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Ask the Experts

Question:

Are there medications that can help me stop drinking and not go back to the bottle?

Answered by: Eric Collins

Yes. There are three medications approved in the United States for the treatment of alcohol dependence.

All the medications will be more effective when they are combined with additional psychosocial treatment, including Alcoholics Anonymous and/or various therapies that have been shown to be effective in helping people maintain abstinence from alcohol.

The oldest medication for alcohol dependence is Antabuse (disulfiram), approved in 1951. It works by interfering with the body's ability to break down an alcohol metabolite. This leads to accumulation of that metabolite (acetaldehyde), which will make someone physically sick, usually with nausea, vomiting, flushing, pulsating headache, difficulty breathing, palpitations, sweating, thirst, low blood pressure, vertigo, chest pain, and, in rare instances, death. Some people take the medication and simply won't drink, because they will avoid the very unpleasant Antabuse-alcohol reaction. But the medication isn't for everyone, because some people do drink despite taking Antabuse.

Also, individuals on Antabuse should have their liver function monitored periodically, because the medication may cause a reversible chemical inflammation of the liver.

The second medication approved for alcohol dependence was ReVia (naltrexone), approved in 1951. ReVia seems to interfere with some of the pleasurable effects of alcohol, although it accomplishes this more effectively in some than in others.

It may also have some effects on reducing craving, particularly in patients with a strong family history of alcoholism and an onset of alcohol problems earlier in life. ReVia appears to help some people maintain their abstinence, even if they have a lapse (slip) and drink a small amount. But it does not work in everyone, and, because it is an opioid-blocking medication, it becomes much more difficult to treat pain with opioids while taking ReVia. Individuals already taking opioids (for pain or illicitly) and those who will need to take opioids for pain should not be given ReVia.

Also, individuals on ReVia should have their liver function monitored periodically (as with Antabuse, above), because the medication may cause reversible chemical inflammation in the liver. People who drink while taking ReVia do not get sick (unlike Antabuse, as described above).

The most recently approved medication for alcohol dependence is Campral (acamprosate), approved in 2004. Campral has beneficial effects on two neurotransmitter systems (the glutamate and GABA systems) that are disrupted by chronic alcohol use. The medication has consistently demonstrated benefit in reducing drinking in alcohol dependent patients, with efficacy comparable to that of ReVia (naltrexone).

Again, however, the medication does not benefit everyone. It appears to be more effective when the individuals taking it have stopped drinking for at least five days, so that is how it is usually used. As with ReVia and unlike Antabuse, individuals who drink while taking Campral will not get sick. The medication is safe, with very few side effects and no significant drug interactions. Some patients may benefit from taking Campral in combination with Revia or Antabuse.

It is worth repeating that all the above medications are more effective when combined with self-help and/or therapies designed to help individuals maintain alcohol abstinence.