Quit Drinking Alcohol Using Anti Craving Medication

While there is no magic potion or special formula to help you manage your alcohol use, there are prescription medications that can help. In the United States alone, more than 18 million people have problems related to drinking alcohol, and about 88,000 people die each year from excessive alcohol consumption. The available medications have been scientifically studied and proven to help people get through the most difficult times as they try to quit drinking.

Steps

Getting Started

1. Choose to start treatment. The single and most effective part of the entire treatment process, including the use of available medications, is your decision to get started. Pressure from friends and family may push you into getting help, but, ultimately, the decision is yours.
2. Know what to expect. Treatment for alcohol addiction involves multiple approaches. Expect to work with a doctor, possibly a psychiatrist, a therapist, possibly a nurse, support systems, like family therapy, and mutual help groups, like AA. Choose treatment opportunities that suit you. Success is very possible, especially if you build several treatment approaches into your plan.
   • Alcohol and/or drug abuse are sometimes present simultaneously with other mental health issues such as depression, and therefore it is important to see a mental health provider for a comprehensive assessment if you or someone you know believes you may have a problem with alcohol. You may need treatment for this other disorder as well as treatment for alcohol abuse.
3. Plan on exams, lab work, and screening assessments. Somewhere early in this process, you will be asked questions about your drinking habits. Be honest with your answers. Most doctors and therapists use routine screening tools, such as CAGE, to evaluate your drinking habits and determine the best course of treatment for you.
   • The CAGE screening assessment tool includes 4 basic questions that follow the acronym C-A-G-E. Those questions are: C- Have you ever felt you needed to cut down on your drinking? A- Have people annoyed you by criticizing your drinking? G- Have you ever felt guilty about drinking? E- Have you ever felt you needed a drink first thing in the morning (eye opener) to steady your nerves or to get rid of a hangover?
   • Physical exams and lab work are important steps in order to provide the best care. For example, you should not take the ant-craving medication naltrexone if your lab work reveals problems with your liver function.
4. Find a doctor to help you. Your regular primary care physician is a good place to start. Your doctor can create a treatment plan that can work for you, or make a referral to a psychiatrist, mental health clinic, or treatment center.
   • Working with an outpatient group or clinic, that provides easy access to multidisciplinary professionals trained in treating alcohol addiction, can make it easier for you by having all your care centered in one place.
5. Commit to your goals. Develop your treatment goals with the guidance of your doctor or psychiatrist, get started with medications that may be helpful to you, work with a therapist to help change your behaviors, and get involved with a support program.
   • Make a commitment to yourself to follow through with your plan for sobriety. For many people, committing to abstinence is a difficult step to take, especially at first. Work with your team of healthcare professionals to set realistic goals.
6. Agree to inpatient care. Some people who are heavy users of alcohol may need to be initially treated in a hospital setting in order to be closely monitored for withdrawal symptoms, such as alcohol withdrawal delirium, delirium tremens, or DT's, can be serious, and possibly life-threatening. Consult with your doctor before beginning any treatment plan
7. Know what inpatient care is like. If your doctor determines that your condition is best managed at an inpatient level of care, you will be evaluated, and treatments will be started that help you get through the difficult detox period. The treatments are designed to make you as comfortable as possible and avoid serious harm that can sometimes occur from heavy alcohol consumption.
   • Part of that care will likely be a short course of medication to make you comfortable as your body goes through withdrawal from the alcohol. Benzodiazepines are commonly used, but treatment protocols vary from one facility to another.
   • The length of stay is usually just a few days. During that time, a physical exam and lab work will be done that provides information on the level of care you need. Plus, the physical and lab work evaluations can be helpful to your outpatient doctor after your discharge. You will likely meet with professionals of other disciplines during your stay that can help, such as nurses and therapists
   • The inpatient team can help arrange your initial appointments, put you in contact with support groups, and get you started with your treatment goals.
8. Comply with prescribed medications. In addition to medications provided during your stay, you may be given prescriptions to get filled once you are discharged. The discharge prescriptions provided can help you avoid lingering problems with physical withdrawal, and feelings of anxiety. A prescription for an anti-craving medication that is suited to your needs may also be provided.
9. Follow through with your treatment goals. Your treatment team, including at least your doctor and therapist, and are there to guide you through your treatment. They may ask you to participate in activities a little outside of your comfort zone, like possibly attending mutual support groups such as AA. Follow through with your treatment plan. Talk to your doctor and therapist if certain aspects are not for you. There are many ways to help you reach your goal.
10. Take control of your environment. Remove all alcohol from your house. Seek the support of friends and family, especially people that live in your home. During the early stages of your treatment, avoid social situations that may trigger your desire to drink.
11. Make changes in your lifestyle. Stay away from former drinking buddies, unless they want to join you in your effort to abstain. Enroll in evening classes, join a volunteer group, start a new hobby, exercise, or enjoy outdoor activities that do not include alcohol.

