Drugging Alcoholics in Recovery:
Is it Really a Good Idea?

The newest trend in addiction recovery is the widespread support for the use of medications in rehabilitation programs. Just in the last couple of years, government officials from President Obama and the Surgeon General on down and advocacy groups have come out strongly in support of the use of medication-assisted treatment—often referred to as MAT. Most of the focus is on the use of drugs like buprenorphine and methadone in treatment of addiction to heroin or painkillers. The truth of the matter is that drugs have been used in the treatment of those addicted to alcohol for many years.

Here’s a list of drugs currently in use and the side effects that can make use of this drug decidedly unpleasant or even life-threatening. One wonders if patients were fully informed of the risks of these drugs, would they continue on that course of treatment?

Disulfiram—This drug is brand-named Antabuse and is well-known in alcoholism treatment circles. Its first use was in the 1950s and it works by preventing the body from fully breaking down alcohol so it can be eliminated from the body. As the liver processes alcohol, it produces acetaldehyde which would normally be broken down into other substances the body can easily eliminate. When the process stops at acetaldehyde, this chemical builds up in the bloodstream, making the drinker feel very sick.

What are the effects of this build-up of acetaldehyde? A throbbing headache, shortness of breath, nausea, vomiting, dizziness, extreme tiredness, chest pain, vertigo, fainting, fast heartbeat, low blood pressure. In severe cases, the interaction of alcohol and disulfiram can cause cardiovascular collapse, acute congestive heart failure and death.

But that’s not all the symptoms a person can experience when taking disulfiram. There’s also the side effects—the “unintended” effects of the drug. These include decreased sexual ability, vision changes, muscle weakness, agitation, confusion, seizures, abdominal pain. A serious allergic reaction is also possible, including swelling of the face or throat, severe dizziness and trouble breathing. The drug can also cause serious or fatal liver disease.

Disulfiram’s only usefulness is to make a person feel sick if they drink alcohol—even if they drink small amounts inadvertently by using mouthwash or a flavoring that contains a little alcohol. The drug does nothing to ease a person’s cravings for alcohol and, of course, it does not help them enjoy a sober life.

Naltrexone—The is a short-acting drug that blocks the effects of opioids or alcohol. Naltrexone is said to reduce the pleasurable effect of drinking and helps with cravings. Patients who can’t stop themselves from drinking tend to drink less when they are on this drug. Side effects of this drug, which is also known as Vivitrol, include weakness, tiredness, insomnia, anxiety, fainting, muscle aches, impotence,

Liver damage may occur if it is taken in larger doses than recommended. Perhaps the worst effects this drug has is on a person’s mental health. Unpleasant and dangerous effects include suicidal ideation, suicide attempts, paranoia, depression and hallucinations.

Acamprosate— This drug, brand named Campral, is supposed to be given to a person who has already stopped drinking. It is supposed to be used to help people refrain from drinking but the benefits appear to be rather ambiguous. The publication Interventions for Addiction stated, “While results from European clinical trials of acamprosate support the medication’s efficacy, findings from US clinical trials are mixed” and “two US clinical trials did not confirm efficacy of acamprosate.”

Side effects of this drug include nausea, dizziness, insomnia, mood changes, thoughts of hurting yourself, depression, confusion, anxiety, suicidal ideation, swollen hands or feet,

Topiramate (brand named Topamax)—Side effects of topiramate include memory problems, difficulty concentrating, drowsiness, weight loss, diarrhea, glaucoma, confusion, dizziness, kidney stones, decreased sweating and reduced ability of the body to cool down. Suicide is also a side effect of this drug. Using topiramate for alcoholism treatment is “off label” which means the drug is not approved by the Food and Drug Administration for this purpose but doctors still prescribe it for this use. It is approved to treat epilepsy and migraines.

There are a few other off-label drugs that may be given to those in alcohol recovery, according to Darryl Inaba, Doctor of Pharmacy.

These include:

Gabapentin (brand named Neurontin): Primarily treats epilepsy and nerve pain. This drug also causes serious mental effects like depression and thoughts of suicide in some patients. 

Ondansetron (brand named Zofran): This drug alleviates vomiting resulting from chemotherapy and is being tested in treatment of alcoholism. Side effects include headache, dizziness, stomach pain, temporary loss of vision, chest pain, fainting, hallucinations, agitation.

Baclofen (brand named Lioresal): This drug is a central nervous system suppressant used to treat muscle spasticity. Side effects include retching, vomiting, confusion, dizziness, bloody urine, chest pain, fainting, hallucinations, impotence, false sense of well-being, blurred or double vision. If the drug is discontinued too rapidly, hallucinations, convulsions, multiple organ failure and death may occur.

Nalmefene (brand named Selincro): This drug is thought to reduce the amount of alcohol drunk by a person in recovery from alcoholism. It is taken at the time that there is a risk a person would start drinking. Side effects include nausea, confusion, decreased libido, dizziness, insomnia, palpitations, vomiting.

Those Addicted to Alcohol Are in a Tough Spot

Certainly, alcoholism is a dangerous problem. Excessive use of alcohol can itself be life-threatening and people subjecting themselves to the risks and side effects of these drugs may feel they have no choice.

At Narconon drug and alcohol rehabilitation centers, we have found that long-term sobriety from alcohol can be achieved without having to rely on other drugs or substances. In our fifty-year history, we have never had to give one of our clients a single drug to help them build a new sober life. (But please note that some people who have been drinking heavily for a long time may need medical support while they withdraw from alcohol before they can start a rehab program.) Perhaps our experience offers food for thought for anyone about to embark on a treatment program that includes one of these drugs.