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Medication to treat alcoholism – Disulfiram, Antabuse and Naltrexone

Posted Jan 09 2013 5:00am

Are there medications to treat alcoholism?

Two ways to chemically treat alcoholism

We have been looking for a medication to treat alcoholism for a long time. There are two principle ways in which this is supposed to work.  One goal has been to find ways to turn the alcoholic back into a normal drinker. If only we could find a medication that relieves the cravings then the problem alcoholic could be taught to drink normally again. The other option is a medication that will keep the alcoholic from drinking.

The search for a cure

As far back as the AA Big Book in the 1930’s Bill was saying that maybe someday there would be a pill or medication that could turn an alcoholic into a normal drinker. It hadn’t happened back then and despite all our medical advances we still don’t have that sort of medication.

While a few medications have been tested to try to reduce the cravings, to date I know of no medication that will restore an alcoholic to a normal drinker. The only option for someone once they have progressed from a drinker to a problem drinker seems to be to stop drinking altogether.

While there are treatment programs to help the alcoholic or the problem drinker give up drinking and stay sober, a cure for alcoholism remains elusive.

Drugs that might reduce the pleasure of drinking, Naltrexone and others, have been suggested for reducing cravings. One characteristic of addiction to all substances is an increase in tolerance after using your drug of choice. Over time the alcoholic needs to drink more to get the same result. Drugs that reduce cravings seem to accelerate the process of drinking more to offset the reduce pleasure from fewer drinks.  

Keeping the alcoholic from drinking

One drug, Disulfiram which is marketed under the trade names Antabuse or Antabus produces so severe a reaction for people who take the drug and then drink it has been widely tested as a preventative.  There are other drugs that produce this same effect.

Disulfiram has uses other than keeping an alcoholic from drinking. Originally tested to treat parasite infections, those who took the drug and then drank became violently ill.

Alcohol when consumed is broken down through several steps until it is transformed into water and can be eliminated from the body. One of these breakdown products is acetaldehyde, which is even more toxic than the original alcohol. Having acetaldehyde in your system is a major reason for the severity of hangovers.  

Disulfriam prevents the elimination of Acetaldehyde and results in prolonging and intensifying many of the symptoms of a hangover.

With Disulfiram in the bloodstream the drinker experiences severe flushing of the skin, nausea, vomiting, headache, shortness of breath and many other serious even life threatening symptoms. Further the longer the Disulfiram is taken the stronger the effects become. People who take Disulfiram develop little or no tolerance to the medication.

You would think that taking a medication that made you violently sick every time you drank would be enough to cure a drinker. It doesn’t work that way.

Medication Compliance is a major problem with most medications. While a psychiatric medication may work exceptionally well, people frequently do not take their medication everyday as prescribed.  

Antabuse is one medication that is not likely to be taken as prescribed. The symptoms it produces are severe and if the alcoholic continues to drink with Antabuse in their system they are likely to end up in the hospital. The alcoholic will often stop taking the medication so they can drink again.

Antabuse clears from the system very slowly. There is a high potential for alcoholics to stop taking their meds and drink. Physicians are warned to discuss the possible medical risks of drinking while taking Antabuse.

The relapse rate with Alcoholics is very high. Many studies have found no improvement in abstinence between those given the medication and those who use other methods to quit drinking. As a result Antabuse is not widely prescribed to treat alcoholism.

Other drugs that make you sick when taken with Alcohol.

Disulfiram is not the only medication that can produce this effect. Drinking Alcohol while you have several other items in your blood stream can result in extreme sickness. Several antibiotics carry label warnings to not drink alcohol while taking these meds because of a possible “Disulfiram like reaction.” Some anti-fungal drugs and at least one type of common mushroom can also interact with alcohol to produce extremely violent hangover like symptoms after as little as one drink.

The conclusions on meds to reduce or cure drinking?

To date no medication has gained widespread acceptance in the treatment of alcoholism. A few people, a few times, have reported that meds helped.  If you think meds will help talk with your doctor. Be forewarned, the meds will not cure you. You will still need to do a lot of work on yourself.

There are some medications that are helpful for treating withdrawals and as alcohol withdrawals can be fatal I recommend that chronic alcoholics need to see a medical doctor for withdrawal. See my post on why Pink Elephants can kill .

The diseases of alcoholism and addiction are mostly in the mind or thinking not in the body. Treatment that changes the persons thinking is far more effective than medications.  

There is no medication that will allow you to drink and not be an alcoholic. Like other life problems you need to do the work of changing yourself. Others can help you but you do the work.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page . For information about my other writing work beyond this blog there is also a Facebook authors page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com

Hope that information about Medication to treat alcoholism – Disulfiram, Antabuse and Naltrexone was helpful for some of you on your path to self-improvement.  


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