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Treatment Guide Spotlight: Can Medications Help Manage Alcohol Use?
In our Treatment Guide Spotlight series, we highlight resources that can help solve specific problems and answer questions associated with alcohol and alcohol use disorder, using the PGDF Treatment Guide as a tool.
Experts in the field agree that clinicians should include medications on the list of treatment options for alcohol use disorder (AUD), yet they are little known and widely underutilized. Research shows that medication works best in conjunction with other forms of psychosocial and behavioral interventions, and can be a powerful tool in managing symptoms of AUD. Medication-assisted treatments (MAT) have been shown to be effective in helping AUD patients to manage cravings and drink less.
The PGDF Treatment Guide section on Medication gives an overview of current pharmacotherapy options for the treatment of AUD. There are medications that help manage cravings for alcohol that are non-addictive and have low incidence of side effects. Currently, there are three medications (disulfiram, naltrexone and acamprosate) approved by the FDA for AUD treatment, as well as other options which have been, and continue to be, studied for their effectiveness in treating AUD.
To learn more about each pharmacological option, you may click through to our Treatment Guide section on Medication. Prescription medications should always be administered under the care of a qualified physician.
Disulfiram interferes with the body’s metabolism of alcohol, causing unpleasant symptoms such as nausea, vomiting, headache and weakness when you drink. It is not a cure for alcoholism and does not stop cravings, but is used as a physical and psychological deterrent— knowing you will get sick if you drink while taking it may stop you from drinking alcohol.
Naltrexone is an opioid antagonist: it blocks the receptors in your brain that produce feelings of pleasure when you drink alcohol. You can feel drunk while taking naltrexone and drinking, but you will not feel the usual pleasurable feelings that accompany drinking. This can reduce cravings for alcohol, which can help you cut back on your drinking. Naltrexone is not a narcotic and is not addictive and has been shown to work best for people who stop drinking at least 4 days before they begin taking it. Naltrexone can be taken as a daily pill or as a monthly injection. Naltrexone can help people to abstain or to drink less.
The Sinclair Method use of Naltrexone
The Sinclair Method (SM) is a treatment protocol that uses the prescription drug naltrexone to reduce cravings for alcohol. SM works via pharmacological extinction, the process of reversing the association your brain has created between alcohol and the release of pleasure-inducing endorphins. The Sinclair Method of using naltrexone is different in that naltrexone is used in combination with your usual drinking habits. Naltrexone is taken every time you drink, and when active in the body, blocks endorphins normally released by drinking, along with the pleasurable feelings usually associated with drinking. This, in time, causes alcohol to lose its appeal, and leads to a reduction in, or cessation of, drinking.
Acamprosate calcium can help people who have quit drinking to stay abstinent. Acamprosate has been shown to work best when used as part of a comprehensive program that includes psychosocial support. Acamprosate eases withdrawal symptoms — such as insomnia, anxiety, restlessness, and feeling blue — that can last for months after you stop drinking. Acamprosate is thought to help balance and normalize brain activity, especially in the glutamate and GABA neurotransmitter systems. Acamprosate is taken in the form of two pills, three times every day. Like naltrexone, acamprosate seems to work best for people who are able to stop drinking before starting treatment.
Topiramate is a prescription drug used to treat seizures and prevent migraines. It is also sometimes prescribed off-label for the management of alcohol dependence. It has not been approved by the FDA for this purpose. The 2018 APA Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder recommends that topiramate be offered to patients with moderate to severe alcohol use disorder who have not responded to naltrexone and acamprosate and want to reduce or stop drinking.
Baclofen is a prescription medication used to treat muscle spasms that is sometimes prescribed off-label to treat alcohol use disorder (AUD), although it has not been approved by the FDA for this purpose. Scientific studies are not yet conclusive on baclofen’s efficacy in treating AUD. Studies in 2015 and earlier showed that high-dose baclofen helped people abstain from alcohol. However, a 2018 study found that taking baclofen led neither to an increase in the number of days a person remained abstinent, nor to a decrease in heavy drinking, craving, anxiety or depression, suggesting that using baclofen as an AUD treatment is premature. The study authors noted that further research is warranted and that baclofen may be an effective option for AUD patients with liver disease who cannot physically tolerate other medications.
Gabapentin is a generic antiepileptic drug currently used to treat seizures and some types of pain. It is sometimes prescribed off-label to treat alcohol use disorder. It has not been approved by the FDA for this purpose. Gabapentin may reduce alcohol craving and alcohol-associated sleep and mood problems. The 2018 APA Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder recommends that gabapentin be offered to patients with moderate to severe alcohol use disorder who have not responded to naltrexone and acamprosate and want to reduce or stop drinking.
The PGDF Treatment Guide section on Medication also offers information on obtaining medications for the treatment of AUD and a section in which we keep track of medications in development or being studied for use in treating AUD.