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Schizophrenia, the Family and Society

Posted Aug 24 2008 1:49pm
DAVID MARKS, MD: I'm Doctor David Marks. For all alcoholics, therapy is essential. But for some, it may not be enough. They may require medications. Here to talk to us about the medications used to treat alcoholism is Dr. Carol Weiss, an addiction psychiatrist at Cornell University Medical College and New York Presbyterian Hospital. Also joining us is Doctor Richard Rosenthal. He's Chief of the Division of Substance Abuse at Beth Israel Hospital in New York. He's also President-elect of the American Academy of Addiction Psychiatry. Welcome, both of you.

CAROL WEISS, MD: Thank you.


DAVID MARKS, MD: What medications are used to help alcoholics with withdrawal from alcohol?

CAROL WEISS, MD: Well, it's important to recognize that it's not safe to just quit drinking, for many people. They can have a very medically dangerous withdrawal syndrome. So, there are medications that are used to replace the alcohols so they can gradually get off that medication, and thereby get off the alcohol safely without any medical consequences. Usually the drugs that are used for that are some forms of sedative in the Valium, Librium, family. Adivan. These are names of some of those sedatives that are used to help the person not go into withdrawal and then, gradually taper those medications, until they're off of them, and are safely off the alcohol.

DAVID MARKS, MD: And they work?

RICHARD ROSENTHAL, MD: They work very well. They're very well tolerated. There is some newer work using drugs that have been used for seizure disorders because one of the things that happens when people have severe withdrawal is that they can have withdrawal seizures. So, people have been using anti-convulsants like Tegretol or like Depakote, which were things that were really used for seizure disorders. They seem to also have efficacy in handling withdrawal.

But by and large, all of these medications are relatively safe. What they do under medical supervision is ensure that the person will be able to basically stop using the alcohol in a safe kind of way, while the alcohol exits the system.

DAVID MARKS, MD: Once they get through that withdrawal period, some patients may require continuous treatment with other medications.


DAVID MARKS, MD: What kind of medications are we talking about?

CAROL WEISS, MD: Well, there are three classes of medications that we tend to use now that we're very interested in. The first is a medication that's been around for a long time. It's a drug called Antabuse. Many people are familiar with it. It's a drug that is taken daily. In and of itself, it doesn't have any effects, but if you drink while you are taking the Antabuse, then you get sick; either flushed, nauseous, throwing up. It is a disincentive to drinking. The knowledge that it's in you helps you not drink.

The other drug that we use is Naltrexone, also called ReVia. This drug has come out just much more recently, for the use of alcoholism. It previously was used with opiates like heroin. Now, it is a drug that you take daily. When you take it, it decreases the craving or the desire to drink. It also decreases the pleasure associated with drinking. So you can drink on it, but you don't want to and so you tend not to. You don't obsess with it as much.

The third class, I'll let Rick talk about.

RICHARD ROSENTHAL, MD: It's the antidepressants. It turns out that there are two things that we know. One is that there's a high rate of depressive disorders among people with alcoholism. Clearly, when you treat those depressions with antidepressants the depression gets better, but it may also have an additive effect on drinking behavior. There seems to be some use of these newer antidepressants, especially the SSRI type of medications, in people with alcoholism in that it will also reduce the amount that they would drink in an episode of drinking. It may also decrease the frequency with which they drink.

None of these things is a panacea. All of these medications only really work well in the context of ongoing treatment, meaning behavioral treatment or psychological treatment.

DAVID MARKS, MD: So they're just another weapon in our armamentarium to treat alcohol abuse.

RICHARD ROSENTHAL, MD: That's correct.

DAVID MARKS, MD: Okay, Carol Weiss, Rick Rosenthal, thank you for joining us. Thank you for joining our webcast. I'm Doctor David Marks.

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