this post was submitted on 03 Sep 2023

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YSK that there are a range of medications that can prevent alcoholics and other addicts from relapsing (quillette.com)

submitted 1 year ago by waterbogan to c/youshouldknow

25 comments fedilink hide all child comments

If you or one of your loved ones is struggling with this its worth knowing and worth asking your doctor about. Article mainly discusses generic anticonvulsants that have proven beneficial, but there are others such as Naltrexone that can also be helpful.

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[–] fubo 57 points 1 year ago (3 children)

However, there already are three FDA-approved medications for alcoholism: disulfiram, naltrexone, and acamprosate. While probably not as effective at maintaining long-term abstinence as NBACs, they still provide benefits—yet they too are grossly underutilized.

These three drugs work in completely different ways, by the way.

Disulfiram gets the patient to stop drinking alcohol by causing the body to accumulate poisonous acetaldehyde — causing drunkenness to rapidly become a hangover.

Naltrexone is used in the Sinclair method, and works by suppressing the positive feelings (psychological reward) of drinking. Notably, Sinclair method patients are instructed to take naltrexone and then drink alcohol; the lack of reward trains the brain to not think of alcohol as pleasant anymore.

Acamprosate counteracts the downregulation of GABA receptors, making it less unpleasant to go without drinking.

[–] waterbogan 18 points 1 year ago

Yes, Disulifram is the oldest of these, been around many years, and some chronic alcoholics just drink over it and power through the hangover

Naltrexone is the one I have heard most positive things about, never even heard of Acamprosate before.

Unfortunately when I was in a relationship with an alcoholic some years back Disulifiram was the only thing doctors here were even aware of.

[–] cheese_greater 2 points 1 year ago

Baclofen has also shown promise as adjuvant to naltrexone, I believe.

[–] cheese_greater 1 points 11 months ago

Hows he doing currently?

[–] weeoooweeooo 34 points 1 year ago (2 children)

My husband is currently taking naltrexone, so I just wanted to hop on here and say to anyone that is considering taking it, please be careful and do your research! It's not that the medication is bad, but you should prepare for it before you start, especially if you currently drink in high quantities. My husband went to a psychiatrist who specializes in substance use, she gave him an RX for naltrexone but didn't provide really any resources or advice about how to approach it. The first night, he decided to drink maybe half of his normal nightly amount of alcohol - he vomited multiple times, had bad chills, etc. There's also risk of seizures if you try to quit or taper down from alcohol too quickly. After that night, he decided that he would only take half his naltrexone dose at first and would taper down very slowly. Things have been going much better for the last few weeks. Also, you really need someone to help you stay accountable if you're going to try an at-home detox. In our case, we locked up all of the alcohol in our house (I keep the key). And I'm in the room with my husband while he drinks a specific amount of vodka each night. Since that first night, I don't think he's really had any significant side effects.

[–] holiday 14 points 1 year ago (1 children)

I went cold turkey and the first week felt like a nightmare. I know everyone is different so a multitude of options is very good. Props to you for being a supportive wife. My wife helped me through my addiction immensely and I'll never be able to repay her for the amount of support she gave me. I'm 2.5 years sober now and feeling great.

I try to find ways to sho my thanks to her everyday and our marriage is significantly better because of me overcoming my urge to drink.

(Used to be 8-12 beers on work nights, drink until blackout on weekends)

[–] [email protected] 15 points 1 year ago* (last edited 1 year ago) (1 children)

This isn't directed to OP of the comment I'm replying to, just piggy backing off it with my experience.

I used to drink a liter of vodka and 12 Steel reserves every day. I'm 7.5 years sober.

I did medical detox. If you are dependent on alcohol, DO NO QUIT COLD TURKEY.

It could kill you.

The truth is after quitting in order to stay sober you really really want to be sober. You need to be 100% committed. It's not easy. People can offer help but the truth is there is little they can do (but any help is good) but its really almost all on you, and you can do it if you want it bad enough... I know because I made it out and my life is better than ever for it.

Thanks for coming to my Ted talk? ❤️

[–] holiday 1 points 1 year ago

I did not see this reply until now. Just want to say keep it up man! I'm proud of you! Would also echo the medical detox if you're dependent.

