Alcohol Treatment: Medications

Treating alcoholism with medications is an ongoing field of research, with scientists seeking answers to many questions. Research suggests that behavioral treatments—a course of action designed to teach an individual how to change his or her unhealthy behavior—can be effective for alcohol problems. The best treatment may be a combination of behavioral and prescription-drug treatment.

There are four main categories of medications that are either currently available or are still being tested for the treatment of alcoholism and alcohol abuse:

• drugs that increase a person's sensitivity to alcohol
• drugs that directly reduce drinking behavior
• drugs that improve mental processes in patients with impairments (damage) caused by alcohol
• drugs that treat psychiatric problems a person may have in addition to alcoholism

Drugs That Increase Sensitivity to Alcohol

Some drugs used to treat alcoholism produce a very unpleasant reaction when the person who takes them also drinks alcohol. In other words, the person's sensitivity to alcohol's effects increases. For example, drinking a small amount of alcohol might now upset a person's stomach and cause nausea. As a result, the drugs help to prevent the alcoholic from drinking.

Currently, the most widely used medication in this category is disulfiram (Antabuse), which has been in use for about fifty years. An alcoholic who takes disulfiram and also drinks alcohol will experience the following symptoms: facial flushing, tachycardia (rapid heartbeat), heart palpitations, indigestion, lowered blood pressure, headaches, nausea, and vomiting. The severity of that reaction depends on the amount of alcohol and disulfiram in the blood. The dose of disulfiram depends on the needs of each patient. High doses can produce side effects such as sedation , lethargy , depression , and toxic hepatitis (a liver disease). Some patients have died as a result of a severe reaction to the combination of disulfiram and alcohol in their bodies.

Drugs That Reduce Drinking Behavior

The development of medications to reduce drinking behavior is an important and exciting area of alcohol research. Researchers have studied the interactions among several brain chemicals, including the serotonin, opioid, and dopamine systems. Medications have been developed to change the way these chemical systems work. The result of these changes is to reduce a person's drinking behavior.

Medications That Affect the Serotonin System. Research suggests that the neurotransmitter serotonin is associated with alcoholism. Alcoholics appear to have less serotonin than nonalcoholics. Drugs known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), and viqualine seem to be modestly effective in reducing alcohol consumption. SSRIs act by helping to increase the amount of the brain chemical serotonin available to nerve cells (neurons). Scientists do not fully understand why these medications can help decrease a person's alcohol use. It may be that higher levels of serotonin interfere with some of the sense of reward that some individuals feel when drinking alcohol. Although SSRIs are sometimes used to help alcoholics decrease their alcohol intake, these medications are more useful for other psychiatric disorders, such as depression and anxiety. When used for alcoholism, the results have been modest—individuals tend to decrease their alcohol intake by about 25 percent.

Medications That Affect the Dopamine System. Dopamine is another brain chemical that influences drinking behavior. Scientists believe that dopamine plays a major role in the effects of alcohol (as well as other drugs) that make people want to drink repeatedly. Research is under way to test the effectiveness of drugs that increase brain dopamine levels to reduce drinking. In studies conducted on rats bred to prefer alcohol, medications such as bromocriptine, GBR 12909, and amphetamine reduced alcohol intake. In studies involving humans, bromocriptine reduced alcohol craving and drinking in severe alcoholics.

Medications That Affect the Endogenous Opioid System. Studies have shown that a chemical system within the body called the endogenous opioid system also plays a role in drinking behavior. Endogenous opioids are compounds that the body produces naturally, such as endorphins and enkephalins. These substances have opium-like or morphine-like properties, including masking pain and increasing feelings of pleasure. Alcohol is thought to increase the availability of endogenous opioids in the brain, causing drinkers to have positive feelings, and reinforcing their desire to drink more.

Naltrexone (Trexan) and naloxone are two drugs that block the effects of alcohol on endogenous opioid availability in the brain. Several studies show that use of these drugs can cause a decrease in drinking. Alcoholics treated with naltrexone have fewer drinking days, fewer relapses , and reduced craving for alcohol. In addition, naltrexone appears to cause few side effects. Interestingly, alcoholics treated with naltrexone who did have one or two drinks were less likely to continue drinking. This is important, since some alcoholics appear to lose control of drinking after one or two drinks.

Drugs That Improve Mental Processes

Heavy drinking over many years can lead to damage of many essential mental processes, including abstract thinking, problem solving, and memory. The two most common diseases affecting mental processes in alcoholics are alcoholic amnestic disorder (Wernicke-Korsakoff syndrome) and alcoholic dementia. Alcoholic amnestic disorder causes severe memory problems. Alcoholic dementia causes difficulties in short-term and long-term memory, abstract thinking, intellectual abilities, and judgment.

Little research has been conducted with medications to treat these conditions. Some areas of drug research may overlap with research on drugs that directly reduce drinking. For example, serotonin-uptake inhibitors have shown some promise in improving learning and memory. In one study with the serotonin-uptake inhibitor fluvoxamine, patients suffering from alcohol amnestic disorder had improved memory, but patients with alcoholic dementia did not. In general, treatment of alcoholics with these conditions has little success.

Drugs to Treat Psychiatric Disorders in Combination with Alcoholism

People with alcoholism may also be diagnosed with other psychiatric problems, including anxiety, depression, antisocial personality disorder , panic disorders, and phobias (fears). Part of the problem in treatment is to determine if the psychiatric disorder developed before alcoholism, or after (as a result of) alcoholism.

Several studies have been conducted with medications used to treat depression. Alcoholism and depression often go together, and depressed alcoholics have high rates of relapse. Depression is often treated with medications called tricyclic antidepressants (desipramine, imipramine, amitriptyline, and doxepin). Whether they can successfully treat alcoholics with depression is still unknown. Furthermore, because mixing tricyclic antidepressants with alcohol can cause adverse effects, depression and alcoholism might be more safely treated with one of the SSRI antidepressants.

Many individuals who abuse alcohol also suffer from anxiety disorders . Buspirone, a medication commonly used to treat anxiety, has shown potential in reducing alcohol consumption. One study reported that buspirone diminished alcohol craving and reduced anxiety. Another study found buspirone to be more effective with alcoholics suffering from high anxiety than those with low levels of anxiety. A third study on more severe alcoholic patients found no effect. Further research is needed before this drug's effectiveness can be accurately evaluated.

Future Outlook

New medications that may decrease drinking, prevent relapse, and restore damaged mental processes in alcoholics continue to be developed. In the future, alcoholism treatment may combine these new medications with other types of therapy, including behavioral therapy. As research reveals the mechanisms responsible for alcohol craving, drinking behavior, and psychiatric disorders such as depression and anxiety, better medications may be developed to cope with these problems. Treating alcoholism with medications is an area of research with many avenues to pursue.

see also Alcohol: Chemistry; Alcohol: Complications of Problem Drinking; Alcohol Treatment: Behavioral Approaches; Brain Chemistry; Brain Structures; Treatment Types: An Overview.