Alcohol and Medicines
The unhealthy use of alcohol—including risky drinking behavior, problem drinking, and alcohol abuse and dependence—may now be treated with medicines, according to increasing research. When coupled with counseling interventions, success rates have increased.
The drug disulfiram (Antabuse) was introduced in the 1940s, with the intent to help alcohol dependent persons abstain from heavy drinking. Now, newer medicines, such as naltrexone and it’s intramuscular injection Vivitrol and acamprosate (Campral), have proven effective for drinking abstinence, especially when paired with behavioral therapies. Currently, four medicines are FDA-approved for the treatment of alcohol dependence: Antabuse, Naltrexone, Campral, and Topiramate.
Antabuse works by interfering with the body’s ability to metabolize alcohol by way of blocking the break down of acetaldehyde by the enzyme aldehyde dehydrogenease. Therefore, the body accumulates a large amount of acetaldehyde, causing the adverse effects of nausea, vomiting, palpitations, and headache. With the effects being immediate, the medication supports a person’s motivation to avoid alcohol; however, the effects may also make medication compliance difficult, and the medicine is proven to be most successful when administered by someone other than the dependent, such as a healthcare provider or family member.
Naltrexone, an opiate antagonist, works by blocking the ?-receptors of the brain, successfully decreasing both the overall number of drinks consumed by the dependent and the number of days the dependent consumed large amounts of alcohol. Taking the oral dose of 50 to 100 mg per day over a period of three months has shown to prevent relapse, especially when combined with medical management.6 During a six-month trial, the monthly injection of 380 mg of Extended-Release Vivitrol kept the dependent adhered to medication and showed results of 32 percent remaining abstinent for a period of six months, compared to 11 percent who received a placebo. The adverse effects experienced were minor, including nausea, headache, and dizziness; however, persons with liver disease and opiate pain management can not use naltrexone or Extended-Release Vivitrol.3
Campral became approved for treating alcohol dependency in 2004, and although how exactly it works is unknown, it has been studied and used largely in various other countries around the world.3 According to Littleton and Zieglgansberger, it is believed to balance the excitatory and inhibitory pathways of the brain, those that are altered by alcohol use. The medicine has shown to improve abstinence rates and prolong the time before the dependent’s first drink. Generally, Campral’s side effects were gastrointestinal; therefore, use in persons with liver disease is admitted. However, persons with kidney impairments are not recommended to use the drug.3
Topiramate, the fourth approved medicine, is an anticonvulsant; however, it has shown to reduce alcohol and cigarette use. At a dosage of 300 mg per day, the drug works by assisting GABA neurotransmitter functioning and opposing glutamate activity, with adverse effects including cognitive dysfunction, abnormal sensations, anorexia, and taste abnormalities. The medication has exhibited the infrequent effects of metabolic acidosis, acute myopia, and secondary narrow-angle glaucoma.3
With current approved medicines having only a moderate effect at treating alcohol dependency, studies identifying new, more effective medicines are underway.3 The selective serotonin reuptake inhibitors line of depression-treating medicines have not shown effectiveness among persons with early-onset dependence; however, some studies concluded it may be with later-onset alcoholism when used in conjunction with naltrexone. According to Addolorate, Leggio, Ferrulli, et al’s study, the “Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis,” medicines that target the GABA and glutamate neurotransmitters may be promising methods of treatment. With early intervention, gabapentin, another anticonvulsant, has also shown promise of effectiveness.6
As most medicines focus mainly on those who are alcohol dependent, those who abuse the substance yet do not meet the criteria for dependence may also benefit from such treatment.3 Young adults fall into the category, as they are mostly interested in only decreasing their drinking instead of abstaining.3 Therefore, motivational interventions like the Brief Alcohol Screening and Intervention for College Students (BASICS) offer personalized feedback and strategies for refraining from alcohol-induced harm. While the interventions alone proved effective, coupled with medicine, it would help reduce drinking even further.8
 Saitz, R.N. Clinical practice. Unhealthy alcohol use. New England Journal of Medicine 352:596– 607, 2005. PMID: 15703424
 Krishnansarin, S.; O’Malley, S.; and Krystal, J.H. Treatment implications: Using neuroscience to guide the development of new pharmacotherapies for alcoholism. Alcohol Research & Health, 31(4):400–407, 2008.
 O’Malley, S.S., and O’Connor, P.G. (). Medications for Unhealthy Alcohol Use: Across the Spectrum. Alcohol Research and Health. Retrieved from http://pubs.niaaa.nih.gov/publications/arh334/300-312.pdf.
 Krampe, H., and Ehrenreich, H. Supervised disulfiram as adjunct to psychotherapy in alcoholism treatment. Current Pharmaceutical Design 16(19):2076–2090, 2010. PMID: 20482514
 Weerts, E.M.; Kim, Y.K.;Wand, G.S.; et al. Differences in deltaand muopioid receptor blockade measured by positron emission tomography in naltrexonetreated recently abstinent alcoholdependent subjects. Neuropsychopharmacology 33(3):653–665, 2008. PMID: 17487229
 Anton, R.F.; Drobes, D.J.; Voronin, K.; et al. Naltrexone effects on alcohol consumption in a clinical laboratory paradigm: Temporal effects of drinking. Psychopharmacology (Berlin) 173(12):32– 40, 2004. PMID: 14722705
 Pettinati, H.M.; O’Brien, C.P.; Rabinowitz, A.R.; et al. The status of naltrexone in the treatment of alcohol dependence: Specific effects on heavy drinking. Journal of Clinical Psychopharmacology 26(6):610–625, 2006. PMID: 17110818
 O’Malley, S.S.; Garbutt, J.C.; Gastfriend, D.R.; et al. Efficacy of extendedrelease naltrexone in alcoholdependent patients who are abstinent before treatment. Journal of Clinical Psychopharmacology 27(5):507–512, 2007. PMID: 17873686
 Littleton, J., and Zieglgansberger,W. Pharmacological mechanisms of naltrexone and acamprosate in the prevention of relapse in alcohol dependence. American Journal on Addictions 12(Suppl. 1):S3–S11, 2003. PMID: 14972776
 Kranzler, H.R., and Gage, A. Acamprosate efficacy in alcoholdependent patients: Summary of results from three pivotal trials. American Journal on Addictions 17(1):70–76, 2008. PMID: 18214726
 Johnson, B.A.; Aitdaoud, N.; Akhtar, F.Z; and Javors, M.A. Use of oral topiramate to promote smoking abstinence among alcoholdependent smokers: A randomized controlled trial. Archives of Internal Medicine 165(14):1600–1605, 2005. PMID: 16043677
 Kranzler, H.R.; Tennen, H.; Armeli, S.; et al. Targeted naltrexone for problem drinkers. Journal of Clinical Psychopharmacology 29(4):350–357, 2009. PMID: 19593174
 Addolorate, G.; Leggio, L.; Ferrulli, A.; et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcoholdependent patients with liver cirrhosis: Randomised, doubleblind controlled study. Lancet 370(9603): 1915–1922, 2007. PMID: 18068515