Alcohol: Medications for Alcoholism

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Alcoholism:  Medications for Alcoholism




Guest:  Dr. Sarah Book – Psychiatry & Behavioral Sciences

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda 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?


Dr. Sarah 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.


Dr. Linda Austin:  Let’s first talk about the medication.  Which are they?


Dr. Sarah 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.


Dr. Linda Austin:  How effective has that been?


Dr. Sarah 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.


Dr. Linda Austin:  So that’s why it’s not used so much anymore? 


Dr. Sarah 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.


Dr. Linda Austin:  So what does work?


Dr. Sarah 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 would. 


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.


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