What is Medication-Assisted Alcohol Treatment?
Seeking professional treatment for alcohol addiction is imperative. Quitting alcohol without any medical intervention can lead to severe withdrawal seizures and even death. Treatment initially aims to ease the withdrawal symptoms by close monitoring and prescribing a slow taper off medications, formally known as medication-assisted therapy (MAT). Medication-Assisted Alcohol Treatment consists of a combination of medications that works to alleviate the withdrawal effects so the recovery journey can go as smoothly as possible.
Alcohol withdrawal can be excruciating, anxiety-ridden, and even life-threatening. Therefore, the combination of medication-assisted alcohol treatment and psychotherapy is known to be the most successful in the treatment of alcohol use disorder. 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).
Benefits of Medication-Assisted Alcohol Treatment
Research shows that Medication-Assisted Alcohol Treatment (MAT treatment) helps individuals modify their behavior and encourages positive lifestyle changes for long-term success. While benefits vary based on factors including dependency on opioids, alcohol, or other substances, these are some common ones:
- Reduces or eliminates cravings
- Decreases withdrawal symptoms
- Reduces the risk of relapse
- Typically eliminates the need for hospitalization
Some individuals might question whether MAT is substituting one drug for another, which is far from the case. Licensed professionals closely monitor patient use of these medications to ensure their effectiveness. Some Medication-Assisted Alcohol Treatment is used short-term with the minimum effective dose and discontinued when the physician deems it appropriate. Some patients receive MAT over an extended period of time to support their ongoing recovery.
Medication-Assisted Alcohol Treatment for Addiction
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in the piece Medication-Assisted Alcohol Treatment Medications, Counseling, and Related Conditions’, the Food and Drug Administration (FDA) has approved several different medications to treat alcohol and opioid use disorders. MAT medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. Medications used for MAT are evidence-based treatment options and do not just substitute one drug for another.
Methadone used to treat those with a confirmed diagnosis of Opioid Use Disorder can only be dispensed through a SAMHSA-certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse.
Medication-Assisted Alcohol Treatment Medications
Acamprosate, disulfiram, and naltrexone are the most common drugs used to treat alcohol use disorder. They do not provide a cure for the disorder but are most effective in people who participate in a MAT program.
- Acamprosate: Is for people in recovery, who are no longer drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consume illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days. It is offered in tablet form and taken three times a day, preferably at the same time every day. The medication’s side effects may include diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping.
- Disulfiram: Treats chronic alcoholism and is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. Offered in tablet form and taken once a day, disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol. Unpleasant side effects (nausea, headache, vomiting, chest pains, difficulty breathing) can occur as soon as ten minutes after drinking even a small amount of alcohol and can last for an hour or more.
- Naltrexone: Blocks the euphoric effects and feelings of intoxication and allows people with alcohol use disorders to reduce alcohol use and to remain motivated to continue to take the medication, stay in treatment, and avoid relapses.
Benzodiazepines as Medication-Assisted Alcohol Treatment
Long-acting benzodiazepines such as diazepam (Valium) and chlordiazepoxide (Librium) are used in the acute detoxification phase of alcoholism addiction treatment since benzodiazepines work on the same receptors in the brain as alcohol. Benzodiazepines can be administered immediately to an individual who is in danger of alcohol withdrawal and can be slowly tapered off once the individual is out of the dangerous withdrawal phase, approximately five days after their last drink. Some individuals may stay on a slow long taper of benzodiazepines, but others will often switch to a safer alternative that is FDA-approved from alcohol abuse.
Medication-Assisted Alcohol Treatment: Medically Managed Withdrawal (Detoxification)
According to the scientific piece, ‘Use of Pharmacotherapies in the Treatment of Alcohol Use Disorders and Opioid Dependence in Primary Care, published by the U.S. National Library of Medicine, medically managed withdrawal or detoxification may be a necessary first step in recovery for patients, who are physically dependent on alcohol, opioids, or sedative/hypnotics.
Medically managed withdrawal serves to palliate otherwise intolerable withdrawal symptoms and reduce the risk of serious medical consequences. Inpatient medically managed withdrawal is appropriate for patients at risk for severe withdrawal, delirium tremens, or with significant medical and psychiatric comorbidities. Institutional protocols can be developed to assist in determining inpatient versus outpatient detoxification.
