From the Guidelines
The most effective medications for alcohol deaddiction and reducing cravings are acamprosate and naltrexone, which should be used in combination with counseling and support groups to achieve the best outcomes, as supported by the most recent and highest quality study 1.
Medication Options
- Acamprosate (666mg three times daily) helps restore brain chemical balance disrupted by chronic alcohol use, reducing cravings and withdrawal symptoms, usually continued for 6-12 months.
- Naltrexone (50mg daily orally or 380mg monthly injection) blocks opioid receptors, reducing alcohol's pleasurable effects and cravings, typically used for 3-12 months.
Considerations
- Disulfiram (250-500mg daily) creates unpleasant reactions when alcohol is consumed, serving as a deterrent rather than reducing cravings directly, but its use is not recommended in patients with alcoholic liver disease due to the risk of hepatotoxicity 1.
- Other options include topiramate (starting at 25mg daily, increasing to 300mg daily) and gabapentin (300-600mg three times daily), which can reduce cravings by modulating glutamate and GABA neurotransmitters, but their use should be carefully assessed due to their tolerance profile 1.
Treatment Approach
- Treatment should be supervised by healthcare providers who can monitor side effects, adjust dosages, and provide comprehensive care addressing both physical dependence and psychological aspects of addiction.
- Medication selection depends on individual factors including medical history, previous treatment response, and patient preferences.
- The use of pharmacological treatments should be considered in combination with counseling and support groups to promote the maintenance of alcohol consumption targets (abstinence or reduced consumption) in dependent patients 1.
From the FDA Drug Label
The efficacy of naltrexone hydrochloride as an aid to the treatment of alcoholism was tested in placebo-controlled, outpatient, double blind trials. In one of these studies, 104 alcohol-dependent patients were randomized to receive either naltrexone hydrochloride tablets 50 mg once daily or placebo. In this study, naltrexone hydrochloride proved superior to placebo in measures of drinking including abstention rates (51% vs 23%), number of drinking days, and relapse (31% vs. 60%). In a second study with 82 alcohol-dependent patients, the group of patients receiving naltrexone hydrochloride were shown to have lower relapse rates (21% vs. 41%), less alcohol craving, and fewer drinking days compared with patients who received placebo
Naltrexone is a drug that can be given for alcohol deaddiction and for reducing craving.
- The recommended dose is 50 mg once daily.
- Naltrexone has been shown to support abstinence, prevent relapse, and decrease alcohol consumption.
- It is most effective when used as part of a comprehensive treatment program that includes social and psychotherapeutic methods 2.
From the Research
Medications for Alcohol Deaddiction
The following medications are approved by the U.S. Food and Drug Administration for treating alcohol dependence:
- Disulfiram
- Naltrexone
- Acamprosate 3 These medications have been shown to be effective in reducing relapse rates and increasing abstinence rates.
Reducing Craving
Naltrexone, an anticraving agent, has been shown to reduce cravings and increase abstinence rates 3, 4, 5. Acamprosate also reduces relapse rates and increases abstinence rates 3, 4. Other medications such as topiramate, gabapentin, and varenicline have shown promising results in reducing heavy drinking and cravings 6, 7.
Efficacy of Medications
Studies have shown that:
- Naltrexone is 27% better than placebo in supporting continuous abstinence 4
- Acamprosate is 52% better than placebo in supporting continuous abstinence 4
- Naltrexone reduces craving and alcohol use among patients with alcohol dependence syndromes 5
- Disulfiram appears to be effective only when intake is supervised 4
Off-Label Medications
Off-label medications such as baclofen, gabapentin, ondansetron, and topiramate are commonly prescribed for the treatment of alcohol use disorders 6, 7. However, the efficacy of these medications is still being studied, and more research is needed to determine their effectiveness.