What Medications Are Used to Treat Alcoholism?

Thanks to years of research, doctors and health professionals now have multiple options to treat alcohol use disorders. Building on this progress, scientists continue to work on the development of new medications and are discovering new ways to improve the effectiveness, accessibility, quality, and cost-effectiveness of treatment.

According to research, medications seem to be a positive part of the most effective combination for the treatment of alcohol use disorders—it's also underused as a treatment method.

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"The most robust finding in the study is that those receiving any medication did much better than those who received no pills at all," says Professor Barbara Mason, of Scripps Research Institute, and an author of the study. "This should be a wake-up call."

"With less than one percent of those seeking help for alcohol dependence receiving a prescription, medication is underutilized. Medication for alcoholism can offer patients an advantage for their recovery, especially in a real-world setting," says Mason.

COMBINE Study

A massive study published in 2006 followed more than 1,300 study participants at 11 academic locations over a three-year period to determine what combination of treatment, medication, and counseling was the most effective for treating alcohol use disorders.

The Combining Medications and Behavioral Interventions for Alcohol Dependence (COMBINE) study produced some surprising results when it revealed that one of the newer medications used for the treatment of alcoholism failed to improve treatment outcomes on its own.

After 16 weeks, the COMBINE study showed overall positive outcomes for study participants.

• All groups studied substantially reduced drinking during treatment. The overall percentage of days absent tripled, from 25 to 73 percent, and alcohol consumption per week decreased from 66 to 13 drinks, a decrease of 80 percent.
• Patients who received medical management plus either Revia or Vivitrol (naltrexone) or specialized counseling showed similarly improved outcomes of alcohol abstinence (80 percent) compared with patients who received medical management and placebo pills (75 percent).
• Patients who received Revia or Vivitrol reported less craving for alcohol.
• Adding either Revia or Vivitrol or specialized alcohol counseling to medical management almost doubled the chance to do well.

Antabuse (Disulfiram)

Antabuse (disulfiram) was the first medicine approved for the treatment of alcohol misuse and alcohol dependence. It works by causing a severe adverse reaction when someone taking the medication consumes alcohol. Most people who take it will vomit after a drink of alcohol. This, in turn, is thought to create a deterrent to drinking.

Disulfiram was first developed in the 1920s for use in manufacturing processes. The alcohol-aversive effects of Antabuse were first recorded in the 1930s. Workers in the vulcanized rubber industry who were exposed to tetraethylthiuram disulfide became ill after drinking alcohol.

In 1948, Danish researchers trying to find treatments for parasitic stomach infections discovered the alcohol-related effects of disulfiram when they too became ill after drinking alcohol. The researchers began a new set of studies on using disulfiram to treat alcohol dependence.

Shortly thereafter, the FDA approved disulfiram to treat alcoholism. It was first manufactured by Wyeth-Ayerst Laboratories under the brand name Antabuse.

Initially, disulfiram was given in larger dosages to produce aversion conditioning to alcohol by making the patients very sick if they drank. Later, after many reported severe reactions (including some deaths), Antabuse was administered in smaller dosages to support alcohol abstinence.

Naltrexone

Naltrexone is sold under the brand names Revia and Depade. An extended-release, monthly injectable form of naltrexone is marketed under the trade name Vivitrol. It works in the brain by blocking the high that people experience when they drink alcohol or take opioids like heroin and cocaine.

Naltrexone was first developed in 1963 to treat addiction to opioids. In 1984, it was approved by the FDA for the treatment of use of drugs such as heroin, morphine, and oxycodone. At the time, it was marketed by DuPont under the brand name Trexan.

In the 1980s, animal studies discovered that naltrexone also reduced alcohol consumption. Human clinical trials followed in the late 80s and early 90s. These showed that when combined with psychosocial therapy, naltrexone could reduce alcohol cravings and decrease relapse rates in alcoholics.

The FDA approved the use of naltrexone to treat alcohol use disorders in 1994. DuPont then renamed the drug Revia.

The COMBINE study found that, when combined with a structured outpatient medical management intervention consisting of nine brief sessions conducted by a healthcare professional, the alcohol-deterrent medications Revia and Vivitrol (naltrexone) and up to 20 sessions of alcohol counseling were equally effective treatments for alcoholism.

"These results demonstrate that either naltrexone or specialized alcohol counseling—with structured medical management—is an effective option for treating alcohol dependence," said Mark L. Willenbring, MD, director, division of treatment and recovery research, National Institute of Alcohol Abuse and Alcoholism.

"Although medical management is somewhat more intensive than the alcohol dependence interventions offered in most of today's health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus."

Campral (Acamprosate)

Campral (acamprosate) is the most recent medication approved for the treatment of alcohol dependence or alcoholism in the U.S. It works by normalizing alcohol related changes in the brain, reducing some of the extended physical distress and emotional discomfort people can experience when they quit drinking (also known as post-acute withdrawal syndrome) that can lead to relapse.

In 1982, the French company Laboratoires Meram developed acamprosate for the treatment of alcohol dependence. It was tested for safety and efficacy from 1982 until 1988 when it was authorized for use by the French government to treat alcoholism. It was first marketed under the name Aotal.

For more than 20 years, acamprosate was widely used throughout Europe for treating people with alcohol use disorders. It was not approved for use in the U.S. until July 2004. It was first marketed in the United States in January 2005 under the brand name Campral. Campral is currently marketed in the United States by Forest Pharmaceuticals.

The COMBINE study found that combining another alcohol-deterrent drug Campral (acamprosate) with the medical management program did not improve outcomes. Campral did not perform better than the placebo or dummy pill. This finding stumped researchers since previous studies performed in Europe using Campral had yielded positive treatment outcomes.

The Sinclair Method

In 2001, David Sinclair, PhD, a researcher in Finland claimed an 80 percent cure rate for alcohol dependence when anti-alcohol drugs Revia or Vivitrol are prescribed according to his Sinclair Method. Dr. Sinclair's research has been published in the peer-reviewed journals Alcohol and Alcoholism and the Journal of Clinical Psychopharmacology.

The Sinclair Method is the standard treatment protocol for alcohol dependence in Finland, the method is also used in the U.K., but the method has yet to catch on in the United States. 

With the Sinclair Method, people only take Revia or Vivitrol before drinking and never otherwise. Revia and Vivitrol are not like other anti-alcohol drugs that cause intense sickness and hangover sensations when taken with alcohol. The change in behavior only appears over time.

With the Sinclair Method, Revia or Vivitrol is taken one hour before drinking alcohol. At the end of four to six months of treatment with the Sinclair Method, 80 percent of people who had been overusing alcohol were either drinking moderately or abstaining entirely.

The way this process works is when people normally drink alcohol, endorphins are released into the brain, and this reinforces the behavior of drinking alcohol. Revia and Vivitrol block the feel-good endorphins. Much like when Pavlov's dogs were presented with food when a bell was rung, these dogs became conditioned to salivate at the sound of the bell alone. However, when these dogs continued to be presented with the ringing bell and no food, the salivating stopped.

It is believed that the main reason the Sinclair Method has not caught on in the U.S. is two-fold. In the U.S., 12-step programs based on abstinence seem to dominate treatment plans prescribed by doctors, and doctors do not like that the Sinclair Method encourages people with alcohol dependency problems to continue drinking.