Medication Assisted Treatment for Alcohol Addiction

Alcohol dependence and addiction is far more prevalent than opioid addiction.

The health related adverse effects of alocohol use take much longer to develop, and are not as eye-catching as those of opioid use.

One hardly hears about death from alcohol overdose, but, it is the most common ingredient of untimely deaths … be it drug overdose … motor vehicle accidents … firearm injuries … suicides … or drowning; … alcohol has a hand in it.

Alcohol in high concentration is toxic to tissues … it affects every part of the body. It damages your stomach, your liver, your brain, and your heart.

Like any other addiction, it gradually destroys personal relationships, professional performance, financial stability, and causes legal troubles.

Once alcohol usage has reached the point of dependence, or addiction … personal will and resolve to stop using it may not be sufficient.

Any attempt to discontinue using it leads to withdrawal symptoms, and inability to function normally. If you are unable to do it by yourself … let medical science help you.

Common withdrawal symptoms

Craving, anxiety, inability to concentrate, tremors, lack of appetite, headache, irritability, sweating, rapid heart rate, confusion, inability to sleep, and nightmares.

Usually this is relieved by consuming alcohol … and that is what most people end up doing … and the cycle continues.

The more extreme form of withdrawal is called “Delerium Tremens”. It happens in people who have been using alcohol for a very long time, and in large quantities, who have suddenly no access to alcohol, … it takes a few days to develop. The symptoms are very dramatic; they include confusion, shaking, agitation, hallucinations, seizures, vomiting, and dehydration. If allowed to progress to this point … it will require a visit to the Emergency Room or an inpatient facility.

Alcohol withdrawal is rarely seen … because beer is available at every intersection, and drinking is socially acceptable.

Do you have alcohol dependence or addiction?

The test is simple … and can be done at home. Go without any alcohol for a week or two, and see if you feel normal … if not, then you have it.

Do you need to be treated by a doctor, … with medications?

Not necessarily. If you have not damaged your liver, have mild symptoms of withdrawal, then progressively reducing your alcohol use, in quantity, as well as frequency, … may be enough. But if you can not do that … then it is in your interest to seek professional help.

You may also need professional help if your alcohol use is causing personal, professional, financial, or legal problems.

Medications currently approved by FDA to assist the treatment of alcohol addiction are:

  • Naltrexone tablet: (Trexan) (Revia)
  • Naltrexone injection: (Vivitrol) – Once a month injection
  • Acamprosate tablet: (Campral)
  • Disulfiram tablet: (Antabuse)

There are anecdotal reports of other medications being helpful in the treatment of alcohol addiction, such as,… Fluoxetine (Prozac), Sertraline (Zoloft), Topiramate (Topamax), Ondansitron (Zofran), Baclofen, Gabapentin (Neurontin), Buprenorphine (Suboxone), Bupropion (Welbutrin), etc. At present none of these drugs have been approved by the FDA for the treatment of alcohol addiction.

How do these medications work?

Most of these medications work on receptors in your brain. They were never designed to treat alcohol addiction, but over the years they were found to have beneficial effects and were further studied and approved if they did make a significant difference in the treatment of addiction.

Alcohol addiction is a behavior problem, the behavior needs to be changed.

Medications to not cure addiction, … they help in controlling withdrawal symptoms, and reduce craving.  Patients are then in a better position to make behavioral changes, while staying at home, attending work, and caring for their family.

The same medication does not work for everyone, and one may have to try more than one medication to find one that helps them most. The duration of medication assistance typically is 3 to 6 months, rarely upto one year.

I prefer to prescribe Naltrexone and Acamprosate tablets to assist in the treatment of alcohol addiction. I may prescribe a short course of benzodiazepines for a week at the beginning of treatment in the first month.

Naltrexone is an opioid blocker, average dose is 50 mg tablet by mouth, once a day. It can not be prescribed to patients who are taking opioid medications for pain. It has to be used with caution in patients who have liver damage. It can be used in patients who have addiction to alcohol as well as opioids.

Naltrexpone and Campral do not cause any sedation, so they are safe with driving or working with machinery.

They reduce the craving, reduce withdrawal symptoms, and are not addictive. These do not interact with alcohol.

Acamprosate is prescribed as 333mg tablets, two tablets to be taken three times a day (six tablets per day).

Naltrexone and Acamprosate are known to reduce craving. Not everyone is cured, but even a partial success is better than no success.

Another benefit of these two medications is that even if one has a relapse, the treatment need not be stopped … and one can get back on track. These medications do not interact with alcohol.

When will power is not enough … when complete abstinence is difficult, when you are in a court ordered program, when using alcohol can destroy your health, professional, and family life … medical assistance is available … without going to rehab, from a doctors office in your own community.

Naltrexone, because of its ease of single daily dose is the preferred drug in my practice. For patients who can not be prescribed Naltrexone, Acamprosate(Campral) is the next choice. Unlike Buprenorphine (Suboxone/Subutex), Naltrexone and Campral do not require special certification by DEA for prescription and there is no patient limit. Ask your Primary Care Provider for treatment or referral to a treating physician.

Disulfiram works by reacting with alcohol and producing unpleasant symptoms, which is supposed to deter patients from using alcohol. The dose is 500mg once a day. I do not recommend it, but will prescribe it … if that is what the patient prefers.

Addiction is not cured by a pill. It can help while you work with a counselor or therapist to modify your behavior. It makes giving up alcohol a little easier and in any case reduces the frequency and the amount of alcohol consumed.

Requirements of my program:

  • Referral is not required.
  • Must be enrolled with a counselor/therapist for the purpose of addiction treatment.
  • Must be a resident of Dallas Fort Worth metro area.
  • Insurance is not accepted, file your own claim.
  • Patients with Medicare, Medicaid or similar Government funded insurance are not accepted.

Procedure:

  • Telephone interview and discussion.If accepted you are asked to come to the clinic with your blood test results.
  • Completion of form, review of blood test results, payment of fee, appointment.
  • Medical examination, discussion, prescription.
  • Once a month follow-up.

Fee schedule:
Initial enrollment: $225
Follow up visits: $95
Urine drug screens are included.
Blood tests are not included.

Blood tests can be done through your PCP. No special test is required.
CHEM-7 is a test that is routinely done by your PCP and it includes basic liver function and renal function tests.

Approximate cost of medications:

Naltrexone: $1-$2 per 50 mg tablet. Cost per month $50 to 100. (30 tablets per month)

Acamprosate: $1 to $1.50 per 333mg tablet. Cost per month $180 to $270. (180 tablets per month)