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What are the medications used for the treatment of Alcohol use disorder
Table of Contents
The terminology Alcohol use disorder refers to a physical and psychological state in which an individual loses control over the consumption volume and frequency. It is a progressive disorder which makes him absolutely dependent on alcohol, even for carrying out his everyday activities. According to Dr. Silkworth he may reach a state, where he can neither live with alcohol nor without it. It is called the chronic state of alcoholism.
Medications for Alcohol Abuse
So far there has been no scientific evidence to prove when a social drinker turns into a heavy drinker, becomes dependent, and turns into an alcoholic. The medications for alcohol abuse may vary depending on the intensity of his physical and psychological disorder and dependency.
The initiation of the medications for alcohol abuse may start when the patient continues to drink or he has abstained from consumption. Experience of the patients at the alcohol rehabilitation centers shows abstinence works more effectively. In most of the advanced and chronic cases it is the only way.
Some of the medications are Naltrexone, Disulfiram, Acamprosate, Oral Naltrexone, Depot Naltrexone, Vivitrol, and Acamprosate which are used for the first line of treatment.
Disulfiram, Topiramate, Gabapentin, Baclofen, Nalmefene, and Ondansetron are some of the second line medications.
Combination medications are used by the alcohol rehabilitation centers to increase the effectiveness of treatments. They are also useful when the individual medicines don’t show the expected results. Many more are still in the stage of development and experimentation.
The key parameters to consider in the medications for alcohol abuse are related to the patient, medication, abstinence treatment (most difficult part), functionality, effectiveness (intensity and duration), limitations, and the side effects.
Patient Parameters: Some of the patient related parameters could be categorized into biological predisposition, level of disorder and dependency (physical and psychological), risk of relapse, 5-HTT gene carriers,pregnancy in women, genetic susceptibility, etc.
Medication Parameters:Some of themedication related parameters could beblockage of mu-opioid receptor, modification of hypothalamic-pituitary-adrenal axis, Glutamate neurotransmission modulation on metabotropic-5 glutamate receptors, effects on kainate glutamate receptors, GABA (A) receptors, etc.
Abstinence Treatment: Alcohol rehab centersfocuson long term abstinence (One-Day at a time) during the treatment and the post treatment period, when the patient walks out of the center and mingles with the external world. Experience shows the probability of relapse to be highest here.
First Line of Medications
Naltrexone is known to reduce the physical craving for alcohol among the patients. The ability of the medication to bond with the opioid receptors is stated to be its strength. Many of the alcohol rehabilitation centers have successfully used it to treat the patients. But there seems to be little contradiction in its usage. Some of the doctors say it can be sued while the patient is still drinking. But the others say it could be dangerous to use it when the patient continues to consume alcohol. However, the specialists at the best alcohol rehab centers know how to provide the medication based on individual cases.
Disulfiram is stated to produce the best effects when the patient abstains from alcohol consumption. It should preferably be accompanied by the psychological counseling and behavioral therapy to keep the patient away from the mental obsession for alcohol. The best alcohol detox centers may also use Acamprosate after ensuring the abstinence from alcohol. But the medication might cause side effects if the patient starts drinking during the administration of Acamprosate or Disulfiram.
Oral Naltrexonecan suppress the physical craving for alcohol by blocking the μ-opioid receptors (MOR). It also reduces the probability of relapse (when the patient tends to resume drinking after a period of abstinence). But it needs consistent follow up after the completion of the detox and rehabilitation period.
Depot Naltrexone is stated to be effective for long term alcohol use disorder treatment. The time gap between two successive administrations is longer compared to the others.
Vivitrol is an intramuscular injection to be administered at the glutes by a specialist from the alcohol detoxification center. It is stated to be approved by the FDA and effective.
Acamprosateis known to modify the metabotropic-5 glutamate receptors and prevent the craving for alcohol. Abstinence from alcohol consumption is the key criterion for making the Acamprosate work effectively.
