By Dr. Ed Wilson and Dr. Mary Ellen Barnes

Naltrexone – The Anti-Craving King

Approved in 1994 by the FDA for use in the treatment of alcohol dependence, Naltrexone has a two-fold effect. In addition to eliminating cravings for alcohol, it also interferes with alcohol’s pleasurable effects. This one-two punch frequently helps alcoholics break the drinking patterns that have held them captive for years.

Because of the manner of its effectiveness, Naltrexone has also been used successfully by people wishing to moderate but not eliminate their alcohol use. While moderation isn’t politically correct in the U.S., it’s a widely accepted treatment outcome elsewhere, and is an option at the best U.S. programs.

Naltrexone is inexpensively available in tablet form to be taken daily, or in the very expensive monthly injectable form called Vivitrol™

Of course merely breaking the pattern temporarily doesn’t cure the problem permanently. As with most significant behavioral change, competent help will make long term success more likely, as well as making the process shorter, more effective, and more cost efficient.

Antabuse – The Old Aversive

Antabuse was the first medicine approved for the treatment of alcohol abuse and alcohol dependence by the F.D.A. It is an “aversive,” serving as a physical and psychological deterrent for someone trying to stop drinking. It does not reduce the person’s craving for alcohol, nor does it treat any alcohol withdrawal symptoms.

Research in Europe has shown that long-term use of Antabuse is effective in helping some people stop drinking. The longer people take Antabuse, the more effective it is, because they develop a “habit” of not drinking, while they acquire new interests and skills.

Antabuse works by interfering with the body’s usual metabolic processing of alcohol and can cause reactions that range from mild to severe, depending on how much Antabuse and how much alcohol is consumed, along with an individual’s tolerance of the drug.

If you drink while taking Antabuse, you may experience flushing, nausea, copious vomiting, sweating, thirst, throbbing headaches, respiratory difficulty, chest pain, hyperventilation, tachycardia, and distress. Severe reactions can include respiratory depression, cardiovascular collapse, myocardial infraction, acute congestive heart failure, unconsciousness, arrhythmias, convulsions, and death.

Campral – A New Contender

Campral is prescribed as a “post-abstinence” or “anti-relapse” support medication. It has no effect on cravings, withdrawal, or other early stage discomforts. It’s requires 90 days of abstinence prior to taking it.
The results of European studies seem to indicate a modest positive effect – compared to placebos with relapse prevention benefits lasting a few months. Research suggests very modest benefits from Campral in widening a person’s “window of opportunity” for making change.

Campral’s manufacturer notes that its effectiveness is directly related to participation in ongoing counseling. It seems plausible that the counseling has more effect than the drug.

What’s A Person To Do?

We are always happy to discuss medication choices with you. Our personal bias is towards Naltrexone because it has a long and effective track record. Antabuse certainly works but aversives are not usually the most effective treatment options for most people. Furthermore, you need to be very careful when using Antabuse since even hair dye has alcohol in it and that little bit of alcohol can cause you to get very ill. Campral may be of benefit to you after 90 days of sobriety, if you are still struggling with not drinking. However, many people find that after 90 days without a drink, they really don’t need any medication at all. Give us a call at 888-541-6350 and we can discuss your options with you.