Effective Over-The-Counter Treatment For Alcoholism?

Alcohol use disorder (AUD), commonly known as alcoholism, is a medical condition characterised by a pattern of heavy alcohol consumption with loss of control over drinking despite negative social, occupational or health consequences. It is a leading cause of preventable death in the United States, with over 29.5 million Americans aged 12 and above suffering from AUD in 2022. While there are various treatments for AUD, including psychotherapy, support groups, and medications, this paragraph will focus on the availability of over-the-counter (OTC) medications for alcoholism.

Naltrexone: reduces cravings and blocks the pleasurable effects of drinking alcohol

Alcoholism, or alcohol use disorder, is a chronic disease that tends to run in families. It is a serious condition that can interfere with daily life and cause problems in various areas. Treatment for alcoholism typically involves stopping drinking alcohol, which can be challenging due to the strong cravings and withdrawal symptoms associated with alcohol dependence.

Naltrexone is a medication that can aid in the treatment of alcoholism by reducing cravings and blocking the pleasurable effects of drinking alcohol. It works by blocking the parts of the brain that associate alcohol with pleasure and reward, making it easier to stop drinking. Naltrexone does not cause negative side effects like nausea or sickness if alcohol is consumed while taking it, unlike some other medications used for alcoholism, such as disulfiram (Antabuse).

Naltrexone is typically taken once a day and can be administered as a daily pill or a monthly injection. It is important to follow the instructions provided by a healthcare professional when taking this medication. While Naltrexone can help reduce cravings, it is not a cure for alcoholism. It is often used in conjunction with other treatments, such as counselling, support group meetings, and talk therapy.

It is worth noting that Naltrexone may cause some side effects, such as nausea, headache, constipation, dizziness, nervousness, insomnia, drowsiness, and pain in the arms, legs, or stomach. These side effects are typically rare, and any concerns should be discussed with a doctor. Additionally, Naltrexone should be used with caution in certain populations, such as pregnant women and those taking narcotics or opioids, as it can cause withdrawal symptoms in these cases.

In conclusion, Naltrexone is a valuable medication that can aid in the treatment of alcoholism by reducing cravings and blocking the pleasurable effects of alcohol. However, it should be used under medical supervision and as part of a comprehensive treatment plan that addresses the psychological and behavioural aspects of alcohol dependence.

Acamprosate: eases withdrawal symptoms such as insomnia, anxiety, and restlessness

While there are no over-the-counter medications for alcoholism, there are a few supplements available that can help curb alcohol cravings and manage withdrawal symptoms. Acamprosate is a commonly prescribed medication for treating alcoholism and easing withdrawal symptoms. It is one of only three medications approved by the Food and Drug Administration (FDA) for this purpose.

Acamprosate is used to help restore the brain's chemical balance after chronic alcohol exposure. It interacts with GABA signalling, which is a neurotransmitter that alcohol mimics in the brain. By inhibiting the activity of GABA, acamprosate can reduce alcohol cravings and consumption in those dependent on alcohol. It is important to note that acamprosate is not a standalone treatment and should be accompanied by counselling and social support. It is typically prescribed for a year but can be taken for shorter or longer periods.

The medication does not prevent withdrawal symptoms, but it can alleviate them. It is most effective when taken after the initial withdrawal and detox stages. Acamprosate is usually taken orally, three times a day, with or without food. However, many users find it easier to remember to take the medication if they associate it with meal times.

While acamprosate is generally well-tolerated, with mild side effects, it is important to be aware of the risks. There is a chance that acamprosate may increase the risk of self-harm or suicidal thoughts. It is important to monitor for symptoms of depression, including anxiousness, hopelessness, irritability, sleep problems, and restlessness. If any of these symptoms occur, a doctor should be consulted immediately.

Antabuse: creates unpleasant side effects when alcohol is consumed

There are several medications available to treat alcohol use disorder, also known as alcoholism. However, these medications are prescription drugs and not available over the counter.

One such medication is Antabuse, also known as Disulfiram, which changes the way the body breaks down alcohol. When alcohol is consumed while on this medication, it causes an increase in acetaldehyde, a toxic substance that causes a person to become ill. This is known as the disulfiram-alcohol reaction, which occurs within 10 to 30 minutes of alcohol consumption and typically lasts between 30 to 60 minutes. The side effects of this reaction can include nausea, vomiting, headaches, sweating, and other hangover-like symptoms. In some cases, more severe reactions such as difficulty breathing, chest pain, and increased heart rate may occur. It is important to note that these side effects can last up to 14 days after the last dose of Antabuse if alcohol is consumed.

