Alcoholism: Medications for Alcoholism
Guest: Dr. Sarah Book – Psychiatry & Behavioral
Host: Dr. Linda Austin – Psychiatry
Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Sarah Book,
Psychiatrist, Center for Drug and Alcohol Programs. Dr. Book, there are a number of ways now that
psychiatrists think about treating alcohol.
What are some of those ways?
Book: The approach that we have to treat
alcoholism is really what I would call a bi-modal approach. There are lots of medications on the market
now that you can use to treat alcoholism, however none of those medications
have been shown to work unless they are given in the context of some kind of
therapy to help somebody not drink.
Austin: Let’s first talk about the
medication. Which are they?
Book: The first medication to come on
the market for the treatment of alcoholism, that lots or people, perhaps, have
heard of, is called Antabuse; the generic is Disulfiram. Essentially, how Antabuse works is, when you
take Antabuse and then you drink, it makes you very sick. So, if you’re taking Antabuse, you’re less
likely to drink because you don’t want to get sick.
Austin: How effective has that been?
Book: That’s one of the problems with
Antabuse. Since it’s been given an FDA
indication, the way we study medications has changed. So now, when we study medications, we always
compare a medication to a sugar pill.
And, in those studies that started after this medicine got its
indication, in almost all of those studies, Antabuse has not been shown to work
better than a placebo, a sugar pill.
Austin: So that’s why it’s not used so
Book: One reason that we think is that,
if you want to drink, you just won’t take your Antabuse. The situation in which Antabuse will work is
if somebody else is responsible for administering the medication.
Austin: So what does work?
Book: The next medicine to come on the
market is the one that we probably have the most positive experience with, and
that’s called naltrexone. Its trade name
is Rivea. Naltrexone, essentially, works by making
drinking less fun. You’re not going to
get sick if you drink while you’re taking naltrexone, but it decreases the
positive effects of drinking. It also,
we think, decreases craving for alcohol.
So, in studies looking at what naltrexone does, it may not improve your
success rate at being completely abstinent, but what it is likely to do is,
when you pick up a drink, you might be able to drink less than you otherwise
Dr. Linda Austin: What other
medications do you use?
Dr. Sarah Book: The most recent
medicine to come on the market for the treatment of alcoholism is acamprosate. The trade name for that medicine is
Campral. That medicine has mostly been
shown in European studies to improve the chance of abstinence.
Dr. Linda Austin: How successful
are Rivea and Campral?
Dr. Sarah Book: Well, again, it’s
important to emphasize that these medicines have not been shown to work unless
they are coupled with a psychotherapeutic intervention.
Dr. Linda Austin: Dr. Sarah Book,
thank you very much.
Dr. Sarah Book: Thank you, Linda.
If you have any questions about the services
or programs offered at the Medical University of South
Carolina or if you would like to schedule an
appointment with one of our physicians, please call MUSC Health
Connection: (843) 792-1414.