Alcoholism - Medications

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Acamprosate. Acamprosate (Campral) is the newest drug to be approved for treatment of alcoholism. Acamprosate calms the brain and reduces cravings by inhibiting the transmission of the neurotransmitter gamma aminobutyric acid (GABA). Studies indicate that it reduces the frequency of drinking and, in concert with psychotherapy, improves quality of life even in patients with severe alcohol dependence. One study reported that 60% of patients remained abstinent for 12 weeks, and in another 43% were still abstinent after nearly a year. The drug may cause occasional diarrhea and headache. It also can impair certain memory functions but does not alter short-term working memory or mood. People with kidney problems should use acamprosate cautiously. For some patients, combination therapy with naltrexone or disulfiram may provide greater benefit than acamprosate alone.

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Nalmefene. Nalmefene (Revex) is an injectable opioid antagonist that is similar to naltrexone. It is generally used to reverse the effects of narcotics that are given during surgery. It is being investigated as an anticraving drug for alcohol dependence.

Aversion Medications

Disulfiram. Some drugs have properties that interact with alcohol to produce distressing side effects. Disulfiram (Antabuse) causes flushing, headache, nausea, and vomiting if a person drinks alcohol while taking the drug. The symptoms can be triggered after drinking half a glass of wine or half a shot of liquor and may last from half an hour to 2 hours, depending on dosage of the drug and the amount of alcohol consumed. One dose of disulfiram is usually effective for 1 - 2 weeks. Overdose can be dangerous, causing low blood pressure, chest pain, shortness of breath, and even death. The drug is more effective if patients have family or social support, including AA "buddies," who are close by and vigilant to ensure that they take it. A 2004 study that compared naltrexone with disulfiram during the course of one year found that 86% of patients treated with disulfiram remained abstinent compared with 44% of patients treated with naltrexone. However, patients treated with naltrexone had lower levels of alcohol craving.

Antidepressants

Depression is common among alcohol-dependent people, and it can be a significant problem in people who quit drinking. In fact, one 2002 study found that quitting drinking was associated with a fourfold increase in the risk for major depression. Antidepressants may be helpful, particularly for patients who have a history of depression. Experts reporting on the study suggested that treating these individuals with antidepressants as soon as they quit drinking may help prevent relapse. A 2004 review of clinical trials found that antidepressants had a limited effect on alcohol dependence and should be prescribed in combination with behavioral or pharmacologic therapies that directly address the addiction itself.

SSRIs. Selective serotonin reuptake inhibitors (SSRIs) target the neurotransmitter serotonin and are of particular interest in the treatment of alcoholism. They include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and fluvoxamine (Luvox). Studies indicate that these antidepressants may reduce cravings and desire for alcohol, even in selected people who are not depressed. Studies report reductions in alcohol ranging from 10 - 70% in people with alcoholism who take SSRIs. Research is under way to determine which individuals with alcoholism might best respond to SSRIs. For example, one study suggested that they may be more effective for men than women. Some may be specifically helpful for people with both alcoholism and certain anxiety disorders, such as social anxiety.