Antabuse is not suitable for everyone, and it can be challenging to adhere to due to its association with unpleasant side effects. It is most effective for individuals who have already stopped drinking or are in the early stages of abstinence, are highly motivated to maintain recovery, and have a strong support system in place.

It is important to consult with a healthcare professional before taking any medication for alcohol use disorder, as they can provide guidance on potential side effects, interactions, and the most appropriate treatment plan for an individual's specific needs.

Topiramate: suppresses the alcohol-induced release of dopamine

While there are medications that treat alcohol use disorder, they are usually used in conjunction with talk therapy and support groups. They are not over-the-counter medications.

Topiramate is an anticonvulsant medication with multiple pharmacologic effects that inhibit neuronal activity. It is traditionally used for epilepsy but has been found to reduce heavy drinking. It is not yet approved by the FDA for treating alcohol use disorder. However, it has been hypothesized that topiramate may work by reducing dopamine release in reward-related regions of the brain when alcohol is consumed or individuals are exposed to alcohol cues.

Dopamine is a brain chemical that plays a role in pleasure and reward. Alcohol-related cues, such as visual cues like a beer bottle or a bar, can play a role in ongoing alcohol use and a return to alcohol use after a period of abstinence. Brain imaging studies show that individuals with alcohol use disorder have enhanced dopamine release and brain activation in regions involved in reward processing when exposed to alcohol-related cues.

Topiramate facilitates GABAA-mediated inhibitory impulses and antagonizes glutamate receptors. Glutamate antagonism suppresses ethanol-induced dopamine release from the nucleus accumbens, which blocks the reinforcing effects of alcohol abuse. Through these mechanisms, topiramate may decrease dopamine activity in the reward pathway with alcohol ingestion and reduce withdrawal symptoms.

A recent double-blind, placebo-controlled, randomized trial examined the efficacy of topiramate 200 mg in heavy drinkers whose treatment goal was to reduce drinking to safe levels. The trial found that topiramate treatment significantly reduced heavy drinking days and increased abstinent days compared with placebo.

Gabapentin: interacts with GABA and glutamate systems

Alcohol use disorder, also known as alcoholism, is a medical condition that occurs when drinking alcohol causes serious problems. It can be a long-term or lifelong condition and can relapse after treatment. Treatment for alcohol use disorder often involves a combination of medication and talk therapy or support groups.

Gabapentin is a lipophilic compound initially synthesized to mimic the chemical structure of gamma-aminobutyric acid (GABA) by adding a cyclohexyl to its backbone. GABA is the major neurotransmitter for fast inhibitory synaptic transmission and tonic inhibitory control, and it is present in 25-50% of all synapses. On the other hand, L-glutamic acid (glutamate) is responsible for fast excitatory neurotransmission and is present in approximately 80% of brain synapses. The balance between these two systems in the brain of a person who has been drinking heavily for a long time is disrupted. Gabapentin interacts with the GABA and glutamate systems by increasing the in vivo GABA concentration in the brain, as seen in studies involving both rodents and humans. However, the effects of gabapentin on glutamate are not yet fully understood.

Gabapentin stimulates GAD at drug concentrations of 1.0 to 2.5 mM and inhibits the GABA-catabolizing enzyme, GABA-transaminase (GABA-T), at high concentrations. It increased GABA turnover in 11 out of 12 brain regions tested, although the temporal effect varied across regions. Gabapentin neither binds to GABAA or GABAB receptors nor is it metabolized to GABA. Instead, it may affect glutamate (Glu) production and can normalize GABA and Glu tone during early abstinence from alcohol, helping to manage withdrawal symptoms and facilitating recovery.

While gabapentin has been shown to interact with the GABA and glutamate systems, it is important to note that it is primarily marketed for the treatment of seizures and neuropathic pain. Healthcare professionals sometimes prescribe it "off-label" for alcohol use disorder. Other medications used to treat alcohol use disorder include naltrexone, acamprosate (Campral), and disulfiram (Antabuse). These medications can help reduce cravings, ease withdrawal symptoms, and decrease overall alcohol consumption.

Frequently asked questions