Drugs used in the Treatment of Alcohol Abuse/Addiction Tristan Knowles

Alcoholism Treatment  Lots of alcoholism treatments use a combination of psychological means (such as CBT) in combination with aversion therapy aided by drugs.  Most drugs used in treating alcoholism are aimed at creating adverse reaction to imbibing alcohol.  Currently on the market, there are a limited number of drugs to treat alcoholism.

Disulfiram (Antabuse)  Under normal conditions, alcohol is broken down by alcohol dehydrogenase into acetaldehyde, which is further broken down into acetic acid by acetaldehyde dehydrogenase.  Antabuse works by blocking acetaldehyde dehydrogenase, causing an excess build up of acetaldehyde. sulfiram.png Site/DrugsAZ/frmInfoText.aspx?intCp num=202#none

Symptoms/Effects of Antabuse  Due to the excess build up of acetaldehyde in the bloodstream, patients may feel nausea, vomit, have headaches, chest pain, and several other symptoms after only five to ten minutes after drinking.  There appears to be no “tolerance” to Antabuse; extended use of the drug only adds to its effect as it is both absorbed and excreted slowly by the body.

More Antabuse  Due to its slow excretion from the body, Antabuse can be effective 5-7 days from the last dose.  Therefore, patients using Antabuse to treat alcoholism must continually take the drug (this drug can be court mandated).  Antabuse also shows some effects as a dopamine breakdown inhibitor, and therefore is also being investigated as a treatment for cocaine addiction.

Negative Aspects of Antabuse  Due to its interaction with the enzyme dopamine-beta- hydroxylase, which breaks down doapmine, Antabuse adverse affects when combined with drugs affecting the release and re-uptake of dopamine (Such as Ritalin, Adderall, and Cocaine).  Metabolism of other drugs may be inhibited by Antabuse (such as Benzodiazepines, morphine, and barbituates).  Extremely important to take under consideration when someone is undergoing other medical treatment along with the treatment for alcohol addiction.

Naltrexone (Revia or Vivitrol)  Naltrexone is metabolized in the liver into a variety of metabolites, with the 6-β- naltrexol being the metabolite useful in treating alcoholism.  The mechanism of action is not quite fully understood.  Approved for use in the treatment of alcoholism in April of rexone

Naltrexone Proposed Mechanisms of Action  After metabolizing into the 6-β-naltrexol, the metabolite is believed to act as a competetive antagonist at opiod receptors.  It is because of this reaction that Naltrexone is believed to interact with the dopaminergic mesolimbic pathway, which alcohol activates, therby causing pleasurable feelings.

Naltrexone Actions  Naltrexone is aimed at reducing the psychological need or craving for alcohol.  Naltrexone can be administered in a 50mg tablet with some nauseating side effects.  A Naltrexone shot, administerd intr- muscularly, is also available.  Naltrexone has been shown to be effective for up to 30 days.

Naltrexone Safety  Naltrexone is considered a relatively safe drug for the treatment of Alcoholism.  Little drug-drug interactions have been shown and do not seem significant, except for Naltrexone’s interaction with opiod analgetics.  Some patients, while on Naltrexone have been shown to turn away from alcohol only to pick up another drug.  After treatment with naltrexone, opiod receptors are very sensitive and can lead patients to overdose on some other drug.

Acamprosate (Campral)  First approved by the FDA in 2004, although it has been approved in Europe since 1989  Part of the reason for the delay of approval in the US was due to the action of Acamprosate not being fully understood

Action of Acamprosate  Alcohol inhibits the activity of receptors known as N- Methy-D-aspartate receptors (or NMDARs), causing the brain to create more NMDARs  Absence of alcohol, or no inhibition of the receptor, causes these receptors to be overly active and cause symptoms such as delirium tremens (DT).  Acamprosate is thought to reduce glutamate surges that excite NMDARs. This property makes Acamprosate useful in treating the withdrawal symptoms in alcoholics.  Acamprosate has also been shown in some studies to act as a neuro-protectant and protect neurons from damage caused by alcohol withdrawal

Other Drugs  Benzodiazepines have also been used to treat alcohol withdrawal due to their interaction with the GABA receptor.  Emetine can be used in combination with other drugs (creating a literal “drug cocktail”) and be used in aversion therapy as the “cocktail” will induce nausea and vomiting.

Drugs Alone Are Not the Answer  Because of the complexity of alcoholism, drugs alone are not effective in “curing” alcoholism.  Cases must also be treated on a case by case basis, there is no set proven effective method for everyone.  Psychological measures (CBT) in combination with drugs are usually employed, although sometimes addictions are treated without drug use.

An Example of a Program  Shick Shadel Hospital’s program outline for addiction treatment Shick Shadel Hospital’s program outline for addiction treatment Shick Shadel Hospital’s program outline for addiction treatment