Understanding Your Medication Options

1. Consider taking disulfiram. Disulfiram is most commonly known by the original brand name, Antabuse®. Some people may confuse the way disulfiram works to help people quit drinking, with the way the newer medications work. The mechanisms of the available agents are different in each case.
   • Disulfiram has been used effectively for more than 60 years to help people stop drinking. Disulfiram works by inhibiting one of the enzymes involved in the breakdown and elimination of alcohol by-products from the body. Build up of these by-products occurs if you were to drink after taking disulfiram, resulting in very unpleasant feeling that has been likened to a bad hangover. You may experience symptoms like nausea and vomiting, flushing, sweating, and heart palpitations.
   • Taking disulfiram often involves the help of a close friend or family member to monitor the daily dosing of the medication as the medication will be cleared from the body and therefore not effective within about two to three days from the last dose. Compliance with treatment is important to ensure that the drug remains in their system at all times. Having someone to monitor compliance prevents the person from stopping the doses on their own, then going back to drinking alcohol. Using disulfiram requires a commitment to abstinence.
   • Be aware of safety issues with disulfiram. Serious problems associated with disulfiram involve the dangerous reaction that can occur if you consume alcohol while taking this drug. Topical products that contain alcohol can also trigger that unwanted reaction. The alcohol warning is extended to other drugs that contain alcohol such as some cough syrups and tonics. Disulfiram should not be used in people that are taking metronidazole, or paraldehyde.
   • Disulfiram is not to be used in people with severe heart disease, psychotic disorders, certain allergies to ingredients found in pesticides, and in people that are exposed to alcohol based chemicals in their work.
2. Consider taking naltrexone. Naltrexone comes in an oral dosing form, which is given once a day, and an extended-release injectable form, given once a month. There is no physical reaction or sickness if you drink alcohol while receiving naltrexone.
   • The people that do the best with naltrexone are those that are trying to achieve abstinence. Not everyone is ready, especially at first, to make that commitment. That’s ok.
   • Naltrexone works by blocking receptors in your brain that are involved in the rewarding, and positive, feelings that happen when you drink. Because it works in the reward center of the brain, naltrexone can also help to reduce cravings.
   • Research with the oral dosing form of naltrexone has shown an overall reduction in the risk of relapse during the first 3 months of therapy by about 36%. Plus, about 25% of people taking the injectable form of naltrexone experienced fewer heavy drinking days.
   • Use naltrexone safely. Naltrexone relies on your liver to metabolize the drug into other forms, and to keep your blood level of the drug in a safe range. If you have any liver problems, or signs of liver problems (such as swelling in your legs, bloated abdomen, or intense nausea) while you are taking naltrexone, contact your doctor immediately.
   • Avoid opiates while taking naltrexone, as naltrexone works by blocking the same receptors that opiates bind to. A serious complication can occur if naltrexone is used when there are opiates, or opiate derivatives in your system. The reaction can be severe if any opiates linger in your system as you begin naltrexone therapy.
   • Expect your doctor to perform blood work in order to proceed safely. Taking naltrexone while opiates are in your system can induce a sudden, and sometimes severe, situation of opiate withdrawal. Medical attention is warranted if this should occur. Completely avoid opiates during your therapy with naltrexone.
3. Ask your doctor about taking acamprosate. Acamprosate, currently marketed under the brand name of Campral®, works in a different way. Again, there is no physical reaction that happens if you drink while taking acamprosate.
   • Acamprosate is dosed orally, and given 3 times every day. The drug works in your brain by acting on the receptors that cause the uncomfortable symptoms when you are trying to stop drinking.
   • Some of the symptoms acamprosate can help to minimize include insomnia, anxiety and jitteriness, restlessness, and feeling generally unhappy with life.
   • Studies show that acamprosate may be especially helpful in people that have been drinking for a long time. Plus, the people that did the best with this drug were those that wanted to reach a goal of abstinence. As many as 36% of people taking acamprosate were able to maintain their abstinence for at least 6 months.
   • Know more about taking acamprosate safely. Avoid using this drug if you have severe kidney problems. Acamprosate depends on your kidney function to remove the drug from your system with routine use. You should not take acamprosate if you have serious kidney disease.
   • Do not take acamprosate if you have certain allergies. People that are allergic to sodium sulfite or sulfite containing products should not take acamprosate. Sulfite sensitivity is more common in people with asthma. Sulfites are found in a variety of foods.
   • Some examples include prepared food products such as dried fruit, canned fruits or vegetables, some shellfish, and foods made with potatoes, like instant mashed potatoes. Let your doctor know if you have food allergies that may include sulfites.
   • Watch for feelings of depression or suicidal thoughts. Let your doctor know immediately if you develop feelings of depression or suicide once you start taking acamprosate. These feelings have been reported with this drug, and warrant medical attention if they should develop.
4. Learn how topiramate can help. Topiramate has shown very promising results in clinical studies; however the drug is not yet approved for use in the treatment of alcohol disorders by the FDA. That means that your doctor can prescribe topiramate for you as an off-label use.
   • Topiramate is given in oral doses, with the dosing gradually titrated upward to reach the desired results. This drug works by manipulating chemicals involved with the reward center in the brain. This helps to reduce alcohol use, and to reduce associated cravings.
   • The clinical research studies included people that were still drinking alcohol at the time they were started on the drug. Participants were continuing to show improvement as the 14 week studies came to an end.
   • Overall, topiramate increased the number of days some people were able to remain alcohol-free, and decreased the number of heavy drinking days for others. While comparative results are not available, the study results suggest that topiramate may be more effective than either naltrexone or acamprosate.
   • Take topiramate safely. One of the more serious complications caused by the use of topiramate involves your eyes. If left unattended, changes in your vision can lead to potentially permanent damage. Any visual changes should be immediately reported to your doctor.
   • Be aware of cognitive changes that can occur. Some people report problems with confusion and alertness when taking topiramate. In many cases, these symptoms can be addressed by adjusting the dose.
   • Pay attention to feeling depressed or having thoughts of suicide. These feelings can possibly develop when taking topiramate. Contact your doctor immediately if you develop these thoughts or feelings.
   • It is very important that you do not stop taking topiramate altogether. The amount of topiramate in your blood needs to be gradually lowered in order to avoid serious side effects such as seizures. Consult with your doctor before stopping this medication; she can help you taper the dose gradually to prevent unwanted effects.

