Which Medications Work Best to Help Stop Drinking?
There are five main medications that can be used to help treat alcohol dependency, reduce heavy drinking, decrease cravings, and help with abstinence. Medications can assist an individual in their recovery, but medication alone won’t stop an alcoholic from drinking. Medication works best when taken as part of a treatment plan that includes counseling, group support, and supervision from a specialist.
1. Naltrexone or Vivitrol
The first drug that works to help an individual stop drinking is Naltrexone. Naltrexone is also referred to as Vivitrol and Revia. Naltrexone is the first-line treatment for alcohol misuse, which means that it is usually prescribed before other medications. It is most effective if the individual is able to stop drinking before taking it, but an alcoholic can still start using naltrexone tablets while drinking. If an individual is receiving the extended-release injection, usually Vivitrol, they should abstain from drinking before starting the therapy. People who are taking opioid medications should not take naltrexone because it can cause severe withdrawal and even block the effects of these medications.
Naltrexone works because it helps suppress alcohol cravings by blocking the effects of natural opioids in your body, helping to reduce the effects of alcohol. Naltrexone can be used as a daily tablet or as a once-monthly injection that is administered by a physician. Vivitrol injections and naltrexone pills have not been compared in conclusive research studies, so it is unknown which way works better for alcoholics in general.
However, there are conclusive studies on the effectiveness of the drug. In a comprehensive review of studies, naltrexone was shown to perform better in the body than a placebo in assisting alcoholics reduce how much they drank and how often. Naltrexone can be taken once a day or as a monthly injection, an advantage over other medications like acamprosate, which has to be taken several times a day and can be easily forgotten. The drug itself can cause some nausea, dizziness, and headaches, but on a spectrum of severity. On the bright side, the longer one takes naltrexone, the fewer side effects they are likely to have.
Acamprosate differs from naltrexone in two ways: the method it is administered and the requirement that it be used only once the alcoholic has stopped drinking. Campral is sometimes used as another name for acamprosate. Acamprosate assists alcoholics by adjusting their brain chemistry and dampening the symptoms of alcohol withdrawal, helping the individual desire alcohol less and less. Acamprosate is taken in pill form three times a day for a total of six pills a day.
Comprehensive research has compared acamprosate to naltrexone and found that there is no significant difference between the two in terms of effectiveness. Overall, the medications differ in abstinent status, dosing schedule, and how well individuals tolerate the side effects of one medication compared to the other. The side effects of acamprosate are generally well-tolerated. Therefore, patients experience few side effects while on the drug. The biggest threat to the individual is the possibility of diarrhea, the drug’s most common side effect. Fortunately, medication-related diarrhea should go away within the first few weeks of consumption. The less frequent side effects are abdominal cramps, headache, insomnia, anxiety, and depressed libido.
Disulfiram, unlike oral naltrexone, cannot be used while an individual is still drinking. If a person ingests alcohol of any sort, the drug will make them very sick. This drug is more commonly referred to as Antabuse. It makes the individual sick because it prevents alcohol from being fully metabolized, causing nausea, vomiting, headache, and flushing if alcohol is consumed. Disulfiram is taken once daily as a pill. The average dose in each pill is 250 mg per day, but doses can range anywhere from 125 mg to 500 mg per day.
Disulfiram is a tricky medication for alcoholism because research suggests that disulfiram can only work if the individual is motivated to stay abstinent and their treatment is supervised. Continuing to take the medication as prescribed can be a problem for this drug because of the risk of consuming alcohol. Two well-researched studies found that patients had a difficult time sticking with disulfiram, and a third study reported nearly a 50% drop-out rate. Disulfiram can cause mild to intense side effects during the first two weeks of use. These side effects include skin irritation, headache, drowsiness, and fatigue. This drug can interact with a number of other drugs, so providers should be aware of any other medications that patients are taking when prescribing disulfiram.
Topiramate commonly referred to as Topamax, is used specifically to treat migraines, seizure disorders, and appetite suppression. Even though it is not currently FDA-approved for alcoholism treatment, there have been studies that suggest that it may have the potential to help in recovery and withdrawal. This drug can be used if an individual is still drinking before starting treatment. Topiramate works by adjusting the balance of chemicals in the brain, which reduces the rewarding effect of consuming alcohol. Usually, when an individual is prescribed Topiramate, he or she will increase their dose gradually over several weeks, starting at 25 mg per day and increasing to a maximum of 75 mg a day. Some studies have used doses up to 300 mg per day. These elevated doses may be associated with more side effects, which often leads to the discontinuation of treatment.
There have been several collaborative studies that have found that when topiramate was taken over 14 weeks, the drug did reduce heavy drinking days compared to a placebo. Other research has shown that individuals who used topiramate stayed abstinent longer, had fewer weeks of heavy drinking, and were more likely to be abstinent at four weeks and eight weeks into treatment compared to a placebo. This study also compared topiramate against naltrexone and found no significant differences between the two. Topiramate can irritate users’ eyes and may cause vision problems such as blurred or double vision. It can also cause headaches, dizziness, depression, drowsiness, memory problems, tingling sensations, weight loss, and lethargy.
Gabapentin also referred to as Neurontin, is used to treat epilepsy and postherpetic neuralgia, a condition that causes nerve pain after someone recovers from shingles. Similar to topiramate, gabapentin is not FDA-approved for alcohol dependence even though studies have suggested that it may help prevent relapse by treating symptoms individuals experience when they stop drinking, such as cravings, anxiety, and insomnia. Some people are wary of using gabapentin because it has the potential to be misused, especially by people who have misused drugs in the past. Yet studies have also shown that people who take gabapentin for alcohol dependence are not at high risk of abusing the drug. Gabapentin helps those recovering from alcohol dependence maintain abstinence by stabilizing the brain chemicals that are responsible for many symptoms of alcohol withdrawal. These studies have used a variety of doses to treat alcohol dependence, including 600 mg, 900 mg, 1200 mg, 1500 mg, and 1800 mg daily. It is still inconclusive what the optimal dose is. Your healthcare provider should determine the best initial dose.
Gabapentin seems to be particularly useful for people who are prone to alcohol withdrawal while working to become abstinent. One research study found that 41% of people with alcohol withdrawal symptoms before treatment maintained total abstinence for 16 weeks with gabapentin use. Another study found that gabapentin, particularly at a dose of 1800 mg per day, increased the likelihood of sobriety and reduced symptoms such as insomnia and cravings compared to a placebo. In other studies, alcoholics taking gabapentin for alcohol dependence experienced headaches, insomnia, and fatigue. Other effects of gabapentin can include:
- Lack of coordination
- Drowsiness and extreme fatigue
- Nausea and vomiting
- Double vision
- Difficulty communicating
At Boardwalk Recovery Center, we assist clients with addiction treatment options and care plans that work for them. For some clients, therapy may be enough, but for others, the combination of medicine and therapy can be the optimal treatment for alcohol dependence. Some studies have proven that this combination is most effective. Our on-staff medical professionals and psychiatrists help clients best assist and evaluate what they need for each step of their recovery.