Regardless of the setting, medically managed withdrawal is not by itself addiction treatment but rather a bridge to treatment. Relapse and even death from overdose are not uncommon for those patients who do not successfully transition to treatment and/or support programs to address chronic relapse to drug and/or alcohol use or abuse.
Medication-Assisted Alcohol Treatment: Pharmacotherapies in Overdose Prevention in Primary Care
Overdose prevention education and naloxone prescribing, complement the strategies employed in primary health care. Direct provision of opioid-agonist therapies gives the primary care health provider the greatest opportunity to reduce the morbidity and mortality associated with opioid use disorders in particular, but also for alcohol use disorders. However, primary care health providers have a unique opportunity to support the health and prevent mortality for patients with less clear-cut need, lack of access, or other barriers to entering formal specialty addiction treatment.
Naloxone is an opioid antagonist that acts by displacing opiates from receptor sites in the brain and reverses respiratory depression, a common cause of overdose deaths. Naloxone has not been shown to cause physical or psychological dependence or tolerance nor has it been associated with increased drug use or risky behavior.
Overdose due to opioids is typically a slow process taking place over the course of several hours during which the ability to administer naloxone and provide rescue breathing promptly is lifesaving. It is important to acknowledge that naloxone reverses only the effects of opioids. In the context of overdose-related to multiple substances including opioids, it may still be sufficient to restore adequate respiration. If administered to an individual who is unresponsive due to a medical emergency not related to opioid toxicity, naloxone will have no effect.
Medication-Assisted Alcohol Treatment Relapse Prevention
Research showed that relapse to drug and/or alcohol use after detoxification is common without additional interventions, treatment, and support. Peer support groups, behavioral counseling, and pharmacotherapy combined offer the best course for relapse prevention. For relapse prevention to alcohol use, naltrexone, acamprosate, and disulfiram have been utilized with varied results.
Disulfiram is effective in the treatment of alcohol use disorders when administered as supervised low-dose disulfiram integrated with behavioral counseling and support groups. Oral naltrexone is effective in reducing heavy drinking days as well as with highly motivated patients or patients who have medication support structures; extended-release naltrexone, in combination with counseling and peer support, reduced the level of drinking from four drinks per day at baseline to less than one drink per day within three months in a primary care setting.
Symptoms of Alcoholism
As stated by the National Institute on Alcohol Abuse and Alcoholism, these are the signs to be aware of in terms of this condition:
- Appearing intoxicated more regularly
- Appearing tired, unwell or irritable
- An inability to say no to alcohol
- Becoming secretive or dishonest
- Drinking more, or longer than one intended
- Wanting to cut down or stop drinking, or tried to, but haven’t been able to do so
- Spending a lot of time drinking, being sick or getting over the aftereffects
- Experiencing craving, a strong need, or urge to drink
- Founding that drinking, or being sick from drinking, often interferes with taking care of your home or family, job troubles or school problems
- Continuing drinking even though it was causing trouble with family or friends
- Giving up or cutting back on activities that are important or interesting to you, in order to drink
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)
- Continuing to drink even though it was making you feel depressed, anxious, or adding to another health problem, or after having had a memory blackout
- Having to drink much more than you once did to get the effect you want. Or finding that your usual number of drinks have much less effect than before
- Finding that when the effects of alcohol are wearing off, you have withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating.
Finding Medication-Assisted Alcohol Treatment
Alcohol addiction is a condition that can cause major health, social, and economic problems that should not be taken lightly. We Level Up Washington can provide you, or someone you love, Medication-Assisted Alcohol Treatment with professional and safe care. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
 WeLevelUp.com – Medication Assisted Treatment Program » Drug Alcohol Addiction Rehab (welevelup.com)
 WeLevelUp.com – Alcohol Detox » Drug Alcohol Addiction Rehab (welevelup.com)
 ‘MAT Medications, Counseling, and Related Conditions’ – Substance Abuse and Mental Health Services Administration (SAMHSA) (Samhsa.gov)
 Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed research international, 2015, 137020. – U.S. National Library of Medicine (Ncbi.nlm.nih.gov)