Have you ever wondered if there are any medications that are not addictive, and can also help with an alcohol use disorder?
Some of the most reliable, useful, and brief information sources for details of this kind, written for the public, are found at the:
- National Institute on Alcohol Abuse and Alcoholism (NIAAA)
- National Institute on Drug Abuse (NIDA)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
These are easy to find with an internet search.
Fortunately, there is a very recent review article1 that helps answer this question.
The authors note three medications are currently approved by the U.S. Food and Drug Administration (FDA) to help people stop or reduce their drinking and prevent a return to drinking: disulfiram, naltrexone, and acamprosate. All these medications are non-addictive, and may be used alone or combined with counseling or mutual-support groups.
Disulfiram (e.g. Antabuse) was the first FDA-approved drug for the treatment of alcohol dependence. It inhibits an enzyme, and through a chain of effects causes unpleasant sensations after drinking (i.e., tachycardia, shortness of breath, tachypnea, sensation of heat, anxiety, panic, headache, nausea, and vomiting). The authors note disulfiram looks like a more effective drug in open-label studies compared with naltrexone and acamprosate, but this has yet to be shown true in double-blinded random-controlled trials. The major limitation to taking disulfiram is patient cooperation and that working best with supervised medication compliance. Studies have shown the effect of disulfiram comes from its ability to prevent drinking, as a deterrent, and the best results happen when patients also receive psychoeducational training, family support, and therapy monitoring while taking disulfiram. Due to its ability to produce unpleasant effects when someone drinks, patient compliance can be a problem.
Naltrexone (e.g. Revia, Vivitrol) is associated with the suppression of the reward system and reduction of the pleasure experienced after drinking. Naltrexone was approved by the FDA for medication-assisted therapy of alcoholism in 1984, including in extended-release form. It is also used for opioid dependence. Naltrexone can have some side effects at higher doses. In a study that examined a large group of studies, naltrexone was more effective than acamprosate in reducing heavy drinking and alcohol craving, especially if patients underwent detoxification and maintained a sufficiently long abstinence period before starting naltrexone. Both oral and extended-release naltrexone reduce alcohol consumption. Extended-release naltrexone is associated with prolonged abstinence due to improved patient compliance, so it could be considered for people struggling with the problem of alcohol abuse.
Acamprosate (Campral) is approved by the FDA for the treatment of alcohol dependence. It reduces alcohol craving and unpleasant withdrawal symptoms, improves abstinence rates and physician cooperation, and is associated with significantly higher treatment completion rates. A Cochrane review (a very rigorous method of gathering and summarizing a large number of different research studies) of acamprosate found it reduced alcohol consumption compared with a placebo. Acamprosate is used primarily to achieve and maintain complete abstinence rather than reduce or prevent relapse. Combined with psychosocial interventions it may help improve abstinence maintenance outcomes in people with serious use disorders.
If you’re interested in medically-managed alcohol detox, different medications are used for that. Alcohol withdrawal can be life threatening. You wouldn’t want to try a self-directed home detox for alcohol; to be safe, have a competent and skilled medical professional guide your detox from alcohol.
For those that might be interested, there’s a helpful “Understanding Alcohol Use Disorder” fact sheet at the NIAAA website.
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder.
Reference
1Stokłosa I, Więckiewicz G, Stokłosa M, Piegza M, Pudlo R, Gorczyca P. Medications for the Treatment of Alcohol Dependence – Current State of Knowledge and Future Perspectives from a Public Health Perspective. International Journal of Environmental Research and Public Health. 2023. 20(3):1870. doi:10.3390/ijerph20031870.