Medication For Alcoholism: It Can Be Effective, But Not Often Prescribed
In recent years, the U.S. opioid epidemic has taken precedence over another very concerning problem – alcohol misuse. One reason is that people don’t often die suddenly and in droves from alcoholism – in fact, alcohol poisoning (which is most often a result of extreme binge drinking) is responsible for only around 2,200 deaths per year. Ok, I’ll admit, that’s a lot. But it’s nothing compared to more than 60,000 Americans who died last year from drug overdoses.
Still, alcoholism, like tobacco smoking, is a slow killer. Between 2006-2010, 88,000 Americans died each year from alcohol-related causes. By comparison, 42,000 died from breast cancer. Data from a recent survey estimates that over 15 million adults in the U.S. suffer from alcohol misuse or dependence annually.
The standard treatment for alcoholism usually includes 12-step programs, cognitive-behavioral therapy, and counseling. These can be effective, but they are not for everyone. I’ve witnessed people go through months of rehab and undergo all of the above, and continue to relapse.
The problem is, like with any substance abuse, alcohol misuse rewires the brain. The effects go way beyond the initial reason why someone began to abuse it – it is a change that becomes more or less permanent. That’s when medication-assisted therapy can help. The Food & Drug Administration has approved the following medications to reduce excessive alcohol consumption:
Naltrexone is a medication for alcoholism that was originally indicated for the treatment of opioid addiction, but for reasons unknown, for some people, it also reduces alcohol cravings and the euphoria from drinking. Multiple trials have shown that the risk of heavy drinking is reduced by 20% for subjects using naltrexone vs. a placebo.
Researchers aren’t exactly sure why acamprosate helps decrease alcohol use, but clinical studies have shown that patients on this medication are 15% less likely to consume alcohol compared to others using a placebo and have many more periods of abstinence.
Disulfiram, or Antabuse, works by interfering with the metabolism of alcohol, which often results in patients feeling ill if they consume it. Unfortunately, it is these effects that also prompt patients to stop using it. However, some evidence suggests that disulfiram can limit drinking in the short-term, but other evidence has shown mixed results.
While the American Psychiatric Association and the National Institute on Alcohol Abuse and Alcoholism support the use of all of these medications to help patients, according to many studies, they remain underused.
A 2009 study, for example, estimated that less than 10% of Americans who need treatment for alcohol misuse received a prescription for any of these medications. In 2012, a study showed that over 330,000 persons with an alcohol use disorder at the Veterans Health Administration (VHA) that less than 4% were prescribed medication for the treatment of the condition.
A big reason why people who suffer from alcohol misuse don’t get medication for alcoholism is that, according to a national survey, less than 8% of those with alcohol use disorder in the past year actually sought treatment.
Another reason is that, like drug addiction, there is a stigma associated with alcoholism. There are many medical professionals and researchers that regard alcoholism as a disease caused by a number of factors, including genetics. But in 2010, a study revealed that nearly two-thirds of Americans believed that alcoholism was associated with “bad character” – an increase from 49% in 1996.
And also like drug addiction, research has found that individuals who perceive higher levels of stigma toward alcoholics are less inclined to seek medical assistance for the disorder. Additionally, a 2016 study revealed that many insurance plans require prior authorization for medications indicated for alcoholism, and they may be more expensive for patients.
And there’s always the “substitution of one drug for another” argument. It’s the same with opioid addicts. What many of the un-addicted public don’t realize is that brain changes associated with substance dependence indicate disease, not a lack of morality. Medication-assisted therapy is often just a form of harm reduction. And sadly, in the case of medication for alcoholism, these drugs are infinitely safer and are mostly benign when compared to alcohol abuse.
Fortunately, some medical centers are reaching out about these medications to providers and potential patients. For example, the VHA is offering additional training to clinicians regarding these medicines and giving information to veterans. Also, a lack of training for medical professionals may be a factor – in a national study, 88% of family doctors and 67% of psychiatrists stated they would be more likely to prescribe medications for alcoholism if they go were able to receive training.
Also, in 2016, the Surgeon General’s Report on Alcohol, Drugs and Health contained a review of medications for alcoholism and stressed that they might play a key role in treatment in addition to counseling and other therapies.
~ G. Nathalee Serrels, M.A., Psychology