Question: Although opioids and to a lesser degree methamphetamine get the media attention, RSAT participants also suffer from alcohol use disorder (AUD) at an alarming rate in our program. Are there medications that treat AUD?
Answer: The FDA has approved three medications for AUD. The first is disulfiram (Antabuse). The acetaldehyde dehydrogenase inhibitor disulfiram was the first approved by the FDA in 1951. By blocking aldehyde dehydrogenase, its use leads to the accumulation of acetaldehyde, resulting in numerous related unpleasant symptoms, including tachycardia, headache, nausea, and vomiting. So disulfiram administration paired with alcohol causes aversive reactions. Open-label studies of disulfiram do provide support for its efficacy, as compared to controls, with a medium effect size. The efficacy of disulfiram, of course, depends on patient motivation to take the medication and/or its well supervised administration, given that the medication is primarily effective by the potential threat of an aversive reaction when the person drinks alcohol. It must be taken daily,
Approved as a treatment for alcohol dependence in Europe in 1989 and U.S. in 2004, Acamprosate (Campral) is thought to target the glutamate system by modulating hyperactive glutamatergic states, possibly acting as a receptor agonist. Overall, there is evidence that acamprosate may be more effective in promoting abstinence and preventing relapse in already detoxified patients than in helping individuals reduce drinking. The most common side effect with acamprosate is diarrhea. Other less common side effects may include nausea, vomiting, stomachache, headache, and dizziness, although the causal role of acamprosate in giving these side effects is unclear. It must be taken several times throughout the day.
Naltrexone, also an opioid receptor antagonist, was approved for the treatment of alcohol dependence by the FDA in 1994. Later, a monthly extended-release injectable formulation of naltrexone (Vivitrol), developed with the goal of improving patient adherence, was approved by the FDA in 2006. Naltrexone reduces craving for alcohol and blocks its euphoric effects. It has been found to be most effective in reducing heavy drinking. The efficacy of naltrexone in reducing relapse to heavy drinking, in comparison to placebo, has been supported in numerous meta-analyses. Common side effects of naltrexone may include nausea, headache, dizziness, and sleep problems. Naltrexone should be used with caution in patients with active liver disease and should not be used in patients with acute hepatitis or liver failure or are on opioids. An additional benefit of naltrexone is that it works for both AUD and Opioid Use Disorder, common co-occurring disorders.