain sobriety after withdrawal: Disulfiram (Antabuse). “Disulfiram has been around the longest and was the only treatment available for a long time. It works by making you feel very sick if you combine it with alcohol. It is used much less today because people just don’t like to take it. It can also be hard on the liver, which may already be damaged by alcohol,” says Weaver. If you drink alcohol within 12 hours of taking this once-daily pill, you’ll likely experience flushing, headache, and nausea. (You will also have to avoid foods and medications that contain alcohol.) Side effects include rash and drowsiness. Naltrexone. “Naltrexone works by blocking receptors in the brain that cause the pleasurable feelings you get from alcohol. It can be given as a daily pill or as a monthly injection,” Weaver says. Side effects include nausea, drowsiness, headache, and irritability. Naltrexone also blocks your response to opioid pain relievers — if you need pain relief for any reason, let other healthcare providers know you’re on it. Acamprosate. Acamprosate is the newest medication to be approved for alcohol addiction treatment. It changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated with early sobriety. “There are no significant side effects,” Weaver says. “The only drawback is that you need to remember to take two pills three times per day.”
Other Options for Alcohol Addiction Treatment
Anti-seizure medications. Topiramate, used to treat epilepsy and to prevent migraine headaches, is not approved for alcohol treatment, but is being prescribed by doctors and used successfully — a daily pill of topiramate reduces drinking at least as well as naltrexone and acamprosate, according to an analysis done by the Veterans Health Administration published in the journal Addiction Science and Clinical Practice in 2013. “Topiramate has been shown to reduce drinking, especially when there is a family history of alcoholism. We are not sure how it works. The main side effects are sedation and confusion,” Weaver says. RELATED: How to Recognize Alcoholism A newer anti-seizure medication being investigated for alcohol treatment is ezogabine. Testing in animals suggests that it may reduce alcohol abuse by opening up channels in the brain that reduce the pleasurable effects of drinking alcohol. Ivermectin. Researchers at the University of Southern California have been studying the possible role in alcohol addition treatment of ivermectin, a drug used to treat parasite infections. After successful findings from lab studies involving mice, they are now investigating its potential role on people, not only as a treatment, but also as a preventive.
Combining Medication With Support
Treatment works well when medications and behavioral treatments, such as counseling or a support group like Alcoholics Anonymous, are combined. But commitment is key. “It is hard to put a percentage on success. It really depends on how motivated a person is to change,” Weaver says. “Medications may need to be continued for several years along with behavioral treatments and support.”
