My 34-year-old son is an alcoholic and has been in rehab for five months, court-ordered. After being out for only two weeks, he had a relapse and then went to detox. Now, he is taking Antabuse. How does it work, what are the side effects and what are some other treatment options?
M.S., Lakewood, CO
Answer: Antabuse (disulfiram) was the first prescription pill used for alcoholism and it’s been sold in the United States since 1948. Antabuse won’t curb the intense craving, but it will make your son think twice about having a drink. If he drinks with Antabuse on board, he will experience severe and copious vomiting – the unpleasant goal of the drug. Fight fire with fire, so to speak. It works by causing your body to accumulate a toxic by-product of alcohol called acetaldehyde (yes, the same substance that causes hangovers) and the buildup causes the negative reaction. Antabuse is only for people who really want to stop drinking, who fully understand the consequences of a sip.
Prescription antidepressants may also reduce alcohol cravings, for example Buspar (buspirone). Be careful though, because the SSRI class of antidepressants (Prozac, Paxil, Zoloft, etc) can interact dangerously with alcohol, so please let a physician who specializes in addiction and rehab prescribe the right antidepressant for you.
Naltrexone is another prescription medication that can be taken once daily in pill form (ReVia) or once a month as a shot (Vivitrol). No one really understands how naltrexone works, but it tells the brain that you don’t want alcohol anymore, thereby cutting the craving. It doesn’t ease withdrawal reactions and side effects include nausea, vomiting, fatigue, headache and dizziness. Because it can damage the liver (but no worse than alcohol!), it should be approached with caution and careful monitoring of liver function. People who take opiate pain relievers (like hydrocodone, propoxyphene, oxycodone, tramadol, etc.) should not take ReVia or Vivitrol because it could spiral them into severe detox symptoms.
The newest anti-drinking pill is Campral (acamprosate). It attacks the craving and helps prevent relapses by making your brain produce two natural substances called glutamate and GABA. In fact, when you take GABA as a dietary supplement, it relieves anxiety and helps one sleep. GABA is also the same chemical dumped out of the brain when you take prescription sleep aids and sedatives like Valium (diazepam) or Ambien (zolpidem). In alcoholism, it could be that Campral helps your brain ‘relax’ so you have fewer urges to drink.
Here’s some simple sage advice from a recovered alcoholic who told me: No one quits until they are ready! So face up to the fact that you NEED a helping hand from family members, a sponsor or counselor. Give Alcoholics Anonymous a try, and another try, and perhaps another until you are ready. This organization has successfully helped millions on their path to recovery. Go towww.aa.org or call (212) 870-3400.