Deciding if Medications are Right for You

1. Weigh the pros and cons of each medication. The information on the medications can be quite extensive. Know that all drugs have side effects, warnings, contraindications, drug interactions, and possible complications. The published literature about these medications can be overwhelming. Focus on the key points with each drug, and make a list of questions for your doctor.
2. Think of the medications as tools to help you reach your goal. Talk to your doctor about including medications as a part of your treatment plan. Be sure you understand how to safely use the medication your doctor recommends for you. As you consider the possible treatment options, do not overlook the safety risks involved with doing nothing.
3. Talk to your doctor about your existing medications. Drug interactions can be critical if you are taking an existing medication that can cause problems when the new medication, to help you quit drinking, is added to your regimen.
   • Be sure to talk to your doctor about all medical conditions you may have, and every medication you are currently taking, including over-the-counter products.
4. Do your homework. Taking a medication designed to help you manage your alcohol addiction may be critical to your success. Expand your knowledge about how the drugs work, how to take them safely, and how to stop them if they are not right for you.
   • Online and written materials are easily accessed, plus your doctor can provide additional information as you consider the use of medications. The detailed information describing possible side effects and drug interactions goes beyond the scope of the information presented here. A good understanding of the available agents can help you create a list of questions for your doctor. Selecting the drug best suited to your needs can help you conquer your alcohol addiction problem.

Tips

• Develop a strong support system. This might be a sponsor from the AA program, a close friend, spouse, or clergy. Have someone there to support you: someone that you can always count on for help if difficult times challenge your progress.
• Cravings come out of the blue, sometimes months or years later. Be prepared for them.
• Don’t give up if you relapse. The road to recovery often includes a few bumps along the way.
• Reward yourself for your accomplishments. Treat yourself when you reach a sobriety milestone (1 day, 1 week, 30 days, 3 months, 1 year, etc.)
• Talk to your doctor or therapist if you feel your family or close friends are sabotaging your progress. As you grow stronger and healthier, this may threaten some of your existing relationships.
• Eat a healthy diet. The proper balance of nutrients, possibly including probiotics, can help to offset any vitamin imbalances caused by alcohol consumption.
• Alternative treatments have become increasingly popular in addressing alcoholism. Consider options like acupuncture, EFT (Emotional Freedom Technique), hypnotherapy, mindfulness, and therapeutic massage.
• Spirituality is often a very important component in achieving sobriety. Whether you choose a traditional religion or explore new options, the reflection, self-awareness, and support, can be very powerful.

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