Several therapeutic agents exploit the known pharmacology of alcohol and are approved for treating alcohol dependence. One of these, naltrexone, blocks -opioid receptors . As for opioid abuse, -opioid receptors theoretically also contribute to the euphoria and high of heavy drinking. It is therefore not surprising that a -opioid antagonist would block the enjoyment of heavy drinking and increase abstinence by its actions upon reward circuitry . This theory is supported by clinical trials, which show that naltrexone not only increases the chances of attaining complete abstinence from alcohol, but also reduces heavy drinking (defined as five or more drinks per day for a man and four or more for a woman).
Outcomes for patients with alcohol dependence who take naltrexone may be more favorable when the form of naltrexone that is administrated is given once monthly by intramuscular injection, called XR-naltrexone. This may be due to the fact that this method of drug administration forces compliance for at least a month. Monthly rather than daily drug administration may be just what the reward circuitry needs for someone with a substance-abuse problem. As discussed earlier in this chapter, patients addicted to various substances lose their ability to make rational decisions, and instead respond immediately and impulsively to the desire to seek drugs, and have vast capacity for denial of the maladaptive nature of their compulsive decisions. It is hard enough to get a patient with a substance-abuse disorder to enter treatment or take medications at all, let alone make that person decide every day not only to stay abstinent but also to take a medication. Addiction and human nature being what they are, it is not surprising that patients frequently drop out of treatment and resume substance abuse. If you drink when you take naltrexone, the opioids released do not lead to pleasure, so why bother drinking? Some patients may also of course say, why bother taking naltrexone? and relapse back into drinking alcohol. However, if you have been given an injection that lasts for a month, and have an irresistible impulse to drink, and you slip and start to drink, you are not able to discontinue your naltrexone. Thus, if you drink over your naltrexone, you may discover that you do not get the buzz or enjoyment out of intoxication, and therefore might stop after a few drinks. You might even become abstinent for several days again.

camprosate is a derivative of the amino acid taurine and interacts with both the glutamate system, to inhibit it, and with the GABA system, to enhance it, a bit like a form of artificial alcohol (compare Figure 14-15 with Figure 14-17). Thus, when alcohol is taken chronically and then withdrawn, the adaptive changes that it causes in both the glutamate system and the GABA system create a state of glutamate overexcitement and even excitotoxicity as well as GABA deficiency. Too much glutamate can cause neuronal damage, as discussed in Chapter 13 and illustrated in Figures 13-28 and 13-29. To the extent that acamprosate can substitute for alcohol in patients during withdrawal, the actions of acamprosate mitigate the glutamate hyperactivity and the GABA deficiency (Figure 14-17). This occurs because acamprosate appears to have direct blocking actions on certain glutamate receptors, particularly mGlu receptors (specifically mGluR5 and perhaps mGluR2). One way or another, acamprosate apparently reduces the glutamate release associated with alcohol withdrawal. Actions, if any, at NMDA receptors may be indirect, as are actions at GABA systems, both of which may be secondary downstream effects from acamprosates actions on mGlu recepton.

Disulfiram is the classic drug for treating alcoholism. It is an irreversible inhibitor of aldehyde dehydrogenase and, when alcohol is ingested, results in the build-up of toxic levels of acetaldehyde. This creates an aversive experience with flushing, nausea, vomiting, and hypotension, hopefully conditioning the patient to a negative rather than positive response to drinking. Obviously, compliance is a problem with this agent, and its aversive reactions are occasionally dangerous.
Experimental agents that show some promise in treating alcohol dependence include the anticonvulsant topiramate, the 5HT3 antagonists New opioid antagonists such as nalmefene (Selinco) are also in late-stage clinical testing. The subject of how to treat alcohol abuse and dependence is obviously complex, and the psychopharmacological treatments are most effective when integrated with structured therapies such as 12-step programs, a topic which is beyond the scope of this text. Hopefully, clinicians will learn how to better leverage the various treatments for alcoholism that are available today, and determine whether they can be used to treat this devastating illness to attain far better outcomes than are available when no treatment is provided, accepted, or sustained.

Hello nick209,

I cannot tell you what to do but personally I would not go down the route you have mentioned.

