I have alcohol use disorder. You may call that alcoholism, alcohol abuse, having a drinking problem … I’ve also heard a lot of less nice phrases. One thing that surprised me in recovery from alcohol use disorder (AUD) was just how common it is. I used to feel like I was the only one who couldn’t control my drinking … on the rare occasions I wanted to control my drinking. But there are a lot of other people with similar experiences. One national study found that over 29% of respondents experienced alcohol use disorder at some point in their lives. I’m so grateful that I got help, but I know that’s not necessarily the case for everyone. That same study found that less than one in five people with AUD were ever treated for it.
Another thing that surprised me was learning that there are medications that have been approved by the FDA to treat AUD. I came into recovery through 12-step programs, so I had no idea that these treatments were available. Maybe it wouldn’t have seemed so shocking if I had known the long history of research around medical treatments for AUD. Even AA’s founder, Bill W., experimented with incorporating medical treatments into his recovery. Today we don’t have to experiment in that way, because we have options that are well-researched and FDA-approved. With the caveat that I am not a doctor and that you should speak with your own provider about your medical decisions, here’s a look at the three medications that can help you drink less or support you in stopping completely:
Naltrexone (ReVia, Depade, and Vivitrol)
Naltrexone (brand names ReVia, Depade, and Vivitrol) is an opioid antagonist. It works in the brain by blocking the pleasurable or euphoric effects of drinking alcohol and has been shown to relieve cravings and reduce the amount and frequency of drinking episodes. Some people take naltrexone daily to support their abstinence from alcohol, and others take it before drinking to help them manage their consumption and drink less.
Naltrexone comes in pill form (brands ReVia, Depade) and is also available in an extended-release, monthly injection (brand name Vivitrol). Some of the reported side effects of taking naltrexone include sleep problems, dizziness, joint pain or muscle cramps, nausea and/or vomiting, and loss of appetite. It can also cause cold-like symptoms, like a stuffy nose, sore throat, and sneezing. As with most side effects, they vary per person and can dissipate after a period of time taking the medication.
Benefits of choosing naltrexone:
- Individuals can still drink if they choose.
- It can relieve cravings and support recovery.
- Naltrexone can be taken in a targeted manner: one hour before drinking to help maintain control over the amount the person drinks, or if cravings arise, to help resist drinking.
Drawbacks of choosing naltrexone:
- It cannot be used with pain medications containing opioids, as it blocks their effects and will cause precipitated withdrawal.
- It should not be taken if the individual has liver problems, experiences depression, is pregnant, or is breastfeeding.
- Some find that it may also reduce other pleasurable effects of activities like exercise.
- If a person stops taking naltrexone and uses opioids, they are at increased risk of an opioid overdose.
Over time, addiction affects the brain chemicals responsible for providing a sense of calm. This is one of the reasons why you may feel uncomfortable and anxious when you quit drinking. Acamprosate (brand name Campral) works to relieve these unpleasant feelings and help you maintain abstinence from alcohol.
Acamprosate is prescribed to people who have already stopped drinking alcohol and it won’t work for those who continue to drink alcohol. The goal of this medication is to sustain abstinence recovery and make the process easier. Some of the side effects associated with acamprosate include diarrhea, headache, dizziness, difficulty sleeping, and dry mouth.
Benefits of choosing acamprosate (Campral):
- It can relieve cravings and support recovery.
Drawbacks of choosing acamprosate:
- The person taking it must maintain abstinence from alcohol for it to be effective.
- It should not be taken if you have kidney problems.
- It must be taken at least twice per day, which can be difficult for some people to keep track of.
Disulfiram (brand name Antabuse) is a medication that causes you to get sick when you consume alcohol. Disulfiram provides negative reinforcement by causing unpleasant physical effects—including headache, nausea, and vomiting, among others—shortly after even a small amount of alcohol is consumed. These effects can occur within minutes after drinking and keep happening for more than an hour.
Disulfiram is taken daily and is primarily used by people in stable recovery, to provide added discouragement from resuming drinking. The physical consequences discourage alcohol consumption by making it so unpleasant. It doesn’t relieve cravings or withdrawal symptoms. Some of the side effects associated with disulfiram include drowsiness, tiredness, headache, acne, and a metallic/garlic-like taste in the mouth.
Benefits of choosing disulfiram (Antabuse):
- It can be taken if a person relapses (after being alcohol-free for at least 12 hours).
Drawbacks of choosing disulfiram:
- Even if a person doesn’t drink, they may encounter alcohol in sauces, foods (like vinegars, mirin, vanilla extract, etc.), mouthwash, and medications. Disulfiram can make them very sick if they consume these.
- It can interact unpleasantly with cosmetic or external products that contain alcohol, like cologne, skin toner, aftershave, rubbing alcohol, and muscle linament.
- No alcohol may be consumed during the 12 hours prior to taking it.
Medication is not for everyone. But if you could use added support in your recovery from AUD, talk to your provider about these three options.