[–] cheese_greater 1 points 11 months ago

Naltrexone cuts of the euphoria by blocking opioid receptors. Opioid receptors also mediate liking so you stop liking the experience because you're blocked at the time. Eventually, you stop neurochemically associating alc with pleasure and benefit. You just get the shitty impairment effects, no joy

[–] [email protected] 24 points 1 year ago (2 children)

And in the US they insist religion will cure it. My sister in law had to demand medication, she just kept getting referred to AA. Guess which one finally got her sober?

[–] waterbogan 15 points 1 year ago (1 children)

Yes, referring someone to AA if they know it will not work for them is just stupid. AA may work for some people but it cannot and should not be the only referral or treatment option - medication is going to be a better option for many. Unfortunately its much the same here

[–] lars 12 points 1 year ago (1 children)

If you don’t mind the magical thinking monotheism and 1930s pseudoscience and sexism that must never be changed, then it may work for you. Plus its success rate is a non-negative number. What’s not to like??

[–] waterbogan 4 points 1 year ago

Funnily enough all of the above does actually work for some people, but it should absolutely never be the first or only option. When peole ask me if they should use medication, therapy, or 12 step programmes I would say all of the above

[–] Zerlyna 3 points 1 year ago (1 children)

I read that AA has an 8% success rate. It didn’t work for me.

[–] [email protected] 1 points 1 year ago

Someone very close to me was an atheist alcoholic who went into AA. The mental gymnastics that went into getting around all the "higher power" stuff to somehow make the program effective was horrible to see. I wish it wouldn't get pushed as a real option for alcoholics in the US, especially for those people actively asking for help.

[–] [email protected] 6 points 1 year ago (4 children)

How do these work? As a nicotine addict, most prescriptions I get are “more nicotine”. Which is healthier and cleaner but doesn’t really help with my addiction

[–] BackOnMyBS 16 points 1 year ago (1 children)

Wellbutrin/Zyban/bupropion is FDA approved for smoking cessation. I was prescribed it for depression and found it helpful for that. At the same time, I was smoking and didn't know that it worked for smoking cessation. Shortly after starting it, I noticed that cigarettes no longer gave that calm feeling and tasted extra disgusting. I eventually stopped smoking because it wasn't enjoyable anymore and seemed pointless.

Bonus: it can make orgasms insanely intense

[–] [email protected] 8 points 1 year ago (1 children)

Opposite effect for me. Wellbutrin dulled sex and I swear it did something to my ears. They started tickling when I was on it and literally a decade later I still feel it. Maybe just in my head but it put me off.

Still addicted to nicotine too

[–] ugjka 3 points 1 year ago (1 children)

I did Wellbutrin and dermal patches combo, now 2 years nicotine free

[–] [email protected] 2 points 1 year ago

Nice! I've at least quit smoking. Every day vaper tho. Better than nothing but I'm lack discipline

[–] marcos 7 points 1 year ago (1 children)

There are drugs that cure nicotine addiction in a majority of the patients that are not composed of "more nicotine".

If the experience of several of my relatives that smoked is a rule, way too many doctors actively refuse to acknowledge and prescribe them, and believe only "willpower" based abstinence (known to fail in the vast majority of cases) is a reasonable treatment.

I have no idea why doctors do that. The reasons from the article don't really explain what I see (the article imply doctors are universally corrupt). But be aware that this problem exists, and it's possible that you have options you don't know about.

[–] dustyData 4 points 1 year ago

Doctors are human, they push their biases, worldviews and fears unto patients, often unawares. It doesn't help that virtually all societies idolize them as infallible demigods. But they're just people after all, no smarter or dumber than your average Joe.

[–] [email protected] 3 points 1 year ago (1 children)

I mean, I hate to go all Reddit on you, but read the article. It explains the whole thing.

[–] waterbogan 3 points 1 year ago

Apparently they regulate brain chemistry - from the article;

Long-term alcohol abuse causes dysregulation in brain chemistry and neural function that can last for months or even years after the initial period of detoxification. Perfectly sober patients, who are well past the detox phase, often experience crushing levels of anxiety, insomnia, irritability, depression, loss of appetite, and anhedonia (the inability to take pleasure in any aspect of life). Addiction experts now believe these post-withdrawal symptoms are a driving force behind chronic relapsing.

I'm not sure how applicable these would be for nicotine addiction however, the article mainly discusses alcohol and drug addictions