By Laura Buck, MSW, LCSW, CAC
|Approved Medications||Drawbacks to ReVia|
|Drawbacks to Antabuse||Drawbacks to Campral|
Nineteen million (or eight percent) of Americans could benefit from treatment for “an alcohol problem.” Although 2.4 million people are diagnosed with alcoholism, only 139,000 of them receive treatment with medications.
The most common form of treatment for alcoholism consists of group and/or individual therapy, including community self-help programs. Treatment can often be time consuming. For example, individuals are often encouraged to go to 90 meetings in 90 days or they are involved in structured group therapy three to five days per week at two to three hours per day. Often, people want to know, “Isn’t there a pill that can fix the addiction to alcohol?” Unfortunately, there is not a pill that can cure the addiction, but there are medications that can perhaps make it easier to effectively participate in treatment.
The Food and Drug Administration (FDA) has approved only three drugs in the past 55 years to treat alcoholism. Each of these drugs acts differently in the body to interrupt the addiction process. They are Antabuse, ReVia, and Campral.
For those with an alcohol problem, the oldest medication thought to “cure” the disease is Antabuse (disulfiram). Wyeth-Ayerst Laboratories Division first marketed Antabuse in 1948. This drug causes many unpleasant effects when the individual consumes alcohol, even in small amounts. The effects can range from facial flushing, headache and mild nausea to severe vomiting and increased blood pressure and heart rate.
The expectation is that as a person associates these negative symptoms with drinking, the individual will be less likely to want to drink another time. Usually, the threat of becoming ill after a drink of alcohol will deter most motivated people. However, the effectiveness of the drug depends mostly on the individual’s motivation for remaining abstinent.
While Antabuse will build up in the person’s system those who choose to resume drinking will simply stop taking the medication for a few days prior to consuming alcohol.
Another problem is that people have reported experiencing very mild reactions with the use of mouthwash that has a percentage of alcohol in it, foods with vinegar like salad dressings and ketchup, and certain colognes and aftershave. Your doctor should talk to you about what is best to avoid and what to experiment with in terms of over-the-counter products and medicines.
Antabuse should not be prescribed for people with cirrhosis or other chronic medical conditions, including heart disease or diabetes. Let your doctor make this decision. This drug should also not be prescribed for people over 60 years of age. Severe reactions to Antabuse have included heart attacks, and some cases have even resulted in death.
The FDA approved the use of ReVia (naltrexone) in December 1994 for the treatment of alcoholism. It was initially marketed by DuPont Merck Pharmaceutical company for treating narcotic dependency. ReVia blocks the parts of the brain that experience pleasure from drug/alcohol use.
Studies began to show that when used to assist with treating alcoholism, the drug helped to decrease cravings and relapse when it was used over a period of three to six months. The success of the drug, however, is likely dependent on a person’s simultaneous involvement in a structured treatment program that can educate them on addiction, recovery, and relapse prevention behaviors.
The studies on ReVia and alcoholism treatment all occurred in settings that combined psychotherapy and psycho-education with the medication. Therefore, the FDA approved ReVia for alcoholism only as an adjunct to traditional supportive therapy. According to the FDA, “This drug is non-addictive but can cause liver toxicity if prescribed at doses higher than recommended.
ReVia is not recommended for people with active hepatitis and other liver diseases (www.fda.gov).” Side effects include nausea, headache, dizziness, fatigue, and sometimes vomiting and insomnia. This is a daily medication to be taken orally; however, a long-acting injection is being developed.
Campral (acamprosate) is the newest drug approved by the FDA to assist with alcohol abstinence. It was approved in July 2004 for marketing and distribution by Forest Pharmaceuticals, Inc. Though the exact workings of the drug are not understood, it is believed that Campral can restore imbalanced brain chemicals to a normal balance, thereby reducing cravings and thus relapses.
Campral is prescribed once someone has made the decision to remain abstinent and he/she is currently alcohol-free. The medication is most effective when combined with a structured treatment program that can teach relapse prevention skills, or provides social support, such as community self-help groups.
Campral has been used in Europe for over 10 years and has been shown to be useful for individuals with mild to moderate liver problems. Side effects have been reported as diarrhea, fatigue, nausea, gas, and itching. The most common side effect, diarrhea, usually resolves with time.
In all cases, a primary care physician or psychiatrist can prescribe and monitor the medications. Also, in all cases the recommendation is to use medication as a part of a comprehensive plan for treating addiction. The person with an alcohol problem should be willing to participate in some sort of supportive treatment program, ranging from community self-help groups like Alcoholics Anonymous / Narcotics Anonymous, Rational Recovery, etc, to a structured treatment program involving a combination of group and individual therapy and education. Recovering from addiction involves a lifestyle change. The medications can only assist in making the changes easier by reducing cravings and/or drinking behaviors so that you can focus on recovery.
Sources and Recommended Websites:
Forest Pharmaceuticals, Inc. Campral Brochure. 2005.