ASK DR. BAUGHAN                                             July 4, 1998

MEDICATIONS FOR ALCOHOLISM

Anytime Americans celebrate a holiday, alcohol is around.  For approximately ten percent of our population, though, alcohol consumption means abuse and pain rather than celebration and joy.  If holidays connote dread of another flare of the disruption and damage of alcoholism, there is guarded hope for help from some medications.  The medications are never the answer in themselves.  First, the person must acknowledge that alcohol is a problem, and denial is a major barrier to treatment.  If the person and family are past that point, though, then family and social support systems are the backbone of any treatment program.  Individual and group counseling can be invaluable;  Alcoholics Anonymous still has the best statistics for achieving and maintaining sobriety.  With these components of therapy in place, some people may benefit from certain medications.

Antabuse (disulfiram) has been around for decades and still has a role for some people.  The person must have a strong personal or legal commitment to maintaining sobriety, because the medication has no direct effect on reducing the desire for alcohol.  It works on a principle of psychological aversion.  If the person takes the medicine regularly, and then drinks alcohol, they can become very nauseous, vomit and have a severe headache.  If they are determined to avoid alcohol, then Antabuse can strengthen their resolve.  It can remind them that alcohol makes them sick, just much more quickly than they may experience otherwise. 

Many alcoholics are also depressed.  It is not accurate to say “they drink because they are depressed,” because alcohol itself is a depressant.  It makes depression worse.  Many people, though, learned to numb the pain of depression with alcohol.  They seek “no feeling” rather than “bad feeling,” and it make take years to realize that alcohol in the long run makes bad feelings worse.  Treating depression when someone is sober may give them better reasoning and problem-solving skills so they are less likely to make poor, impulsive choices or use old lame excuses to drink.  The older antidepressants had higher risk of interactions with alcohol.  The newer antidepressants (Prozac and progeny) have a better safety margin.  Again, the combination of medication and psychotherapy have the best result.  If we were talking about treating cancer, we would use both, not one or the other.  Alcoholism is just as lethal as cancer.

Revia (naltrexone) has been on the market for a couple of years now and has a certain niche in treating alcohol abuse.  It decreases or eliminates the craving for alcohol.  Some patients who have relapsed into drinking several times have found this hard to believe until they tried it.  It does not produce a bad or dangerous effect if a person consumes alcohol, but it would be a terrible waste of money.  One of the limiting features of Revia has been its cost ($150-170 per month).  That may be cheap compared to the costs of alcohol and its health consequences, but people have always been willing to pay more for bad drugs than good drugs.  Many insurance plans will cover the cost as long as the person continues in counseling or some other type of treatment program, which is reasonable since taking an expensive pill by itself is not effective treatment for a complex disease.  Revia also blocks the effect of narcotic pain medications.  If the person has some chronic pain problem, this must be considered in treating the co-existing conditions.

I will mention tranquilizers (such as Valium, Serax, Xanax, etc.) only to emphasize their very limited role in treating alcoholism.  They are very useful in preventing seizures, delirium tremens (DTs) and severe alcohol withdrawal syndrome for 2-4 days.  They are not intended to make a person feel “good.”  They are used to prevent serious complications.  Unfortunately, they can be addicting, also, so prolonged use runs the risk of trading one addiction for another.  If an alcoholic person has an anxiety disorder best treated with one of these medicines, they require careful close medical supervision and carefully structured psychotherapy. 

The goal in treatment is to learn how to live healthfully, not to avoid bad feelings.  To live in freedom, as we celebrate today, means to embrace the diversity of human emotions and experience them with our full awareness.  When alcoholism prevents that freedom, seek help.  Be safe today.