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Published: July 17, 2024
Reviewed by Matthew N. Parker, MD
Affecting 29.5 million Americans, alcohol use disorder (AUD) is a common medical condition in the U.S. Alcohol addiction, or dependence, is serious and can be life-threatening, which is why treatment and intervention are so important.
There are many AUD treatment methods, but one of the most effective is medication-assisted treatment (MAT). Keep reading to learn more about MAT including what medications are used to treat AUD, how they work, and frequently asked questions.
AUD, or the misuse and dependence on alcohol, is characterized by an inability to control one’s alcohol intake and a dependence on alcohol to function. It is a medical condition that requires professional help in most cases.
AUD is caused by physical and psychological dependence on alcohol. Essentially, when you consume large amounts of alcohol on a regular basis, your body gets used to functioning with alcohol in its system. Eventually, your body will rely on the alcohol to perform regular functions and if that alcohol is not present, you’ll experience withdrawal symptoms.
Additionally, alcohol also changes your brain chemistry by increasing the effects and levels of certain neurotransmitters. Over time, your brain can get used to these changes and you may start to believe you need alcohol to get through the day.
There are many physical, mental, and behavioral symptoms associated with heavy drinking and AUD. These can include mood swings, increased alcohol intake, nausea, vomiting, engaging in risky behaviors, insomnia, paranoia, irritability, increased heart rate, increased body temperature, and more.
There are many treatment options for alcohol misuse and alcohol dependence. The type of treatment you choose to pursue may be based on several factors including the severity of your AUD, drinking habits, and other personal needs.
That being said, many treatment plans for alcohol dependence include medication use. MAT can help support a comprehensive treatment approach as medications can help manage cravings and withdrawal symptoms.
Benefits of MAT include:
The U.S. Food and Drug Administration (FDA) has approved several medications for MAT, some of which are for opioid use disorders (OUD) and others for alcohol use disorders (AUD). Those approved for AUD include naltrexone, acamprosate, and disulfiram.
Naltrexone (Vivitrol, Revia) is an injectable opioid antagonist. While this may be confusing as opioid is in the name, opioid antagonists can also treat AUD. Essentially, naltrexone binds to endorphin receptors in the brain. Endorphins are neurotransmitters that are released when you drink that create the pleasurable feeling many people experience with alcohol. With your endorphin receptors blocked by naltrexone, your desire to drink and cravings are reduced.
Treatment with naltrexone typically lasts at least three to four months, though it depends on the individual.
Common side effects of naltrexone include:
More serious side effects like depression, pneumonia, liver damage, hepatitis, and allergic reactions can also occur with naltrexone treatment.
A study published in the New England Journal of Medicine found an 80.6% abstinence rate with naltrexone treatment.
Acamprosate (Campral) is a medication used to treat AUD by helping you stop drinking. Unlike naltrexone, acamprosate does not reduce withdrawal symptoms. Instead, it decreases cravings and urges to drink alcohol.
Long-term alcohol misuse alters brain chemistry and the way your brain works and acamprosate can repair these changes by balancing the levels of glutamate and gamma-aminobutyric acid (GABA), two neurotransmitters, in your brain.
Treatment with acamprosate usually lasts about 12 months but varies between individuals.
Common side effects of acamprosate can include:
One study published in Therapeutics and Clinical Risk Management found an 86% reduced risk in a return to any drinking with acamprosate treatment.
Disulfiram (Antabuse) is a medication that blocks the breakdown of alcohol in the body to treat alcohol dependence. If you drink while taking disulfiram, a build-up of a toxic alcohol-related compound called acetaldehyde occurs causing unpleasant side effects that discourage alcohol consumption.
These effects include:
In extreme cases, drinking while taking disulfiram can cause severe breathing problems, heart problems, seizures, or death.
Disulfiram is less commonly used to treat AUD due to the risks associated with the medication’s interaction with alcohol.
In addition to FDA-approved medications for AUD, there are also a couple of off-label medications that can be used to treat alcohol dependence. Off-label use of a drug simply means the drug has not been approved to treat that specific condition, in this case, AUD. That being said, these medications are still FDA-approved to treat other conditions. Off-label medications can be just as effective as FDA-approved medications, it all depends on individual needs.
Sometimes, off-label medications are used after you have tried FDA-approved medications and did not see improvements. For AUD, off-label meds include topiramate and gabapentin.
Topiramate (Topamax) is an anticonvulsant and nerve pain medication typically used to treat epilepsy and migraines. However, it can also be used to treat AUD by reducing alcohol cravings. This is suspected to be because topiramate interacts with GABA and dopamine, both of which are affected by alcohol.
Side effects of topiramate can include:
A study published in BMC Psychiatry analyzing the use of low-dose topiramate in AUD found an 18.8% reduction in relapse rate. Results also found a decrease in depression and anxiety symptoms during early alcohol withdrawal.
Gabapentin (Gralise, Neurontin) is another anticonvulsant and nerve pain medication typically used to treat seizures, pain from shingles, and restless leg syndrome. Off-label, it can be used to treat AUD by increasing levels of GABA in the brain and, in turn, reducing mild alcohol withdrawal symptoms, alcohol cravings, anxiety, and insomnia. It may also help with relapse prevention, though results are mixed.
Common gabapentin side effects include:
A study published in JAMA Internal Medicine found a 41% abstinence rate with gabapentin treatment in patients with high alcohol withdrawal symptoms.
With several options, it may be overwhelming to think about choosing a medication to treat your alcohol dependence. Thankfully, your treatment provider will help you make this decision based on several factors.
Some medications used in MAT are only intended for particular groups of people, so you may only be eligible for certain medications. From there, your doctor will evaluate the extent of your condition, what exacerbates your symptoms, and other personal needs you may have.
If it comes down to choosing between a couple of different medications, you may want to consider how the medications work, how long treatment will last, and any interactions or contraindications they may have. All of these differ between medications, but your healthcare provider should be able to provide more information on each treatment option.
While medications can be immensely helpful and effective in treating AUD, it’s essential to note that they often cannot treat this condition on their own. In other words, MAT should be just one part of a comprehensive treatment plan.
Integrating MAT with behavioral therapies has proven to be particularly effective in treating AUD, reducing the risk of relapse, and encouraging long-term recovery.
Behavioral therapy is a type of psychotherapy that focuses on changing thought patterns and behavioral habits that contribute to dependence. The most common types of behavioral therapy used in AUD treatment are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).
Like any other medication, medications used to treat AUD often come with side effects. These differ between medications but often include nausea, vomiting, insomnia, drowsiness, dizziness, and pain.
You can manage or mitigate these side effects by:
If you’re feeling overwhelmed by the side effects of your medication, don’t be afraid to discuss them with your doctor.
Naltrexone, acamprosate, and disulfiram are all commonly used to treat alcohol dependence. Topiramate and gabapentin are also sometimes used off-label to treat AUD.
No, you cannot get naltrexone over the counter. Naltrexone, like other AUD medications, must be prescribed by a healthcare professional.
Other medications you can take for alcohol dependence instead of naltrexone include acamprosate and disulfiram. Off-label medications like gabapentin or topiramate may also be options.
The most common treatments for alcohol dependence are therapy and medication-assisted treatment. Behavioral therapy and MAT are found to be most effective for AUD when used together.
Medication in alcohol dependence treatment can be immensely beneficial and encourage long-lasting sobriety and recovery. There are several FDA-approved medications that can be used to treat AUD as well as a couple of off-label medications.
Looking for MAT for alcohol treatment in your area? Give our helpline a call today for more information.
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