Medications for Relapse Prevention
Non-addictive medications can play an important ancillary role in a recovery treatment plan. At Kolmac we use three of these.
Antabuse
Antabuse (disulfiram) has been used to block alcohol intake for over
50 years. By interfering with an enzyme (acetaldehyde dehydrogenase)
that helps in the breakdown of alcohol in the liver, it causes a temporary
build-up of acetaldehyde. The person experiences facial flushing, a pounding
headache, and sometimes vomiting. The severity of the reaction depends
on the amount of alcohol and the dose of Antabuse, as well as variables
within each individual. A reaction can occur if alcohol is drunk for
up to three days after Antabuse is taken. The usual Antabuse dose is
250 mg daily, but 125 mg causes a less severe reaction and has less
likelihood
of a reaction to inadvertent contact, such as with topical agents containing
alcohol. Side effects are virtually non-existent at the lower dose and
allergic reactions, such as a skin rash or allergic hepatitis, are less
frequent. Allergic reactions occur within the first month, therefore
liver enzymes levels should be measured four weeks after the medication
has been started.
Although Antabuse is less controversial than when it was initially
introduced, some physicians still prefer not to prescribe it because
of concerns about its safety or doubts about its effectiveness. When
used as the sole treatment element ("Antabuse abuse"),
there is little evidence of effectiveness. When it is used, however,
as a component in a comprehensive recovery plan, many patients who
use it briefly or for an extended period of time find it highly useful
and regard it as a sobriety saver.
Campral
Campral (acamprosate) has been used since 1989 in Europe where it has been found to reduce alcohol relapses and to have no significant side effects. It was released in this country in January of 2005 and our patient’s experience with it has been positive. It appears to work by reducing preoccupation with alcohol and reducing the power of triggers that would ordinarily set off thoughts of drinking. It is believed to accomplish this by reducing the activity of glutamate – an excitatory neurotransmitter that becomes overactive when alcoholic drinking stops.
Naltrexone
Naltrexone (Revia, Vivitrex) has been used for many years to block the action of opioid drugs. More recently it has been found to be useful in reducing alcoholic relapses. Naltrexone does this by reducing both cravings for alcohol and the euphoric effect of alcohol if a person does drink it.
More Medications
Return to Essays on Treatment
|
|
