Can Medicines Help You in Addiction Recovery?

In early recovery, treatment professionals sometimes prescribe “maintenance pharmacotherapy” drugs to help alcoholics stay sober. These drugs include Antabuse, Naltrexone and Acamprosate is widely used worldwide. Of course, these are available under different brand names in other countries. Another class of drugs known as SSRIs (selective serotonin reuptake inhibitors) are not used explicitly for relapse prevention. Still, they help many recover alcoholics who suffer from depression, anxiety or panic attacks, or obsessive-compulsive disorder.

While a few of these drugs show promise in alcoholism treatment, long-term controlled studies are needed to confirm early reports of encouraging results. Antabuse, which was first introduced in 1951, is the only sobriety-maintenance drug studied over a long period; yet even with this drug, the number of controlled clinical trials is limited and reveals mixed findings. Naltrexone has been on the market since 1994. It has proven to be reasonably effective and safe. Acamprosate has been extensively studied in Europe and the United States; once again, long-term research has indicated encouraging results.

Researchers who believe that maintenance pharmacotherapy drugs help in addiction treatment point out that long-term studies are needed before any conclusions can be reached about these drugs’ long-term effects and potential benefits. Our recommendation is to approach all drug therapies with caution, including medicines that are specifically designed to help you stay sober.

In Twelve Step programs, no drugs are involved; yet the recovery is remarkable, as seen over the years worldwide.

Disulfiram (Antabuse)

Disulfiram interferes with the metabolism of alcohol, leading to a buildup of a highly toxic substance called acetaldehyde. If an alcoholic drinks while taking Antabuse, it causes a highly unpleasant reaction, with symptoms such as flushing, violent headaches, nausea, vomiting, sweating, extreme thirst, chest pain, heart palpitations, difficulty in breathing, abnormally rapid heart rate, weakness, blurred vision, and mental confusion.

As long as recovering alcoholics continue to take Antabuse, they know they can’t drink without suffering the consequences. The problem most often cited with Antabuse (in addition to the fact that it must be used with caution in alcoholics with known liver disease) is that the drug does not eliminate the craving for alcohol. If the craving continues, all the alcoholic has to do is stop taking the daily Antabuse pill, wait several days, and start drinking again.

Naltrexone

Naltrexone is a narcotic antagonist that was initially used to treat heroin addicts. Unlike Antabuse, which makes people violently ill when they drink, naltrexone blocks the craving for alcohol and is sometimes used to help alcoholics “unlearn” the positive, reinforcing effects of the drug.

How does the drug work? Naltrexone stands like a well-built bodyguard in front of the opiate receptors, refusing entry to alcohol and other opiate-type drugs such as heroin. Thus, when you take naltrexone and drink alcohol (or take heroin), you won’t get the rewarding euphoric kick because naltrexone blocks alcohol from entering the opiate receptor, which prevents the release of the feel-good chemicals that create the euphoric high. Alcohol and heroin lose their buzz—many alcoholics and addicts who take naltrexone claim that it makes alcohol or heroin repulsive.

Naltrexone is not in any sense treatment for alcoholism or drug addiction, nor can it be considered a cure because it does nothing to dismantle the neurological scaffolding that supports addiction. If alcoholics or addicts want to feel the magic again, all they have to do is stop taking naltrexone; the bully guarding the opiate door disappears, and the euphoric high returns.

Acamprosate

Acamprosate has a similar structure to GABA (gammaninobutyric acid), one of the brain’s most widely distributed neurotransmitters and a key chemical involved in alcohol and drug addiction. GABA helps quiet down the brain cells, decreasing brain activity. Valium and other benzodiazepine drugs exert their sedative effect on the brain through their interactions with GABA.

Acamprosate may have the most significant potential of all the maintenance psychotherapeutic drugs available for recovering alcoholics and addicts. The drug is well tolerated and has no sedative, hypnotic, anxiety-reducing, anti-depressant, or muscle-relaxant properties that could lead to physical or moderate diarrhea. Studies suggest that acamprosate “enhances abstinence” and reduces drinking days, although only minimal evidence exists that the drug diminishes craving or relapse rates.

Still, the biggest problem with acamprosate (as with naltrexone) appears to be one of patient compliance. Dropout rates in acamprosate studies are high.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors or SSRIs (Prozac, Zolfresh, etc.) are nonaddictive. They may be helpful for some alcoholics and addicts who suffer from depression, chronic anxiety, recurrent panic attacks, or persistent sleep disturbances unrelated to drinking alcohol or drug abuse or withdrawal symptoms from the substances. SSRIs alter the synthesis of serotonin and other neurotransmitters in the brain; since addiction is related to a genetic defect that contributes to neurotransmitter deficiencies, it makes sense that these drugs might help correct those imbalances.

Hope Trust is cautious that they don’t hand out these drugs in large quantities to their clients without carefully assessing each patient. Although depression and anxiety may exist independently of addiction, in most cases, these disorders disappear after several months of abstinence. Ongoing emotional or psychological problems may be a symptom of protracted withdrawal (or Post-Acute Withdrawal Symptoms) rather than a sign of a dual disorder, the current terminology for serious psychological problems that coexist with alcoholism and drug addictions.

SSRIs should never be considered a standard part of addiction treatment. Recovering alcoholics and addicts who report chronic depression, sleep disturbances, anxiety, or panic attacks may be good candidates for SSRIs. Still, in most cases, Hope Trust recommends waiting six to twelve months to see if these problems disappear as the addict’s body heals itself and balance is restored. However, suppose depression, anxiety, or sleep disorders have a profound effect on the recovering alcoholic’s ability to stay sober. In that case, SSRIs may help in the transition from early sobriety to a sable, secure recovery.

These products (Antabuse, Naltrexone, Acamprosate, SSRIs) may help certain individuals stay sober, but they are, at best, only a partial answer. Maintaining sobriety is best done by combining psychotherapy and involvement in self-help groups such as Alcoholics Anonymous. An integrated approach, which includes pharmacology, psychiatry, psychotherapy, Twelve Step facilitation and a structured lifestyle in rehab, has the best results.

If you or a loved one is struggling with addiction, call +91 90008 50001 or 94906 84998