Dr. Hernandez has provided a three part series on opioid use disorder, alcohol use disorder, and Kratom use as well as treatment options and first steps to take.
Jul 12th, 2019
Are you or a loved one struggling with abuse and dependence on substances such as opiates or alcohol?
Have you recently experienced a hard time as a result of substance abuse such as the loss of a job or difficulty managing all of your responsibilities?
Drug and alcohol addictions are such prevalent issues and yet, can often be a taboo subject to address. People are often unsympathetic and impatient and clearly don’t understand the struggles involved. Sometimes all we need is someone who understands the complexities of the issue and an open ear to listen, and an offer to help. Dr. Hernandez, a board-certified psychiatrist here at CPCH, has created a three-part series detailing helpful information of the addiction to three common substances often experienced: opiates, alcohol, and Kratom. She has artfully explained critical information regarding the origination and use of these substances as well as information on treatment and medication management for overcoming addiction to these substances.
The following information is provided by Dr. Hernandez who has significant experience treating mental health and substance abuse issues and knows the path to effective treatment. Have a look for yourself to see the ways that Opioid use can affect your life as well as your friends and family.
Pharmacological Treatments for Alcohol Use Disorder
About 15.1 millions of Americans suffer from alcohol use disorder; it is highly prevalent among all social classes and ethnic groups. Unfortunately, only about 5-6% receive treatment. The good news is that there are actually multiple options for treatment.
It is currently not recommended to drink more than 3 drinks in a day or more than 7 drinks in a week for women. For men no more than 4 drinks in a day and no more than 14 drinks in a week. A standard drink consists of 12 oz regular beer, 5 oz glass of wine or 1.5 oz of liqueur. Drinking more than this, either per day or per week, significantly increases the risk of that person having an alcohol use disorder.
There are 3 types of treatments for alcohol use disorder:
- Behavioral Treatments: therapy that helps the patient develop healthy coping skills, recognize patterns and possible triggers for drinking.
- Pharmacological treatment: medications that aim to reduce alcohol use.
- Support groups: they provide peer support and encouragement for those struggling with alcohol use. They provide a place of acceptance and understanding. There are many types of support groups, some are religious and some are secular. Alcoholics Anonymous, SMART Recovery (free online meetings), Celebrate Recovery, Women for Sobriety, Life Ring secular recovery, Secular organizations for Sobriety (SOS).
The best treatment responses are for patients, who in addition to pharmacological treatment, are also receiving therapy and have involvement with support groups.
I would like to review the medication interventions most frequently prescribed for alcohol use disorders.
Naltrexone: This medication affects the reward pathway in the brain. Naltrexone decreases the “reward” a person feels after consuming alcohol. Alcohol becomes less reinforcing and the interest in drinking decreases. Clinical studies have shown that naltrexone decreases the amount of alcohol consumed, decreasing the frequency of heavy drinking days. This medication requires liver function monitoring-checking blood work at the beginning of treatment and then every couple of months. The most common side effects are dizziness, nausea, and vomiting.
Naltrexone IM (Campral): this is an injectable long-acting form of naltrexone that lasts 30 days. It is much easier to monitor and assure compliance with the injectable than with the oral naltrexone.
Acamprosate (Campral): this medication is used to decrease alcohol cravings. Its mechanism of action is unclear. Clinical studies have shown a decrease in the number of drinking days on patients taking Campral. This medication is usually very well tolerated. The most common side effects are diarrhea and vomiting. It is not recommended for patients with problems in their kidney function.
Acamprosate + Naltrexone: this combination has also been studied and appears more effective than either medication alone in decreasing episodes of drinking and the amount of alcohol consumed.
Disulfiram (Antabuse): this is a medication that produces an unpleasant reaction when alcohol is used. It works as a deterrent to drinking. If a person taking disulfiram uses alcohol they will experience flushing, sweating, palpitations, shortness of breath, low blood pressure, nausea, and vomiting. Severe reactions can occur and would require medical treatment. This medication should only be prescribed to highly motivated individuals who have a goal of achieving abstinence. The most frequent side effects are fatigue and metallic taste. This medication requires liver function monitoring-checking blood work at the beginning of treatment and then every couple of months.
Topiramate (Topamax) and Gabapentin (Neurontin): (these two medications are not FDA approved) these agents are frequently used for the treatment of seizures, migraines and chronic pain. There are some clinical studies which have shown they also decrease heavy drinking and frequency of drinking days. Gabapentin only had a small positive effect in the studies, therefore the evidence of its effectiveness is low.
The National Institute on Alcohol Abuse and Alcoholism and Substance Abuse (NIAAA) and Mental Health Service Administration (SAMHSA) have great resources on their websites. They have treatment navigator/locator, recent publications, and many educational tools.
There are also support groups for those dealing with a loved one who is abusing alcohol-drugs.
AL-ANON, Alateen, Adult children of alcoholics, Co-dependent anonymous and Partnership for drug-free kids.
Have you been considering treatment but don’t know where to begin? Visit our blog for more information regarding these substances and the most specific and effective treatment methods for each substance. Give us a call at 919-636-5240 to set up an appointment. Let us help you get better, faster.
*Thanks for viewing our content on alcohol use disorder! Did you catch the article last week on Opioid use disorder as well? View that article here.
Andrea Hernandez, MD, is a board-certified psychiatrist at Cognitive Psychiatry of Chapel Hill, North Carolina. Fluent in both English and Spanish, Dr. Hernandez treats adult patients with mental health and substance abuse disorders.