Drug Treatment for Alcohol Dependence

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Drug Treatment for Alcohol Dependence

Alcohol Dependence Alcohol Withdrawal Staying Stopped Combinations of medications Other medications How to choose the right medication Further information What Works Fact Sheet

South Australian Alcohol and Other Drug Strategy 2011-2016 The South Australian Alcohol and Other Drug Strategy 2011-2016 was released on 24 November 2011. More Suboxone Film now has Therapeutic Goods Approval for the treatment of opiate dependence. More More In Focus Items

Alcohol Dependence
Alcohol affects the brain - in the short term it impairs judgment, coordination and reflexes. When people use alcohol regularly they may develop tolerance and dependence. Tolerance means they will require more alcohol to achieve the same effect they used to get with smaller quantities, because the brain compensates for the sedating effects of alcohol and the liver breaks it down more quickly. Dependence means that alcohol use becomes central in their life. A lot of time is spent thinking about alcohol, obtaining it, using it and recovering from its effects. Use is continued despite knowing that it is causing harm. A common feature of dependence is that a person will experience withdrawal symptoms if they reduce or stop drinking, due to increased excitability (irritability) of the brain. Typical alcohol withdrawal features last about 5 days and include: shaking (tremor) nausea & vomiting anxiety depression sweating headache difficulty sleeping (may last several weeks) Alcohol withdrawal can be very dangerous (e.g. seizures may occur); people drinking 8 or more standard drinks a day are advised to discuss a decision to stop drinking with their doctor as medication may be needed to prevent withdrawal complications.
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Alcohol Withdrawal
Withdrawal can be undertaken in a variety of settings. In South Australia this could be at home (with the help of a GP and supportive friends/family), in hospital or in an inpatient unit (e.g. Drug & Alcohol Services SA Withdrawal Units). For further information about alcohol withdrawal contact the Alcohol & Drug Information Service: Tel: 1300 13 1340 Any medications prescribed by a doctor for managing withdrawal should be taken as directed. It is important not to take medications without telling the doctor or to start drinking (or taking illegal drugs) while still taking the prescribed medication.

Diazepam (Valium, Antenex, Ducene)

Diazepam belongs to the group of drugs called benzodiazepines. They have a similar action in the brain to that of alcohol so are good at relieving many of the symptoms of alcohol withdrawal. Clinical studies have shown that this group of drugs is the safest and most effective available. Diazepam is usually prescribed for the first few days (up to a week), often in reducing amounts. This ensures that the person does not develop benzodiazepine addiction; long-term use is not appropriate.

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Higher doses may be safely used in an inpatient setting, rather than in the home. Diazepam is usually taken several times a day in the beginning. Diazepam (and other benzodiazepines) has additive effects with alcohol and other sedatives so the person should not drink while taking them. Benzodiazepines also affect ability to drive or operate machinery.

Thiamine
Thiamine is one of the group B vitamins (vitamin B1). It is important to the normal functioning of the nervous system. Chronic alcohol drinkers do not absorb it well from the gut and often have a poor diet. Some symptoms of thiamine deficiency include memory disturbance, confusion, double vision, poor coordination and unsteadiness. Thiamine is better absorbed by injection and this is recommended at the start of treatment. Once a person has stopped drinking they may be given oral thiamine tablets.
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Staying Stopped
Stopping drinking (and going through withdrawal) is just the first step in the process of giving up - it takes time to become dependent on alcohol and time to give up. Attending counselling and/or using other supports (e.g. AA - Alcoholics Anonymous) are very important to help reduce the likelihood of a relapse back to drinking - they increase the chance of success. In addition there are a number of medications available that may help.

Acamprosate (Campral)
How it works: Acamprosate works on the brain - it acts on some of the same receptors and transmitters (messengers) as alcohol. It can help to restore the chemical imbalance in brain cells caused by long-term heavy alcohol use. Acamprosate can help to reduce craving for alcohol making it easier to resist a lapse to drinking - studies have shown that it doubles the chances of staying abstinent. Who can take it and who can't: A person must have alcohol dependence and want to stop drinking. It is recommended that acamprosate is started after a person has stopped drinking. It should not be taken by pregnant or breastfeeding women or people who have kidney disease or severe liver disease. How often, how long and side effects: Acamprosate tablets are taken three times daily (usually two tablets each time) at meal times (making it easier to remember). Most people do not experience any side effects from acamprosate; if they do occur the most common ones are diarrhoea and nausea or a skin rash. It takes about a week for the drug to reach its full effect and it can be continued for as long as needed (usually up to 12 months). There is some evidence that the benefits may continue even after stopping taking it. Cost: Acamprosate is subsidised by the government (PBS), and is available on prescription from a doctor (cost is approx. $5.30 for health care card holders and $32.90 without concession). The doctor needs to phone for an authority - the person must have alcohol dependence with a goal of abstinence and be in a comprehensive treatment program. The doctor is only allowed to prescribe 1 or 2 months supply at a time but can continue prescribing for as long as needed.

