Drugs used in the Treatment of Alcohol Abuse/Addiction

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Drugs used in the Treatment of Alcohol
Abuse/Addiction

• Tristan Knowles

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Alcoholism Treatment

• Lots of alcoholism treatments use a combination
  of psychological means (such as CBT) in
  combination with aversion therapy aided by drugs.
• Most drugs used in treating alcoholism are aimed
  at creating adverse reaction to imbibing alcohol.
• Currently on the market, there are a limited
  number of drugs to treat alcoholism.

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Disulfiram (Antabuse)

• Under normal conditions, alcohol is broken down
  by alcohol dehydrogenase into acetaldehyde, which
  is further broken down into acetic acid by
  acetaldehyde dehydrogenase.
• Antabuse works by blocking acetaldehyde
  dehydrogenase, causing an excess build up of
  acetaldehyde.

http//www.everydayhealth.com/PublicSite/DrugsAZ/f
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http//en.wikipedia.org/wiki/ImageDisulfiram.png
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Symptoms/Effects of Antabuse

• Due to the excess build up of acetaldehyde in the
  bloodstream, patients may feel nausea, vomit,
  have headaches, chest pain, and several other
  symptoms after only five to ten minutes after
  drinking.
• There appears to be no tolerance to Antabuse
  extended use of the drug only adds to its effect
  as it is both absorbed and excreted slowly by the
  body.

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More Antabuse

• Due to its slow excretion from the body, Antabuse
  can be effective 5-7 days from the last dose.
• Therefore, patients using Antabuse to treat
  alcoholism must continually take the drug (this
  drug can be court mandated).
• Antabuse also shows some effects as a dopamine
  breakdown inhibitor, and therefore is also being
  investigated as a treatment for cocaine addiction.

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Negative Aspects of Antabuse

• Due to its interaction with the enzyme
  dopamine-beta-hydroxylase , which breaks down
  doapmine, Antabuse adverse affects when combined
  with drugs affecting the release and re-uptake of
  dopamine (Such as Ritalin, Adderall, and
  Cocaine).
• Metabolism of other drugs may be inhibited by
  Antabuse (such as Benzodiazepines, morphine, and
  barbituates).
• Extremely important to take under consideration
  when someone is undergoing other medical
  treatment along with the treatment for alcohol
  addiction.

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Naltrexone (Revia or Vivitrol)

• Naltrexone is metabolized in the liver into a
  variety of metabolites, with the 6-ß-naltrexol
  being the metabolite useful in treating
  alcoholism.
• The mechanism of action is not quite fully
  understood.
• Approved for use in the treatment of alcoholism
  in April of 2006.

http//en.wikipedia.org/wiki/Naltrexone
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Naltrexone Proposed Mechanisms of Action

• After metabolizing into the 6-ß-naltrexol, the
  metabolite is believed to act as a competetive
  antagonist at opiod receptors.
• It is because of this reaction that Naltrexone is
  believed to interact with the dopaminergic
  mesolimbic pathway, which alcohol activates,
  therby causing pleasurable feelings.

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Naltrexone Actions

• Naltrexone is aimed at reducing the psychological
  need or craving for alcohol.
• Naltrexone can be administered in a 50mg tablet
  with some nauseating side effects.
• A Naltrexone shot, administerd intr-muscularly,
  is also available.
• Naltrexone has been shown to be effective for up
  to 30 days.

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Naltrexone Safety

• Naltrexone is considered a relatively safe drug
  for the treatment of Alcoholism.
• Little drug-drug interactions have been shown and
  do not seem significant, except for Naltrexones
  interaction with opiod analgetics.
• Some patients, while on Naltrexone have been
  shown to turn away from alcohol only to pick up
  another drug.
• After treatment with naltrexone, opiod receptors
  are very sensitive and can lead patients to
  overdose on some other drug.

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Acamprosate (Campral)

• First approved by the FDA in 2004, although it
  has been approved in Europe since 1989
• Part of the reason for the delay of approval in
  the US was due to the action of Acamprosate not
  being fully understood

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Action of Acamprosate

• Alcohol inhibits the activity of receptors known
  as N-Methy-D-aspartate receptors (or NMDARs),
  causing the brain to create more NMDARs
• Absence of alcohol, or no inhibition of the
  receptor, causes these receptors to be overly
  active and cause symptoms such as delirium
  tremens (DT).
• Acamprosate is thought to reduce glutamate surges
  that excite NMDARs. This property makes
  Acamprosate useful in treating the withdrawal
  symptoms in alcoholics.
• Acamprosate has also been shown in some studies
  to act as a neuro-protectant and protect neurons
  from damage caused by alcohol withdrawal

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Other Drugs

• Benzodiazepines have also been used to treat
  alcohol withdrawal due to their interaction with
  the GABA receptor.
• Emetine can be used in combination with other
  drugs (creating a literal drug cocktail) and be
  used in aversion therapy as the cocktail will
  induce nausea and vomiting.

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Drugs Alone Are Not the Answer

• Because of the complexity of alcoholism, drugs
  alone are not effective in curing alcoholism.
• Cases must also be treated on a case by case
  basis, there is no set proven effective method
  for everyone.
• Psychological measures (CBT) in combination with
  drugs are usually employed, although sometimes
  addictions are treated without drug use.

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An Example of a Program

• Shick Shadel Hospitals program outline for
  addiction treatment