Medication-Assisted Treatment for Alcoholism

Medication-assisted treatment (MAT) combines medications, individual and group counseling, and behavioral therapy to treat drug and alcohol use. It’s a method that provides a holistic approach to treating substance use disorders (SUDs).¹

MAT for alcohol addiction can:

• Reduce the risk of overdose
• Reduce criminal behavior
• Normalize the brain’s chemistry
• Lessen cravings by blocking opioid receptors in the brain
• Help individuals maintain abstinence

In addition to MAT, the key components of a successful program often include individual or family therapy and support groups.

People with an alcohol use disorder and a mental health condition are also known as having co-occurring disorders. This condition is common among people undergoing MAT. Additionally, people in MAT may have other health-related conditions that require treatment, like hepatitis, HIV, or AIDS.

Who is a Candidate for Medication Assisted Treatment?

You may be a good candidate for MAT if you:

• Are willing to comply with treatment
• Have an official diagnosis of an alcohol abuse disorder or drug addiction
• Have a lack of physical health issues that medication could worsen
• Are fully educated on alternative options

You may not be a good candidate for MAT if you have:

• A history of medication misuse
• An addiction to a substance that can’t be treated with an FDA (U.S. Food and Drug Administration)-approved medication
• A co-occurring substance addiction whereby the drug may negatively interact with medication
• A low level of motivation to become sober

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FDA-Approved Medications for Alcohol Addiction Treatment

Acamprosate, disulfiram, and naltrexone are the most common medications that treat alcohol dependence. While they don’t cure alcohol use disorder, they’re effective in people who participate in a MAT program to manage symptoms and maintain sobriety.

Acamprosate

This medication is intended for people in recovery who have abstained from alcohol to aid in minimizing cravings. Acamprosate reduces the brain’s dependence on alcohol, but it doesn’t prevent withdrawal symptoms from occurring.

Acamprosate usually starts on the fifth day of abstinence, reaching full effectiveness between 5 to 8 days. The drug is available in tablet form. It’s taken three times a day, preferably at the same time daily.

Side effects of acamprosate may include:

• Diarrhea
• Upset stomach
• Appetite loss
• Anxiety
• Dizziness
• Difficulty sleeping

While it can reduce cravings, the medication hasn’t been shown to work in people who continue drinking.¹

Disulfiram

This medication addresses chronic alcoholism by inducing unpleasant side effects once alcohol enters the body. It’s most effective for people who have previously undergone detoxification or are in the early stages of abstinence.

Disulfiram is provided in tablet form once a day. It should never be taken while intoxicated or at least 12 hours after drinking alcohol.¹

Side effects of disulfiram may include:

• Chest pains
• Headache
• Nausea
• Vomiting
• Difficulty breathing

These side effects can occur as quickly as 10 minutes after drinking even a small amount of alcohol. They can last for an hour or longer.

Naltrexone

Naltrexone is an opioid treatment that blocks the euphoric effects of alcohol intoxication. This medication is available in extended-release pill and injectable form. Naltrexone treatment helps people with alcoholism reduce their drinking by blocking its rewarding effects.¹

Medication for Alcohol Withdrawal

Most people suffering from alcoholism avoid detox because of the discomfort linked with alcohol withdrawal symptoms. Fortunately, many FDA-approved medicines are safe and effective in helping people through detox and withdrawal comfortably.

Many withdrawal symptoms are often physical. However, many substances can also pose psychiatric issues during withdrawal. A psychiatrist will also screen for mental health and psychiatric issues and prescribe other medications as part of a comprehensive treatment plan.

Listed below are some medications your doctor may prescribe for alcohol withdrawal:

Antidepressants

Antidepressants help relieve symptoms of depression, social anxiety, and other types of anxiety disorders. These drugs help correct chemical imbalances in the brain, specifically neurotransmitters that affect mood and behavior changes.

Examples of antidepressants include:

• Celexa
• Lexapro
• Prozac
• Paxil
• Zoloft

Anti-Nausea Medications

During detox, many people experience withdrawal symptoms, including nausea. To treat nausea during withdrawal, many health professionals prescribe anti-nausea medications. 

Some examples of anti-nausea medication include:

• Zofran
• Promethazine
• Metoclopramide

Antipsychotics

For people in detox with co-occurring or psychiatric issues, a health professional may prescribe antipsychotic medication. These medicines can be used to treat psychiatric issues like:

• Schizophrenia
• Bipolar disorders
• Dementia

Antipsychotics don’t cure psychosis but can help reduce and control many symptoms, including:

• Delusions
• Hallucinations
• Paranoia
• Hearing voices

Sometimes antipsychotics can treat withdrawal symptoms like anxiety and major agitation. These include the following:

• Olanzapine
• Risperdal
• Seroquel
• Abilify
• Clozaril

Benzodiazepines

Benzodiazepines, or benzos, are helpful in the acute detoxification phase.³ Benzos and alcohol both primarily affect the GABAergic system in the brain and on the same receptors (GABA-A receptors). Benzodiazepines suppress common symptoms experienced when withdrawing from alcohol addiction, such as:

• Seizures
• Irritability
• Nausea
• Chills and sweats
• Headaches

Benzodiazepines are effective for addiction treatment only in the short-term, as they can become addictive. Remember to consult your healthcare provider to adjust your dosage if you experience adverse effects.

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Can You Get Addicted to the Medication Used in MAT? 

It’s possible to abuse methadone and buprenorphine, both used in MAT to treat substance use disorders.

Drug abuse can develop if you take more of the medication than prescribed. This is why you should only take medications as directed by a medical professional. If you’re worried about drug misuse, speak to your doctor immediately about alternative options.

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Differences Between Medication-Assisted Treatment and Traditional Alcoholism Treatment

Not every type of alcoholism treatment is ideal for everyone. Each person benefits from a tailored approach to their treatment.

Some traditional options besides MAT programs include the following:

• Individual and group counseling: These sessions provide a support network for people recovering from alcoholism to maintain sobriety.
• Medical devices: Some FDA-cleared devices can treat withdrawal symptoms without using drugs or surgical procedures.
• Assessment and treatment for co-occurring mental health issues: Managing conditions, such as depression and anxiety, can help you overcome the need for drug and alcohol use.
• Long-term, follow-up care: Besides undergoing treatment for withdrawal, aftercare programs help you maintain sobriety and prevent relapse. Follow-up care may include working with the community or family as a recovery support system.

Care programs combined with a tailored treatment program and follow-ups can be essential for lifelong recovery from alcoholism. Treatment should include both a medication regimen and mental health services as required.

Summary

Medication-assisted treatment (MAT) for alcoholism includes medications, counseling, and behavioral therapy to treat alcohol use disorder. The most commonly used medicines for MAT are acamprosate, disulfiram, and naltrexone. Antidepressants, anti-nausea medication, and antipsychotics may also help relieve alcohol withdrawal symptoms.

While drug-assisted treatment may help deal with cravings and withdrawal symptoms, it can come at risk of drug dependence. MAT isn’t suitable for everyone, so all options for treating alcohol abuse should be explored beforehand.