Second Line of Medications
The alcohol rehabilitation centers recommend the second line of medications, when the progression of the alcohol use disorder has crossed the first stage. Here, the physical craving for alcohol has become more acute. In some cases it may be chronic. Abstinence from drinking (Also called as period of sobriety when the patient voluntarily stays away from drinking one-day at a time) is the most important factor for making the medications effective.
Disulfiram is known to create physical discomfort among the patient when he consumes alcohol. It is assumed it may dissuade him from taking the next drink. But the usage could be debatable when the after effects like palpitation may lead to severe health conditions. The experts at the best alcohol detox centers avoid it during pregnancy in women. They also don’t recommend it for patients who show the repeated tendency to relapse.
Topiramate is known to work by blocking the two primary receptors responsible for the physical craving of alcohol in the patient’s body. It can reduce the BINGE drinking frequency among the heavy drinkers. BINGE drinkers are those who may abstain from drinking for a period of three to six months or more. Then they start drinking again (Most of the abnormal drinkers don’t know why they relapse). Normally the volume and frequency of the consumption makes up for the abstinence, making their condition worse than before.
Gabapentin is known to be highly effective for the DSM-IV stage alcohol dependence patents. It is the state when the patient can go to any length to get alcohol. He may start consuming alcohol early in the morning and keep drinking throughout the day. Food intake reduces considerably. The level of restlessness increases when he forced to remain sober. Hey may get irritated over trivial issues (primarily due to unknown fear of running out of alcohol), he is often discontented and keeps blaming the others for his condition. He may make several attempts to quit on his own. But soon he finds himself drunk again due to the RID (Restlessness, Irritation and Discontentment) factors.
Baclofenis known to be effective for the long period of abstinence from alcohol. It works best when accompanied by the behavioral disorder therapy conducted by the best alcohol rehab centers. The first priority is alcohol detoxification, when the body is free from the toxic elements and the byproducts of alcohol.
Nalmefeneis known to inhibit many of the alcohol dependent receptors in the body of the alcoholic. It primarily suppresses the craving and induces psychological stability. The medication seems to be highly effective for patients with specific conditions. The 5-HTT gene, early onset dependence and late onset dependence. Some individuals may start drinking before the age of 25 (early onset) and the others after 30+ (late onset). Regardless of the starting age, most of them hit the rock bottom during their drinking period. The terminology “Rock Bottom” is to be selectively used. It is stated to be the stage when the patient’s drinking spree becomes unmanageable, and also his life.
The best alcohol rehabilitation centers use the combinational medications when the first and second line of medication doesn’t produce the desired results individually.
Apart from the above stated medications, the pharmacological experts are conducting research on the other medications including dopamine antagonists, anticonvulsants, and cannabinoid receptor antagonist rimonabant etc.
Best Alcohol Rehab Centers – How They work
The best alcohol rehab centers treat alcoholism as a physical state of allergy and mental state of obsession. The patient’s body is no longer responsive to the alcohol consumption. He doesn’t enjoy his drinking any longer. He is often scared to come out of the state of intoxication. It could be because he may be unable to face the reality of life without the crutch called alcohol.
The best alcohol rehab centers aim to remove the physical dependence on alcohol by the process called alcohol detoxification. Once this stage is halfway through, they provide the behavioral change therapy. It is the stage when the psychological dependence on alcohol is slowly taken out.
The duration of post detox medication and counseling may continue for a long time, depending on the patient’s stage of alcoholism.
Alcohol Rehabilitation Centers – Family Therapy
The alcohol rehabilitation centers focus on family therapy apart from the patient’s treatment and therapy. It is to set right some of the psychological, moral, and the spiritual damages done by the alcoholic during his drinking days.
The patient can recover soon and resume his regular everyday life. The expertise of the specialists at the alcohol rehab centers and the grace of the higher power shall keep him sober and sane one-day at a time, Amen.
Dr. Vikram Tarugu, M.D, is the CEO of Detox of South Florida, Inc and medical professional focused on addiction. A veteran in the medical field with over 25 years of professional experience. He is a consultant for many South Florida Rehab centers. Patients travel from allover the US to seek his help with addiction and Hepatitis C treatment.