Controlling Alcohol Cravings With Medication

Many drinkers who have become alcohol dependent than try to quit experience not only withdrawal symptoms but also report having cravings for alcohol. This craving for alcohol is one of the reasons that a large majority of those who try to quit drinking fail to do so the first time they try.

Medications for Alcohol Cravings

Currently, only three medications are approved by the FDA for the treatment of alcoholism, plus one that is sometimes prescribed for off-label use, and others that are being studied.

  • Naltrexone: Marketed as Revia in pill form and Vivitrol as a once-monthly injection, it works by blocking in the brain the "high" that people experience when they drink alcohol. By blocking the pleasure the drinker receives from alcohol and the reward feedback loop in the brain, naltrexone eventually reduces cravings.
  • Campral (acamprosate) is the only medication available in the U.S. that claims to reduce alcohol craving. It also reduces the physical distress and emotional discomfort people usually experience when they quit drinking. How Campral works to reduce the craving for alcohol is not completely understood, but researchers believe that it helps restore a chemical imbalance in the brain's reward system that is altered by long-term alcohol abuse. Campral does not help someone quit drinking. It is prescribed (usually 3 time-released pills a day) for those who have already stopped drinking alcohol. Because the side effects are mild and well tolerated, it is usually prescribed for up to 12 months following alcohol abstinence.
  • Antabuse (disulfiram) works by causing a severe adverse reaction when someone taking the medication consumes alcohol. Rather than reducing craving, it reinforces aversion to alcohol due to these obnoxious results when you drink alcohol. They include flushing, nausea, vomiting, headaches, and palpitations. There can be severe reactions, so it might be saved for use for high-risk patients, or when you are going into a high-risk situation such as a party where there will be alcohol.
  • Topiramate is not yet FDA-approved for treating alcohol addiction. It is an antiepileptic medication that has shown promise in trials similar to naltrexone. Physicians may prescribe it off-label for alcohol dependence.

Other drugs being studied to reduce cravings include gabapentin, baclofen, nalmefene, selective serotonin reuptake inhibitors (SSRIs), and ondansetron.

Preventing Alcohol Cravings

Combination With Behavioral Therapy and 12-Step Programs

It should be noted that many members of Alcoholics Anonymous report that their cravings for alcohol were removed through the spiritual experience of working the twelve step program, without medication.

As it says in the "How It Works" section of The Big Book: "... our personal adventures before and after make clear three pertinent ideas: (a) That we were alcoholic and could not manage our own lives. (b) That probably no human power could have relieved our alcoholism. (c) That God could and would if He were sought."

Being a member of AA and working the 12-step program does not mean that you cannot also take medication to help reduce your cravings. The combination of medication and support group participation has been shown by research to produce better outcomes.

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