As a drug & alcohol counselor, I've worked with clients struggling with alcoholism for over 25 years. Addiction recovery is difficult and usually a long process - often a lifelong process. Clients (and therapists) naturally find the idea of medications to help with this process appealing and exciting. In my experience, which now includes working with hundreds of men and women battling alcoholism and other addictions, I have yet to see a medication that serves as the so-called "silver bullet" - the one solution that easily cures the addiction. But since medication can be a helpful addition to someone’s overall treatment plan, I thought it might be beneficial to review the menu of alcoholism medications that exist today and how effective they can be.
There are Drugs for Alcoholism Treatment
Disulfiram, marketed under the name Antabuse, has been prescribed in the United States since the 1950s. This medication is designed to stop alcoholics from drinking because it causes them to have headaches, nausea, and vomiting if they drink. The research indicates that Antabuse can be helpful for some alcoholics, but, in my personal clinical experience, I have yet to see it ultimately help. One of the problems with Antabuse is that this medication must be taken every day to be effective. But if they want to drink, alcoholics simply need to not take their medicine for a day or two. I often see clients planning their relapses by stopping their Antabuse, which allows them to drink without the side effects. If this medication were ever to be available in a longer-acting injectable form, it might be more impactful.
Acamprosate, sold under the brand name Campral, has been available in the United States since 2004. This medication works by reducing cravings in alcoholics experiencing withdrawal. The clinical consensus is that Campral is not effective for alcoholics once they complete withdrawal, though it is helpful during the initial period of physiological withdrawal that some alcoholics go through when they stop drinking. Though I have only had a handful of drug & alcohol counseling clients use this medicine, I have seen it help during initial withdrawal.
Gabapentin, a medication prescribed for seizures, neuropathic pain, anxiety, and sleep, is also sold under the name Neurontin. Neurontin is similar to Campral in that it reduces the symptoms of alcohol withdrawal and the cravings that come with it. Again, this medication doesn’t help with alcoholism beyond the initial withdrawal that those dependent on alcohol experience.
Naltrexone, which is sold under the names Vivitrol and ReVia, reduces the pleasurable effects people experience from drinking alcohol by decreasing the amount of dopamine their brains release when they drink. It reduces both cravings and the euphoria many people experience when they drink. This medication has been used to treat alcoholism (and opioid dependence) since the mid-90s in this country. Vivitrol, which comes in pills that are taken daily as well as in monthly injections, has been shown to reduce the amount people drink and how often they drink. The monthly injection, though much more expensive than the daily pill, reduces the ease with which someone can stop taking the medicine if they want to feel the full effects of drinking.
A Possible New Medicine for Alcoholism
Another medicine worth mentioning, which more and more people are taking for weight loss, is Semaglutide (Ozempic or Wegovy). In the last year or so, I’ve heard from both clients and friends who struggle with alcoholism, that Semaglutide, which they’ve been prescribed for weight loss, also reduces their desire to drink and the amount they drink. This seems to be supported by some initial research that indicates that, at least in studies conducted on mice that were made dependent on alcohol, Semaglutide reduced the amount of alcohol consumed and reduced binge drinking. I’m not aware of human studies, yet, but this may one day be an additional medicine that helps with alcoholism.
The conventional wisdom of most drug & alcohol counselors, myself included, is that medications can sometimes be a useful component of an alcoholic’s overall treatment plan. Though primary care doctors prescribe some of these medicines, I always recommend that my clients see an expert - a doctor with a specialization in either addiction medicine or addiction psychiatry.
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