Article at a Glance:
Some medications can help people reduce or stop drinking, although no medication cures alcoholism.
FDA-approved medications to treat alcohol use disorder are Acamprosate, Disulfiram, and Naltrexone.
Anticonvulsants and Baclofen can be used to help someone stop drinking.
The effectiveness of medications varies between individuals.
The Recovery Village can help people use medication options to support their recovery.
FDA Approved Medications to Stop Drinking
The FDA has approved three medications for use in the treatment of alcohol use disorder (AUD):
- Acamprosate
- Disulfiram
- Naltrexone (oral and extended-release injectable)
In addition to the FDA-approved medications, other drugs are sometimes used off-label (without FDA approval) for treating AUD, such as:
- Anticonvulsants (including topiramate)
- Baclofen
Vivitrol (Naltrexone)
Vivitrol (naltrexone) is an opioid antagonist (blocker) medication, but it appears to reduce cravings in some individuals seeking treatment for AUD. This has generally been supported by the research literature, although it is still not possible to predict whom it will work well for.
The research evidence suggests that naltrexone is more suited to helping people reduce their alcohol consumption than it is for helping them to stop drinking alcohol.
However, a recent study demonstrated that Vivitrol merely accelerates a reduction in cravings by a few days. People treated with Vivitrol for alcoholism experienced a reduction in cravings that equaled out with those not treated with Vivitrol by about day 8 of treatment, thereafter the level of cravings were not different.
In this article, we review the major FDA-approved and off-label medications used to treat alcohol use disorder. Some may be useful adjuncts to treatment for some individuals.
For people who are addicted to alcohol, stopping drinking can be a formidable obstacle. For many, all attempts at stopping are in vain, despite repeated earnest attempts. As they watch their alcohol use progressively destroy their lives, they become understandably desperate.
There are some medications that may help some people reduce or stop their obsessive drinking. However, it must be emphasized that, at best, these medications are an adjunct to getting proper treatment for alcohol addiction. There is no pill or no chemical that cures alcoholism.
Rather, lasting, long-term recovery from alcohol use requires carefully identifying and addressing the causes of the addiction and the effects of the drinking and related behaviors on mind and body. That is the function of alcohol treatment programs and the basis of their success.
However, for those who are seeking proper treatment for their alcohol addiction, there are some medication options that may be useful as a tool to support their recovery. The medications’ effectiveness varies between individuals because no two individuals are exactly alike.
Pros
- Naltrexone does not cause dependency
- Naltrexone is a very safe medication
- Naltrexone for alcohol cravings can be given as a long-acting injection for those who are not good pill-takers
- Naltrexone may be a helpful addition to the usual treatment (biopsychosocial counseling and treatment programs) for some people, especially during detox
Cons
- Only one out of nine people are helped to reduce their drinking by taking naltrexone for alcohol abuse
- Only one out of twenty people are prevented from drinking (abstinence) by oral naltrexone
- Vivitrol for alcohol abuse is not associated with serious side effects but may cause stomach pain, nausea, and loss of appetite
- There is no evidence that treatment with Vivitrol leads to improvement in the quality of life above the usual treatments for AUD
Antabuse (Disulfiram)
Antabuse is a rather unusual medication in that it is designed to punish individuals who drink alcohol by making them very sick. It blocks one of the enzymes involved in alcohol metabolism so that toxic metabolites accumulate in the body and cause an unpleasant reaction: rapid heart rate, flushing, nausea, and vomiting.
As such, Antabuse uses a psychological deterrence to alcohol use by providing negative reinforcement; it does not have a direct pharmacological effect in preventing relapse.
However, disulfiram’s efficacy is heavily dependant upon supervised use of the drug; otherwise, people who are planning to relapse simply stop taking the medication. One large study showed that only 20% of people who take Antabuse are compliant without supervision. The psychological threat deterrent created by the drug is completely removed when the drug is stopped.
Pros
- Supervised Antabuse appears to be more effective in the maintenance of abstinence than either naltrexone and acamprosate.
- Antabuse for alcohol treatment helps people learn to live without drinking, improving their ability to exercise self-control
Cons
- Antabuse therapy has a very low compliance rate
- Any potential benefits to Antabuse appear to be completely eliminated when the drug is not administered under supervision
- Besides the adverse effects from combining Antabuse and alcohol consumption, Antabuse has other bothersome side effects (most common: bad breath, rash and acne, fatigue, sexual dysfunction, and headache)
- Some clinicians oppose the use of disulfiram over objections of using an aversion (punishment-based) therapy
Campral (Acamprosate)
Campral is a novel medication to stop drinking. It acts on the same neurotransmitter systems that alcohol targets in the brain (glutamate, NMDA and GABA), apparently acting as an agonist and antagonist (blocker) and modulator of the receptors. Therefore, its effects appear to be from stabilizing the neurotransmitter system from the effects of alcohol.
Treatment with acamprosate for alcoholism is initiated once individuals have been detoxed from alcohol (not before five days after the last drink). Combining acamprosate and alcohol does not produce an aversion reaction.
Related Topic: Aversion therapy
Pros
- Acamprosate for alcohol dependence is supported by clinical studies, which show that it reduces the risk of returning to “non-heavy” alcohol use, and extends the length of abstinence compared to placebo
- Campral side effects with alcohol treatment are generally minor, causing no more treatment discontinuations than placebo (diarrhea was the main side effect)
Cons
- Clinical studies did not find any difference between Campral and placebo for preventing a return to heavy drinking
- Nine people must be treated with Campral to have one person benefit from treatment
- Compliance with taking the medication can be low, and the medication must be taken three times daily
Topamax (Topiramate)
Topamax is an anti-seizure medication that is sometimes used off-label (without FDA approval) to treat AUD. There is some evidence (although conflicting) that it may reduce alcohol consumption in some individuals.
Pros
- There is some clinical evidence that, in some people, it may reduce the number of drinking days, the number of heavy drinking days, and the number of drinks per day
Cons
- Topamax has a lot of potential side effects, some serious
- The research data supporting the use of Topamax for alcohol dependence is limited
- It takes about three weeks to see the effects of Topiramate on alcohol consumption
- It is unknown which characteristics make people likely to benefit from Topamax use
Lioresal (Baclofen)
Baclofen is used off-label, mostly in Australia and some European countries, to treat AUD, despite a lack of clinical evidence backing its use. It is seldom used for AUD in the U.S.
A 2018 review of all available research evidence showed that Baclofen makes little or no difference in the risk of relapse or how often people drink, and may even increase alcohol use.
Pros
- There are no apparent advantages to using Lioresal for alcohol treatment.
Cons
- There is currently no evidence to link Baclofen and alcohol use reduction
- Baclofen has numerous potential side effects
- Baclofen has abuse potential
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