Although the obvious treatment for alcoholism -just don’t drink the alcohol!- seems and in fact is quite simple in theory, it is by no means easy in practice for individuals with the medical illness of alcohol dependence.
The abnormal craving and mental obsession alcoholics have for alcohol causes them to return to it again and again even when their drinking has repeatedly caused terrible problems for themselves and others. Even when they finally reach the stage at which they genuinely want to stop drinking, many alcoholics find abstinence from alcohol difficult or impossible to achieve or to maintain. They may stop for a while only to resume drinking again later, usually with a recurrence of problems followed by another, often unsuccessful attempt to stop and stay stopped drinking. Mark Twain said that “It’s easy to quit smoking – I’ve done it a hundred times.” The same applies to alcoholics who stop drinking. Many, in fact most will stop drinking. But relatively few will be successful in staying stopped for a significant period of time. And length of time without a drink is very important for the alcoholic’s recovery because time is required for his psychological and physiological(biochemical) processes to begin to return to normal.
Anything that assists the alcoholic in refraining from drinking alcohol, therefore, permits his natural bodily and mental functions to reassert themselves after the deformations caused in them by his prolonged drinking. The longer he goes without a drink the more normal his system becomes. After a while most alcoholics no longer crave and never even think about alcohol – unless they drink it and commence the pathological craving and obsession all over again.
Antabuse(disulfiram) has been available for many years as an adjunct to alcoholism treatment. This medication has no effect on the desire to drink but causes severe sickness if alcohol is consumed while one is taking it. Alcoholics who take Antabuse daily know that if they drink they will get sick(vomiting), hence get a boost in the determination to stay sober. The obvious problem and the reason that Antabuse is not more generally effective than it has been is that alcoholics can simply stop taking the drug and start drinking again after a certain period of time(but not right away – Antabuse blocks drinking for quite a while after the last pill is taken). But Antabuse can provide good protection against momentary and overwhelming urges to drink in alcoholics who are otherwise very determined to stay sober.
Other medications such as Revia(naltrexone) and acamprosate do not cause sickness if alcohol is consumed while they are being taken but instead diminish the craving for alcohol and the pleasurable effects from drinking it. Scientific studies show that alcoholics in early recovery who are receiving the standard treatment for alcoholism(counseling, group therapy, AA &etc.) and who are taking these agents along with it are somewhat more successful in staying sober than those who are not. The effect, while real, is not huge. But in a disorder as devastating and difficult to treat as alcoholism, every advantage that can be gained for sobriety is worth using.
When other disorders besides alcoholism(depression, bipolar disorder, anxiety, schizophrenia &etc.) are present along with alcoholism, appropriate drug treatment of these conditions is necessary lest they interfere with the recovery from alcoholism. However, successful treatment of such associated(“dual diagnosis”) psychiatric conditions does not itself directly affect the alcoholism, which is a separate medical condition usually requiring separate medical treatment.
The links below will take you to sites which provide more information about the specific drugs that have been found useful thus far in the medical treatment of alcoholism. It is very likely that new and better drugs will be available in the near future – and that a truly effective treatment for alcoholism will become available that will make its control possible on a much wider scale than ever before.
Meanwhile, alcoholics who get and stay sober usually have to do it “the old fashioned way,” namely (1) don’t drink the alcohol(one day at a time!), and (2) go to AA meetings. Currently available drugs are seldom the total answer for the alcoholic in search of sobriety – but in at least some cases, they can be of enormous assistance.
