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Medical treatment involves the use of medications under the care of a physician for the treatment of alcohol dependence to ensure that the transition from active addiction to active recovery is achieved without harm or unnecessary discomfort. At its earliest stage, medical treatment deals with withdrawal. Alcohol is a drug that produces both tolerance, the need for increasing quantities to achieve desired results, and withdrawal symptoms when use is discontinued. Withdrawal symptoms for any drug are usually the opposite of the desired effects. With alcohol, a hangover can be seen as a type of mild withdrawal. For the individual suffering from alcohol dependence or addiction, the symptoms can be much, much worse and may require supervised medical care. The greatest danger in alcohol withdrawal is the potential for life-threatening seizures, accompanied by delirium. In the worst cases, physicians can utilize what is called a "taper" to help the withdrawing person through the worst of the symptoms and protect him or her from seizures.
A taper is usually accomplished by substituting a long-acting sedative-hypnotic drug, such as phenobarbital, for the alcohol. Alcohol is in the same family as such sedative drugs as barbiturates and benzodiazepines, so these can act to mediate the alcohol withdrawal symptoms. Dosages of the substitute drug are gradually reduced until there is no further danger of seizure and the patient is drug free. If it is to be effective, medical treatment for withdrawal is accomplished along with psychosocial treatment including counseling, therapy, education on the nature of addiction and recovery, and entry into abstinence and a program of recovery. As with all forms of addiction, alcohol dependence is a chronic problem with the ever present threat of relapse. Alcohol dependence is incurable in that the user can never return to non-addicted use. However, alcohol dependence can be brought into long-term, even permanent remission through abstinence from all psychoactive drugs and adoption of a program of supportive recovery, such as that found in the Alcoholics Anonymous fellowship. These may not be enough, however, and so there are medications that will reduce alcohol craving and help guard against relapse into active addiction.
At present, there are two medications that are approved for the treatment of alcoholism. These are disulfiram and naltrexone. Disulfiram reduces desire for alcohol by nullifying the desired reward payoff. It works by blocking the metabolization of an alcohol metabolite, acetaldehyde, in the liver. Acetaldehyde is particularly toxic, and its buildup causes acute discomfort for anyone who drinks alcohol while they are being maintained on disulfiram. The experience is highly unpleasant, and if it does occur, serves as a strong deterrent to drinking.
In contrast, Naltrexone has no overtly negative physiological effect. What it does is occupy certain receptor sites in the brain that are also used by alcohol-activated neurotransmitters in the process of intoxication. Originally used to block the effects of heroin for recovering opioid addicts, naltrexone was found to also reduce craving for recovering alcoholics and dramatically decrease the incidence of slips and relapses. To be effective, medications need to be used on an on-going basis usually for several months, to promote abstinence long enough for the brain of the person with alcoholism to return to normal neurochemical functions. Other post-withdrawal medications are currently in development, either to improve medication compliance or modify other neurochemical pathways, and in the future should serve as a supplement to psychosocial treatment and supported recovery. |