Alcoholism Medication: Glutamate receptor blockers, Aldehyde dehydrogenase inhibitors, Opiate antagonists

Topiramate facilitates GABA function and antagonizes glutamate, which should decrease mesocorticolimbic dopamine after alcohol and reduce cravings. One double-blinded trial with 150 subjects for 12 weeks suggests this is the case (decreased drinking, decreased craving, and greater abstinence). Topiramate is not approved for this use by the US Food and Drug Administration. The U.S. Food and Drug Administration (FDA) has approved three medications for treating alcohol dependence, and others are being tested to determine whether they are effective. Behavioral treatments are aimed at changing drinking behavior through counseling.

With the availability of several FDA-approved medications, a provider may recommend a trial with a new medication should an individual patient not respond to the first medication tried. As reviewed by Mason and Crean (2007), the European studies of acamprosate typically enrolled participants who had completed inpatient detoxification and then received standard care as outpatients. The use of selective serotonin antagonists for early-onset alcohol dependence also has been investigated, with positive results. In one RCT,3 ondansetron (Zofran) was shown to significantly reduce self-reported drinking. Patients who received ondansetron 4 mcg per kg twice per day had fewer drinks per day. They also had a greater percentage of days of abstinence (70 versus 50 percent with placebo) and a greater total number of days abstinent per study week (6.7 versus 5.9 with placebo) in patients with early-onset alcoholism.


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 FDA approved the use of naltrexone to treat alcohol use disorders in 1994. 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.

Used alongside recommended medical treatments, these remedies can include herbs like kudzu and ashwagandha, lifestyle changes to reduce stress, and online counseling and support groups. They may go to a residential treatment center for rehabilitation (rehab). It usually includes several different kinds of behavioral therapies. It may also include medicines for detox (medical treatment for alcohol withdrawal) and/or for treating the AUD.

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Most studies of medications for AUD also include counseling, so it is difficult to assess medication effects without counseling. Acamprosate, available in oral delayed-release tablets (Campral®), was approved for use in the treatment of alcoholism in the United States in 2004, following extensive use in many other countries. Acamprosate is believed to normalize the balance between excitatory and inhibitory pathways altered by chronic alcohol consumption (Littleton and Zieglgansberger 2003), although the actual mechanism of action is uncertain. Using combined data from three European studies that were the basis of the approval of acamprosate in the United States, Kranzler and Gage (2008) found that acamprosate improved rates of continuous abstinence, percent days abstinent, and time to first drink. Two studies conducted in the United States did not find overall efficacy for acamprosate (Anton et al. 2006; Mason et al. 2006); however, the methods of these studies differed in substantial ways from the European studies. Notably, 90 percent of patients in the European acamprosate clinical trials received inpatient detoxification, compared with only 2.3 percent and 7.7 percent of those in U.S. trials (Mason and Crean 2007).

medicine for alcoholism

Oslin and colleagues (2008) completed the only study that has evaluated the intensity of interventions that primary care providers might use. In this 24-week study, participants received naltrexone or placebo and one of three psychosocial interventions. All participants attended nine brief medication visits with a physician for safety monitoring, brief review of drinking, and dispensing of medications. The third group received up to 18 individual CBT sessions with a clinical psychologist or social worker.

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