Naltrexone (Naltrexone QP, Revia)

How it works: Naltrexone also acts on the brain - it blocks the effects of alcohol on the opioid receptors that cause the high or lifting of mood experienced when drinking alcohol. As a result of taking naltrexone, craving for alcohol is reduced and drinking is much less pleasurable. There are some people who are particularly sensitive to the opioid effects of alcohol - they may have a strong family history of alcohol problems. Studies have shown that naltrexone halves the chances of relapsing to heavy drinking. Who can take it and who can't: A person must have alcohol dependence and want to stop drinking. It is recommended that naltrexone is started after a person has stopped drinking. It should not be taken by pregnant or breastfeeding women (unless there are exceptional circumstances) or people who have significant liver disease. It cannot be taken by people who are regularly taking or are dependent on opioids (it blocks their effects and can cause withdrawal). How often, how long and side effects: Naltrexone tablets are

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taken once a day (1 tablet). Most people do not experience side effects from naltrexone; if they do occur the most common one is nausea. Naltrexone starts to work within an hour of taking it and wears off within 72 hours of stopping; it can be continued for as long as needed (usually up to 12 months). Cost: Naltrexone is subsidised by the government (PBS), and is available on prescription from a doctor (cost is approx. $5.30 for health care card holders and $32.90 without concession). The doctor needs to phone for an authority - the person must have alcohol dependence with a goal of abstinence and be in a comprehensive treatment program. The doctor is only allowed to prescribe 1 or 2 months supply at a time but can continue prescribing for as long as needed. Note: Naltrexone is only subsidised for the treatment of alcohol dependence, not opioid dependence.

Disulfiram (Antabuse)
How it works: Disulfiram is an aversive agent - it blocks the breakdown of alcohol. Usually when alcohol is consumed it is broken down by the liver through several steps eventually ending up as carbon dioxide and water. Part way through this process alcohol becomes a chemical called acetaldehyde which is quickly broken down further. A person taking disulfiram is unable to quickly break down acetaldehyde because it stops the liver from making the necessary enzyme. As a result if the person drinks alcohol, acetaldehyde accumulates in the blood stream causing a very unpleasant reaction (flushing, headache, nausea, difficulty breathing, chest pain, collapse). Studies have shown that disulfiram may assist a person to remain abstinent from alcohol, especially if someone observes them take it. Who can take it and who can't: A person must have alcohol dependence and want to stop drinking. Disulfiram must be started after a person has stopped drinking (at least 24-48 hours after the last drink so there is no alcohol in the bloodstream). Disulfiram cannot be taken by those with severe liver, kidney or heart disease, a psychotic illness or in pregnancy. There are a number of other medical conditions that also pose a risk, so it is not usually prescribed as a first option. How often, how long and side effects: Disulfiram tablets are taken once daily dissolved in water (usually 1 tablet). Side effects may occur and range from mild to severe; there can also be interactions with other medications and any foods containing alcohol. Disulfiram starts to work within 24 hours and the effects last for at least a week after stopping taking it; it is continued for as long as needed (usually about 12 months). Cost: Disulfiram is not subsidised by the government and the full cost is borne by the patient - approximately $80-90 per month. It can be prescribed by any doctor but is not usually considered as a first-line treatment.
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Combinations of Medications
Acamprosate and naltrexone is a safe combination and there is conflicting evidence that the combination increases the likelihood of remaining abstinent. Acamprosate and disulfiram is a safe combination and may improve abstinence and craving but there is no good evidence to support this. Naltrexone and disulfiram are not recommended as a combination as both could cause liver problems.
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Other Medications
If people suffer from depression or anxiety that contributes to their alcohol dependence it may be necessary to have treatment for this at the same time. This should be discussed with the treating doctor.
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How to Choose the Right Medication

The decision should be based on the advice of a person's doctor who will take into account the person's experience, their medical history, family history, craving and triggers for drinking. It's an individual choice; sometimes if one medication doesn't seem to help an alternative will. It is very important that people don't have unrealistic expectations change takes time and effort and is unlikely to occur merely as a

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result of taking a particular tablet. It is essential to involve other supports for change (e.g. counselling, AA - Alcoholics Anonymous).
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Further Information
Alcohol & Drug Information Service (24-hour information and counselling) Tel: 1300 13 1340 (South Australian callers - local call fee)
The goal of the South Australian Drug Strategy is to improve the health and well-being of all South Australians by preventing the use of illicit drugs and the misuse of licit drugs. The information in this publication is a guide only. Readers are encouraged to seek appropriate professional advice before relying upon any of the material contained in it. While care has been taken to ensure the material contained in this publication is up-to-date at the time of printing, the Southern Adelaide Health Service Incorporated accepts no responsibility for the accuracy or completeness of the material in the publication and expressly disclaims all liability for any loss or damage arising from reliance upon any information contained within it.

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Disclaimer | Privacy | Copyright | Accessibility Page Last Modified: 9:05 AM 25 Oct 2011 Page URL:http://www.dassa.sa.gov.au /site/page.cfm?u=125

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