Medication-Assisted Treatment for Alcohol
Alcohol-related issues are among the highest-ranked health problems in the U.S.1 Problems with alcohol may vary in their severity, quantities of alcohol consumed, and frequency of consumption. However, there are available treatment options that are effective in helping people struggling with alcohol reduce or stop using it altogether.
Research results suggest that one in three persons who undergo alcohol treatment do not have issues with alcohol one year later, while many others from this group reduce their drinking. As a result, their other alcohol-related issues also decrease.1
When trying to quit alcohol, many people experience very unpleasant withdrawal symptoms and cravings which they cannot withstand, so they resume using alcohol. In such cases, medication-assisted treatment for alcohol can help the patient remain abstinent.2
In addition to medicines, effective therapy also involves behavioral counseling, the purpose of which is to change the patterns of thinking and behavior that have resulted in alcohol abuse. This approach to addiction treatment is referred to as medication-assisted treatment. It is applied in opioid use disorder treatment and in alcohol use disorder treatment.3
How Are Medications Used in Medication-Assisted Treatment for Alcohol Abuse?
In treating alcohol use disorder (AUD), medications are used to achieve the following purpose:4
- Reduce alcohol use
- Prevent overdose
- Mitigate withdrawal symptoms
- Prevent relapse
- Maintain abstinence
It is important to note that medications are not a cure for AUD.3 They are a tool that helps the patient recover from addiction by working on resolving the issues that have led to substance abuse. When used to treat withdrawal, medications help the patient maintain stability, which is necessary in order to focus on other forms of treatment, such as individual psychotherapy, family therapy, peer support groups, etc.2 Therefore medications in medication-assisted treatment for alcohol should not be seen as treatment in itself but rather a key that opens the door to treatment.5
Who Qualifies for MAT for Alcohol
In some cases, medications may be administered through outpatient care. However, there are cases where there is a risk of severe withdrawal symptoms, such as delirium tremens or escalation of co-occurring mental disorders, so inpatient care is necessary when such a patient goes through medically assisted withdrawal.4
Additionally, not all forms of alcohol abuse qualify the patient for medication-assisted treatment for alcohol. In cases where the patient does abuse alcohol but does not meet the criteria for AUD (for example, occasional binge drinking), the patient may be encouraged to abstain from alcohol and is not prescribed medications.4
Which Medications Are Used In Medication-Assisted Treatment For Alcohol Disorders?
There are three medications for treating AUD approved by the Food and Drug Administration (FDA): disulfiram, naltrexone, and acamprosate.3
This medicine is an alcohol aversive, which means that it deters the patient from using alcohol by causing an adverse physical reaction when a patient drinks alcohol. In about 10 to 30 minutes after the person takes alcohol, disulfiram triggers some of the following unpleasant reactions:4
- Heat and hyperventilation
- Blurred vision
- Chest pain or tachycardia
The intensity of these reactions depends on the amount of medicine and the amount of alcohol that is consumed.4
Disulfiram is typically prescribed to people who have gone through detoxification and are in the initial stage of abstinence. It is available in the form of an oral tablet that is taken once a day.5
This medication is used to reduce alcohol cravings by binding to endorphin receptors of the nervous system and blocking the effects of alcohol. In other words, the person on naltrexone does not feel pleasure in consuming alcohol.6
Naltrexone is used in medication-assisted treatment for alcohol to maintain sobriety in patients who are no longer using alcohol. It is available in the form of an oral pill that is taken once a day or an extended-release intramuscular injection that is given by a physician once a month.6
Acamprosate is used to stabilize the chemical balance in the brain that has been affected by alcohol.7 It is prescribed to patients who are in recovery and are motivated to stop drinking.4
It is used in the initial stages of treatment, usually on the fifth day of abstinence,1 to help the patient go through withdrawal more easily and prevent relapse at this stage. It comes in the form of an oral tablet which is taken three times a day.
Frequently Asked Questions
The abbreviation MAT stands for medication-assisted treatment. It involves a comprehensive, tailor-made combination of medicines and behavioral counseling that help the patient recover from addiction and prevent relapse.3
It is the widely adopted standard treatment approach in opioid addiction treatment, including MAT for heroin addiction treatment, where opioid withdrawal symptoms can be quite severe and it may be risky to attempt to quit without medical support. In addition to opioid addiction treatment, there is also medication-assisted treatment for alcohol disorders.3
According to the medication-assisted treatment guidelines of Substance Abuse and Mental Health Service Administration, before any medication is prescribed, the first step is a comprehensive assessment of the patient’s condition, both related to alcohol abuse in particular and their health in general. It is important to establish whether there are co-occurring disorders or contraindications for some of the medications. The factors that are also relevant are the patient’s motivation and the level of support they have in their immediate environment.2
After that, it is decided which medication will be the most appropriate. The initial and maintenance dosages are established, along with a schedule of visits to the treatment facility for the purpose of monitoring the condition and tracking progress.
Parallel with medication administration, the patient is referred to behavioral treatment, which may involve individual or group sessions, family therapy, or perhaps some more extensive psychiatric treatment, especially in cases where patients are diagnosed with a co-occurring disorder.
When medications are used in alcohol treatment, they have proven to have the following positive effects:2
- Mitigating unpleasant withdrawal symptoms
- Reducing the intensity of cravings to drink alcohol
- Decreasing impulsive alcohol use or abuse of alcohol related to some specific situations
In addition to these biochemical effects, medications combined with behavioral therapy improve the following important aspects of treatment:2
- Patients’ attitudes towards change
- Patients’ motivation
- Patients’ retention in treatment
Of course, not all medications are effective in all cases and stages of treatment. It is the role of treatment professionals to assess the treatment needs of a particular patient and prescribe the drugs which would be most appropriate.
Despite the positive effects of medication-assisted treatment for alcohol abuse, it is still being underused. Namely, less than 4% of people with AUD use medications for treating this disorder. This is not surprising since according to official US statistics, only 7.2% of people who suffered from AUD received treatment in the past year.8 A way to improve these figures is expanding access to medication-assisted treatment for alcohol not only through specialized treatment programs but also primary healthcare.2
1. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.
2. Center for Substance Abuse Treatment. (2009). Incorporating Alcohol Pharmacotherapies into Medical Practice. Treatment Improvement Protocol (TIP) Series, No 49.
3. Substance Abuse and Mental Health Service Administration. (2021). Medication-Assisted Treatment (MAT).
4. Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed research international, 2015.
5. Substance Abuse and Mental Health Service Administration. (2020).MAT Medications, Counseling, and Related Conditions.
6. Substance Abuse and Mental Health Service Administration. (2020).Naltrexone.
7. National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 71158, Acamprosate.
8. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.