Treatment for Alcohol Use Disorders

Alcoholism as a disease is a complex medical condition to treat. Treatment choices are based on complexity and stages of presentation. In this material, we shall focus on alcohol use disorders and medications used in the treatment of alcohol dependence.

Depending on the amount of alcohol consumed, alcohol intoxication can be a little buzz at the bar to a serious loss of consciousness, compromised breathing, and even coma.

Serious intoxication is a medical emergency and need to be treated in a hospital setting with oxygen and fluids.

The risks of drinking are innumerable, and even hours after consuming alcohol, your body may still experience adverse effects. Because the liver is the primary metabolizing organ for alcohol and the rate of elimination from the body is constant, it does not matter what you drink or how little you drink – only a certain amount is metabolized and eliminated.

For example, the blood alcohol level will be the same for a person who drinks five drinks at a time in the first hour over a 5-hour span or one drink every hour over the next five hours.

No drinking is “safe drinking.” Getting a comprehensive treatment plan and support group is essential for successfully maintaining sobriety.

Alcohol abuse is not cured, but it can be treated and managed throughout your life. You may always get cravings when you watch sports or pass by a bar, but a comprehensive management program can help you to move past those cravings and lead a productive, happy life. There are approved medications to help with alcoholism but there is not a miracle pill or a quick fix. Treatment to prevent alcohol use and maintain abstinence should include medication, psychosocial support and other self-support groups.

The most common symptom of alcohol treatment is withdrawal. This is an unpleasant experience typically noticed 6-8 hours after the last drink. The discomfort associated with withdrawal peaks after 24 hours and usually resolves within 7 days.

Common alcohol withdrawal features are:

• Nervousness
• Feeling down
• Irritability
• Jumpiness or shakiness
• Disturbed sleep
• Nausea and vomiting
• Sweating
• Increased heart rate and
• Tremor of the hands or other body parts

The goal of treatment during withdrawal usually involves preventing severe withdrawal and minimizing discomfort. They are treated using medications like benzodiazepines such as Lorazepam (Ativan), Diazepam (Valium), or Chlordiazepoxide (Librium).

• Delirium Tremens (DT’s): Delirium Tremens is a severe form of alcohol withdrawal that can bring agitation, severe confusion, fever, seeing or feeling things that are not there (hallucinations) and seizures. The goal of treatment for DT involves minimizing or preventing seizures and to bring full state of consciousness. DT is treated with the same medications used for withdrawal.

There are several medications that have been approved by FDA as safe and effective in treating alcoholism. There are medications to help alleviate the symptoms of withdrawal, as well as medications aimed at curbing future cravings.

Withdrawal Medication

As stated above, the most common medications used in alcohol abuse management are Lorazepam (Ativan), Diazepam (Valium) and Chlordiazepoxide (Librium). Brain chemical (GABA) is involved in the effects of alcohol use. These medications control the receptors of this brain chemical to minimize withdrawal discomforts. It is important to remember that these medications are primarily used to reduce withdrawal symptoms and complications. It has no role in long-term treatment of alcoholism.

Cravings and Maintenance Medication

Medications used to prevent craving and relapse are – Disulfiram (Antabuse), Naltrexone (Revia), Acamprosate (Campral) and Vivitrol (Injectable Naltrexone).

• Disulfiram (Antabuse): Disulfiram is a medication that acts as an alcohol deterrent. It has been used in the medical practice for last 50 years. It works by blocking the alcohol metabolizing enzymes and if a patient on the medication consumes alcohol then it results in an unpleasant reaction of headache, flushing, nausea, and vomiting. This fear of triggering a disulfiram-alcohol reaction makes patients to stay away from consuming alcohol. It is not known to help with craving or withdrawal symptoms. 
• Acamprosate (Campral):  Acamprosate (Campral) was approved by the FDA in 2004 to treat alcohol dependence. It is known to help with discomfort from withdrawal, craving, and maintenance of abstinence. These positive effects of Acamprosate (Campral) are due to its action on brain chemicals called GABA (gamma-aminobutyric acid) and NMDA (N-Methyl-D-aspartate). It does not create unpleasant reactions when alcohol is consumed with the medication.  
• Naltrexone (Revia) and Vivitrol (Injectable Naltrexone): Naltrexone is also an FDA approved medication to help with alcoholism. Its mechanism to help with alcoholism has not been fully understood but experts believe Naltrexone blocks the alcohol induced dopamine release and therefore makes the alcohol less pleasurable. It is also known to reduce cravings and reduce heavy drinking. Revia is an oral Naltrexone preparation that needs to be taken once a day. Vivitrol is an Injectable Naltrexone preparation that needs to be injected once a month.