Alcoholism has been recognized as a serious medical condition for at least a century. For most of that time, there existed no clear medical treatment other than supporting an alcoholic through withdrawal and encouraging them to avoid drinking.
Many treatments have been tried with limited success – most haven’t stood up to strict review and testing. At one time, for instance, LSD was thought to help alcoholics maintain sobriety. A study from Canada1 claimed a 65% success rate (abstinence at 18 months) but a follow up study in Toronto was unable to duplicate the effect.
Current drugs – FDA approved
There are currently three medications approved for use in the treatment of alcoholism.
Campral
The latest to receive FDA approval is Campral (generic, acamprosate) which became available for use in the U.S. in July, 2004.
The mechanism of action of Campral is not well understood, but it is thought to interfere with how alcohol affects the brain. It has a good track record in Europe (where it has been available since the 1980s) and reduces the cravings that lead to relapse.
Antabuse
Antabuse (generic, disulfiram) directly affects how alcohol is metabolized in the body. Instead of normally processing the alcohol, disulfiram causes a buildup of acetone as an alternative breakdown product. In effect, alcoholics who are taking Antabuse are poisoned if they then drink alcohol. Unfortunately, the relapse rate for patients taking Antabuse is no better than those on no medication at all. They either stop taking the medication or simply suffer the consequences when their cravings get the better of them. This does not mean it cannot help someone who is otherwise motivated to quit drinking, but the drug is far from a cure.
Trexan
The third drug is Trexan (generic, naltrexone) which is an opioid antagonist – it blocks the brain receptors for narcotic drugs like morphine and heroin. The medication seems to lessen cravings and reduce the enjoyment of drinking. The same drug is marketed as a once a month injection under the brand name Vivitrol.
Not yet approved
There are several medications that are used ‘off label’ for alcoholism treatment. While these medications are not approved for a diagnosis of alcoholism, doctors sometimes find them useful and are legally allowed to prescribe them.
- Prozac (Fuoxetine) can be used when alcoholism has a strong component of depression.
- Zofran (ondasetron) like Prozac, this is an SSRI inhibitor, but is more targeted than Prozac.
- Topamax (Topiramate) – an anticonvulsant that has been used to treat withdrawal, it is now being studied as a longer-term treatment for alcohol cravings.
- Revex (Nalmefene) is similar to Trexan but hasn’t received approval by the FDA yet.
Is there a cure in a pill?
There is unlikely to ever be a ‘one-size-fits-all’ for alcoholism treatment. Just as people vary in their physiology, their reasons for drinking alcohol also vary. This is an important point – if one medication isn’t helpful, it is rational to try another rather than giving up completely. Along with this, it must be recognized that alcoholism is more complex than the ‘chemical imbalance’ model implies. The disease has physiological, psychological and sociological components.
Medications are now, and will continue to be adjunct therapy – one piece of a larger treatment strategy. And just as there is no single pill that is best for every alcoholic, so too there is no single treatment that will work for everyone. Each part of therapy has to be matched to the person who is undergoing it. The unique problems and personality of that person have to be addressed.
Drugs can and do help. This is still an active area of research and much remains to be discovered. A technical summary of the drugs mentioned in this article can be found at the site of the American Academy of Family Physicians.2
photo by Nyboer Creative
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References
- "LSD treatment for alcoholism gets new look," Ryan Smith, Universty of Alberta
- "Medications for Treating Alcohol Dependence," American Academy of Family Physicians, 2005 Nov 1;72(9):1775-1780.
