Want to drink less? There are medications that can help.
Alcohol consumption dramatically increased during the COVID-19 pandemic. A 2021 study found that heavy drinking increased by 21% during the height of the pandemic.
It’s a worrying statistic. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that 95,000 people (about 68,000 men and 27,000 women) die of alcohol-related causes annually. That makes alcohol the third-leading preventable cause of death in the U.S. The NIAAA also reports that nearly 15 million people age 12 and older struggle with Alcohol Use Disorder (AUD).
If you or someone you know has AUD and needs help managing it, there are medications available. These medications should be used along with supportive therapies. These could include counseling, group support and behavioral therapy.
Getting medical help with AUD can make a big difference, says Cara Borelli, DO. She’s an addiction medicine fellow at Mount Sinai West in New York City. She notes that many people with AUD don’t see a doctor for heavy drinking. They go only once they have an alcohol-related health issue, such as a liver problem. Or they seek help when they begin to experience withdrawal symptoms.
Care may also happen in the emergency room. Dr. Borelli says that many people start their detox there. Or they come in if their AUD symptoms are severe. (Per the NIAAA, alcohol is involved in about 18.5% of emergency room visits each year.)
It’s best to start with your primary care doctor. He or she will determine a potential AUD diagnosis. Your doctor will do a thorough review of your current and past medical history. Your provider will use that review to figure out which medication is best for you.
If your doctor recommends medication for AUD, show your pharmacist this free prescription discount card. It could save you up to 80% on your medications.
Naltrexone is the most common medication given to people with AUD. It works by blocking opioid receptors, which stops the “feel-good” effect of alcohol. Naltrexone is not habit-forming. It also does not cause withdrawal symptoms.
It comes in the form of a daily pill. It also comes as a monthly extended-release shot given by a doctor. Dr. Borelli notes that people often find the shot more manageable. “You can just get the shot and then not have to think about it,” she says.
“It can cause some side effects like headaches and gastrointestinal symptoms like nausea and abdominal pain. It can also cause liver problems. So if a patient already has liver problems, we’re not going to be able use naltrexone,” says Dr. Borelli.
You can take naltrexone even if you’re still using alcohol. It doesn’t stop someone from drinking or reverse the effects of alcohol. But it does reduce the amount that you drink over time. It may take several weeks before you notice fewer alcohol cravings.
Acamprosate is a delayed-release pill. It targets neurotransmitters in the brain to decrease cravings for alcohol. It should be given only to people who have stopped drinking.
When a person drinks heavily, the brain’s chemical balance changes. Alcohol decreases the excitatory neurotransmitter glutamate. This creates a sedative effect. When someone with AUD stops drinking, glutamate comes back up to normal levels. That makes the brain and spinal cord hyperactive and sensitive. It causes feelings of anxiety and restlessness, which can make a person crave alcohol again. Acamprosate inhibits the release of glutamate. Less glutamate means fewer symptoms.
One study found that patients taking acamprosate reduced their likelihood of returning to drinking by 86%. And they had an 11% longer period of abstinence compared with a placebo.
Acamprosate is usually taken only for a year. But that can vary depending on the person’s situation. It can also be used with naltrexone or disulfiram.
The dosage is usually 2 tablets, 3 times a day. “Patients struggle to keep up with that,” notes Dr. Borelli. “But it is a safe medication, especially for those with liver problems.”
She notes that side effects can include anxiety, dizziness and depression. Speak to your doctor if you experience any of those symptoms.
Recommended reading: What happens if I drink alcohol while taking Wellbutrin?
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Disulfiram is a daily pill that blocks the breakdown of alcohol in the body. If you drink while taking this medication, it creates a buildup of an alcohol-related compound called acetaldehyde. That buildup causes people to become very sick. (The reaction starts 10 to 30 minutes after drinking alcohol.) The effects can include dizziness, racing heart, vomiting and headaches. Those unpleasant reactions help people stay away from alcohol.
Disulfiram is not supposed to be a stand-alone method of treating AUD. It should be used with other methods of treatment. The medication can help a person remain sober during the early stages of treatment. There is no set time limit for how long to use the medication. Patients should keep taking it until they have been alcohol-free for several weeks.
Common side effects include:
- Skin rashes or acne
- A sore tongue
More serious side effects include:
- Vision changes
- Numbness in the arms and legs
- Muscle weakness
- Mood changes
Call your doctor immediately if you have any serious side effects.
The bottom line: Depending on your goals, you may not need medication to lessen how much you drink or to stop drinking altogether. Support groups, talk therapy, lifestyle changes and other behavioral changes may be enough. But if you do need extra help, these medications can be helpful. Work with your doctor to find the treatment that’s right for you. (And don’t forget to bring this free prescription discount card with you to the pharmacy. It could save you up to 80% on your medications.)
Alcohol use during the pandemic: Massachusetts General Hospital (2021). “Alcohol consumption during the COVID-19 pandemic projected to cause more liver disease and deaths”
Alcohol statistics: National Institute on Alcohol Abuse and Alcoholism
Diagnosing AUD: National Institute on Alcohol Abuse and Alcoholism (2021). “Alcohol use disorder: a comparison between DSM–IV and DSM–5”
Naltrexone: Substance Abuse and Mental Health Services Organization
Acamprosate: Therapeutics and Clinical Risk Management (2012). “Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility”
Topiramate: BMC Psychiatry (2011). “Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study”
Gabapentin: JAMA Internal Medicine (2020). “Efficacy of gabapentin for the treatment of alcohol use disorder in patients with alcohol withdrawal symptoms”