What to Know About Medication-Assisted Treatment for Alcohol Use Disorder

Naltrexone, disulfiram, and acamprosate are the three medications approved for treating alcohol use disorder.

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Alcohol use disorder has existed under many names: alcohol abuse, alcohol addiction, alcohol dependence, and simply alcoholism. Regardless of what it’s called, all these terms describe a problematic pattern of alcohol use that can severely impact both the person affected and those around them.

Managing alcohol use disorder can be very challenging, but the substance use disorder is treatable — especially with a comprehensive approach known as medication-assisted treatment. Below, we delve into medication-assisted treatment for alcohol use disorder, including how this form of addiction treatment helps people manage problematic alcohol use and improve their chances of long-term recovery.

What to know about alcohol use disorder

Recent data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that alcohol use disorder is the most common substance use disorder, affecting 28.9 million people. According to the agency, one in 10 Americans aged 12 or older had an alcohol use disorder in the past year (10.2%), with those aged 18 to 25 being most at risk. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies an individual as having alcohol use disorder if they exhibit at least two of the following 11 symptoms within one year:

• Alcohol consumption in larger amounts or over a longer period than was intended
• Having a persistent desire or unsuccessful efforts to cut down or control alcohol consumption 
• Spending a great deal of time in activities necessary to obtain alcohol, use alcohol, or recover from its effects
• Experiencing cravings or a strong desire or urge to use alcohol
• Failing to fulfill major role obligations at work, school, or home due to recurrent alcohol use
• Continually using alcohol despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
• Reducing or giving up important social, occupational, or recreational activities because of alcohol use.
• Taking alcohol regularly in situations in which it is physically hazardous.
• Continuing alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
• Experiencing tolerance, either as:
  • A need for markedly increased amounts of alcohol to achieve intoxication or the desired effect 
  • As a markedly diminished effect with continued use of the same amount of alcohol
• Experiencing alcohol withdrawal, as manifested either as:
  • The characteristic withdrawal syndrome of alcohol
  • Taking alcohol — or a closely related substance, such as a benzodiazepine — to relieve or avoid alcohol withdrawal symptoms

The number of signs a person exhibits determines the severity of their alcohol use disorder, with two to three symptoms classified as mild, four to five indicating moderate, and over six labeled severe. It’s essential to consult with a healthcare provider if you’re struggling with substance or drug abuse for diagnosis and treatment. 

Medication-assisted treatment for alcohol use disorder

There are a variety of therapies and tools that can help someone cope with alcohol use disorder. Medication-assisted treatment, which combines medication with counseling and therapy, can be particularly helpful for those who haven’t succeeded with other methods or have severe alcohol dependence.

So, how can medication reduce these symptoms and help someone to reduce or completely stop their alcohol use? There are three medications available for treating alcohol use disorder: naltrexone, disulfiram, and acamprosate. Each addiction medicine offers different benefits and risks, as discussed below. 

How naltrexone works

According to Charlie Health Psychiatric Mental Health Nurse Practitioner Rebecca Holland, PMHNP-BC, naltrexone works to block cravings for substances by limiting the euphoric effects and sensation of being intoxicated. It’s available either as a daily oral medication or an extended-release injection administered monthly. The latter, known as Vivitrol, can be favored over the alternative “because it does not need to be taken daily, and many feel it has fewer side effects than oral naltrexone,” says Holland. Vivitrol is also approved for treating opioid use disorder. 

This addiction medicine treatment usually lasts about three to four months. Medical professionals typically administer naltrexone after a person detoxes from alcohol as this helps to avoid potential side effects such as severe nausea and vomiting, reports SAMHSA. Potential side effects of naltrexone include:

• Nausea or vomiting
• Sleepiness or trouble sleeping
• Headache or dizziness
• Decreased appetite
• Painful joints or muscle cramps
• Cold symptoms
• Toothache

How disulfiram works

Disulfiram works to make consuming alcohol an immediately unpleasant experience. According to the National Library of Medicine, disulfiram works by giving you several uncomfortable physical effects if you consume alcohol. The medication is taken orally once a day and should not be digested within 12 hours of an alcoholic drink. 

If you choose to consume alcohol while taking disulfiram, then you could experience headaches, nausea, vomiting, weakness, breathing difficulty, and anxiety — to name only some of the possibilities. Basically, it gives you the worst hangover of your life, but within 10 minutes of taking that drink — and it lasts for about one hour. Since it needs to be taken daily to work, it often works best if the person has someone in their support system who can administer the medication daily to ensure adherence.

On top of the impact it’s meant to cause, the National Library of Medicine warns about potential side effects of disulfiram, such as:

• Skin rash or acne
• Mild headache
• Drowsiness or tiredness
• Impotence
• Metallic taste or garlic-like taste in the mouth

How acamprosate works

The third medication available for treating alcohol use disorder focuses on reducing the desire to drink. The way that acamprosate works is not fully understood, however, it appears to help balance chemicals in the brain that are involved in alcohol cravings; it doesn’t limit withdrawal symptoms, the National Library of Medicine reports.

According to SAMHSA, it’s taken three times a day without food, and medical professionals typically recommend taking it five days after ceasing alcohol intake. It reaches its full effectiveness in five to eight days. 

The National Library of Medicine cautions about the following side effects of acamprosate:

• Diarrhea, gas, upset stomach, or nausea
• Loss of appetite
• Dry mouth
• Dizziness
• Itching
• Weakness
• Anxiety
• Difficulty falling asleep or staying asleep
• Sweating  

How Charlie Health can help

If you or a loved one is struggling with alcohol abuse or alcohol dependence, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for young people and families dealing with serious mental health conditions, including substance abuse. Also, in some states, Charlie Health offers medication-assisted treatment for alcohol addiction as part of our treatment program. Each medication-assisted alcohol addiction treatment plan consists of 9-12 hours per week of curated substance-use disorder groups, individual therapy, family therapy, and psychiatry. With this kind of holistic treatment, managing unhealthy alcohol use is possible. Fill out the form below or give us a call to start healing today.