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Treatment Options Overall treatment plans consist of three components: medical, psychosocial, and support from loved ones and people who have experienced alcohol dependence or abuse. Each patient will require a combination of resources to suit their individual treatment needs. These are not competing assets but complimentary to one another.

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Medication-Assisted Treatment (MAT)

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Medication-Assisted Treatment is pharmacotherapy relating to substance misuse. It combines pharmacological intervention with counseling and behavioral therapies. This provides the patient with a comprehensive approach in the treatment of substance misuse disorders. MAT is clinically driven and focuses on the patient as an individual and care is provided as such.1

Effective MAT for alcohol dependence has been shown with the FDA approved medications Naltrexone (ReVia®, Depade®), Naltrexone for Extended-Release Injectable Suspension (VIVITROL®), Disulfiram (Antabuse®) and Acamprosate Calcium (Campral®).

When MAT is part of a comprehensive treatment program, the results have shown to:

  • Improve outcomes
  • Increase retention in treatment
  • Decrease illicit opiate use
  • Decrease hepatitis and HIV infections
  • Decrease criminal activities
  • Increase employment
  • Improve birth outcomes for patients2

About Oral Naltrexone (ReVia®, Depade®)
Naltrexone is an opioid antagonist, which means that it occupies the opioid receptors in the brain without activating them; and blocks opioids from attaching to the receptors. In the treatment of alcohol dependence, it is not completely understood how the mechanism works, but preclinical data suggests that the opioid receptors are involved with alcohol dependence. Thus, the blocking action of naltrexone to the opioid receptor is thought to reduce the pleasurable effect of alcohol, and, in turn, reduce alcohol consumed in one sitting and reduce heavy alcohol consumption days.3,4

Naltrexone does not stop patients from consuming alcohol, nor does it precipitate any physical symptoms when alcohol is consumed while the patient takes naltrexone.

ReVia and Depade are the oral formulations. The average dose is 50mg once taken daily.

About Naltrexone for Extended–Release Injectable Suspension (VIVITROL®) Physician Locator
The newest medication treatment option for alcohol dependence is VIVITROL® which was FDA approved in 2006. Although naltrexone itself has been used in oral form since 1994 for alcohol dependence (1985 for opioid addiction), VIVITROL is a long-acting formulation administered as a once-monthly IM injection.

Studies have shown that when combined with proper psychosocial therapy, VIVITROL is much more effective than support alone.5

VIVITROL-Related Links:
VIVITROL  www.vivitrol.com   Alkermes®/Cephalon® product website
VIVITROL PI
Clinical Trial Report. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence. A Randomized Controlled Trial." James C Garbutt, MD, Henry R. Kranzler, MD, Stephanie S. O'Malley, Ph.D, David R. Gastfriend, MD, Helen M. Pettinati, Ph.D, Bernard L. Silverman, MD, John W. Loewy, Ph.D, Elliot W. Ehrich, MD for the Vivitrex Study Group. JAMA, April 6, 2005–Vol 293, No. 13 pp 1617-1625
http://download.ncadi.samhsa.gov/prevline/pdfs/SMA07-4267.pdf

Naltrexone-Related Links
MedlinePlus  http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a685041.html
NIAAA http://pubs.niaaa.nih.gov/publications/combine/FAQs.htm

About Acamprosate Calcium (Campral®)
FDA approved in 2004, acamprosate calcium reduces the physical and emotional distress that may occur in the weeks and months after alcohol consumption is stopped.6 Acting on the GABA and glutamate nerurotransmitter systems7, Campral is an oral medication with a recommended daily dose of two (2) 333mg tablets three times a day. Patients must be abstinent before beginning treatment.8 The medication should be part of an overall treatment plan which should include professional therapy and peer support.8

Campral does not stop patients from consuming alcohol, nor does it precipitate any physical symptoms when alcohol is consumed while the patient takes Campral.

Campral-Related Links:
Campral    www.campral.com   Forest Laboratories, Inc. product website
FDA Label
Campral PI
MedlinePlus     http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a604028.html

About Disulfiram (Antabuse®)
Introduced in 1948, Antabuse was the first medication approved for Alcohol Dependence. Of the four currently approved medications, Antabuse is the only one that is aversive. It interferes with the metabolizing of acetaldehyde into acetic acid, which then causes the side effects of flushing, nausea, chest pain, breathing difficulty, headache, confusion, blurred vision if alcohol is consumed within two weeks of dosing. These effects start approximately ten minutes after alcohol enters the body and last for an hour or more.7,9 Anatabuse is an oral medication, taken once daily. The patient must be very cautious not consume anything containing alcohol, such as mouthwash, cough syrup, and all foods containing alcohol.9

Antabuse-Related Links:
MedlinePlus: http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682602.html
FDA Label
NIAAA: http://pubs.niaaa.nih.gov/publications/Practitioner/pocketguide/pocket_guide4.htm

References

  1. "About Medication-Assisted Treatment" http://www.dpt.samhsa.gov/patients/mat.htm
  2. "Pharmacotherapy for Substance Use Disorders" http://www.dpt.samhsa.gov/medications/index.htm
  3. "Naltrexone" http://www.dpt.samhsa.gov/medications/naltrexone.htm
  4. "Medical Treatments for Alcohol Dependence" A speech by Joseph R. Volpicelli, MD, Ph.D, 11/30/95; http://www.uphs.upenn.edu/recovery/news/medicalJournals/volpicelliJoeseph.htm
  5. "Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence. A Randomized Controlled Trial." James C Garbutt, MD, Henry R. Kranzler, MD, Stephanie S. O'Malley, Ph.D, David R. Gastfriend, MD, Helen M. Pettinati, Ph.D, Bernard L. Silverman, MD, John W. Loewy, Ph.D, Elliot W. Ehrich, MD for the Vivitrex Study Group. JAMA, April 6, 2005–Vol 293, No. 13 pp 1617-1625 http://www.doctordeluca.com/Library/AddictionMeds/EfficacyInjectableNaltrexone05.pdf
  6. "Acamprosate Calsium" (Campral®) http://www.dpt.samhsa.gov/medications/acamprosate.htm
  7. "Prescribing Medications for Alcohol Dependence" NIAAA, 2005, http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide18.htm
  8. "Campral®" http://www.fda.gov/cder/consumerinfo/druginfo/Campral.htm
  9. "Disulfiram" MedlinePlus, http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682602.html

This page was last modified on : 08/18/2008
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