By the time that I stopped drinking I was a hopeless alcoholic and believed that I would be locked up or dead within a short time. However, I have a great freedom today and alcohol doesnt bother me in any way. I went to meetings but more importantly, I got a sponsor who knew about the Twelve Steps and that is where I continue to find the answers and a permanent solution.

You are fighting a gruelling battle with alcoholism but that is a battle that you probably will never win. It was only when I stopped fighting and admitted defeat that I could find the solution.

I'm not a fan of chemical treatments when there are non chemical solutions. I would treat obesity, for example with a better dote, exercise and therapy. Similarly with addiction to booze or other drugs.
Why swap one set of chemicals for another with side effects that can be harmful?
More importantly for me I love sober life. I like my life today and live what it entails. I love the work and the rewards. So no, no quick "fix" for me...

I did not take Naltrexone but from what I have read, it is an effective treatment for addiction. If I tried quitting multiple times and was unable I would take it in a heartbeat. I would also get into good counseling -- Naltrexone will knock down the physical cravings and desire to drink, but you need to make sure you treat the whole person and get into the "why" behind the drinking as well.

I am cautious about taking drugs -- but this is one that has been proven to help you deal with a deadly condition. Let us know how it goes.

The last paragraph i my post is important. It is recommended that additional therapies be integrated with the drug. This could be AA or Life-Ring, a therapist, etc,
I use mindful meditation and I go to Dharma class once a week. You can substitute a good therapist for the Dharma class.

I was on camprell for a short time and it helped me alot. Took away my cravings for alcohol It's a prescription medication you take 3 times a day, so of course, you will have to ask your doctor.

Good Luck!

I took it. I took Antabuse . I went to therapists. I drank milk to try not to drink, I drank a glass of water every other beer, I drank wine, I drank less more concentrated beers , I drank lite, I drank dark, I drank sake I drank malt bevgs. Thing is I'm an alcoholic. I drink to obliviate life. I had such a bad habit at the last I was drinking in the hospital parking lot.
The only thing that could get me to 23 months is the ability to know that not drinking was better than drinking. I had to learn how to live and process life's events. I only could do this by being taught. I go to a couple of mtgs a week. Talk about and deal with my illness. Admit I'm an alcoholic and move on

You can too. I wanted the magic bullet. I tried anything ... Hel I would even eat a stick of butter before going out. Talk about f..ing crazy. I was certifiable.
1is2 many

If you are addicted to alcohol and really want to recover, then you have to get immediate help from drug rehab center. Alcohol is one of the most difficult and unhealthy for physical and mental processes. It is dangerous in its determination and must be carefully rooted out of your life. This needs to be cured and recover from it. Drug rehab treatment also offers to abuse people to overcome from addiction of alcohol. You have to motivate yourself and need family supports to keep going.

Check out topamax too. New studies are promising..

I just want to share my experience. I think the treatment is finally available.
The Esperal implant for alcohol addiction works for almost 5 years. I had it implanted in Philadelphia PA and it works great. If someone interested in this - let me know and I'll send you more info.

Hey GSManagement, I remember you and yes we met at his waiting room. This guy is a magician in this field. Not only he implanted an Esperal in my body, but he also treated me with acupuncture and hypnosis. I agree - he is the best. I think you still have my phone number. Give me a call and let's go for a couple Coca-Cola drinks.

I tried Naltrexone a few times (daily pill form). It helped a little...and in the end not enough to warrant the cost ($6/pill). I saw a documentary the other night about "Evidence Based" Alcohol therapies. Turns out Naltrexone for alcoholism only works well in people who have a particular gene, which only 25% of the drinking population have. There is a test to see if you have it -- so talk to you doctor (an addictions specialist would be even better). Good luck.

Esperal is completely different . According to the clinical studies, It works for 97% of people. Check for ESPERAL on youtube. I don't know and I don't want to push, but for me it was a life changer.

Nature zone comes in pill form. I used it for the first year. I avoid surgery at all costs, even though I have had to have about 5 through my life and I'M only 45! The oral Naltrexone would be a much safer option IMHO. Sly

Auto correct pisses me off! Not nature zone, Naltrexone. Lol