Alcohol dependency has the power to ruin a person’s life. A reliance on alcohol can have an impact on finances, work and relationships and unfortunately, it is a problem that is not easy to overcome.
An estimated 586,000 people in the UK currently depend on alcohol, and since the substance is so cheap and widely available, there’s little wonder it’s a habit that’s so hard to kick. Unfortunately, only 18% of people living with alcohol dependency are currently in treatment. 
Treatment for alcohol dependency isn’t simple or easy. Giving alcohol up ‘cold turkey’ is physically and emotionally taxing, and can even be dangerous should severe physical withdrawal symptoms occur. Many people experience intense alcohol cravings while trying to quit and in these instances anti-craving medications can be helpful.
In this article, we’ll explain how anti-craving medications work and the role they can play in helping people to overcome their dependency on alcohol.
Controlling alcohol dependency
Only 5% of people who are dependent on alcohol are capable of returning to a controlled level of drinking without total abstinence, according to Noeline Latt in her book ‘Addiction Medicine’.  For most people, the only way is to quit alcohol completely and live a life of sobriety, but this is not an easy process and unfortunately, relapses are common.
Treatment for alcohol dependency is necessary to minimise the risk of relapse. It is rare for patients to quit alcohol completely overnight, particularly if they are being treated outside of a rehabilitation environment.
Many people find it helpful to set short-term targets, such as staying sober for a month – then two, then three, and so on – rather than face the daunting task of maintaining sobriety for the rest of their lives. There are many steps involved in overcoming alcohol dependency, and managing the initial withdrawal period is just one of them.
Strategies for beating alcohol dependency include:
– Accepting the reality of dependency rather than denying it
– Motivational interviewing to increase the desire for treatment and a better future
– Residential rehab if necessary
– Changes to key lifestyle factors such as diet, sleep schedule and exercise regime
– Use of 12-step programmes and/or support groups
– Family therapy
– Treatment of co-occurring physical health and/or mental health conditions
– Cognitive therapy, behavioural therapy, and/or holistic therapy
– Medically supervised detoxification
– Pharmacotherapies such as anti-craving medications
Value of pharmacotherapies and anti-craving medication
Medications used to treat alcohol dependency are known as pharmacotherapies. They can be used alongside other treatment programmes and coping strategies to reduce cravings, make drinking less pleasurable, or even deliver negative reinforcement in the case of one particular drug called disulfiram.
Pharmacotherapies are usually only prescribed after seven days of alcohol withdrawal. This is because withdrawal symptoms can be extreme and dangerous, and some of them are similar to side effects caused by pharmacotherapies. Doctors need to be sure which symptoms are caused by withdrawal in order to properly monitor their patients’ health.
It’s important to note that anti-craving medications should not be solely relied upon to overcome alcohol dependency, but they can help to reduce cravings in order to help patients avoid drink while they undergo therapy and other treatment methods.
Naltrexone and nalmefene
These two drugs are opioid antagonists, which mean they interrupt the normal function of the brain’s opioid receptors. Alcohol usually triggers a pleasurable feeling due to its impact on endorphins and opioid receptors, but naltrexone and nalmefene inhibit this process and reduce the amount of pleasure that alcohol brings.
The effects of naltrexone remain in the body for 24 hours, while the effects of nalmefene can last for weeks or months. This means that nalmefene can make it harder for a patient to relapse, but otherwise, the two drugs work in a very similar way.
A study into naltrexone found that a daily dose of 50mg for three months cut rates of relapse by up to 50%.  However, this was when the drug was used alongside psychological therapies to control alcohol dependency.
Naltrexone and nalmefene are usually prescribed at least seven days after initial withdrawal from alcohol. Common side effects include nausea and diarrhoea. For optimum benefits, patients should be engaging in a broad treatment regime involving therapy, detox and support groups.
It isn’t clear how the anti-craving medication acamprosate works, but experts believe it antagonises glutamate in the NMDA receptor.  Heavy drinking can cause a flawed reward system in the brain that leads to alcohol craving, and the action of acamprosate is to interrupt and therefore correct this flawed system.
Meta-analyses on acamprosate studies have proved that it can support sobriety, but there are mixed results when it comes to research into the drug. However, its side effects are mild and since it can be prescribed for up to a year after initial alcohol withdrawal, it can be a helpful medication for treating dependency.
When alcohol is consumed with disulfiram, it creates a toxic compound called acetaldehyde. This creates very unpleasant physical side effects such as:
– Hot flushes
– Low blood pressure
– Heart palpitations
Even very small amounts of alcohol, such as low levels found in foods and cough medicines, can trigger these unpleasant symptoms when a person takes disulfiram. The idea is that patients are negatively conditioned to avoid alcohol because the effects of drinking while taking the medication are so uncomfortable. It can be taken no sooner than a day after alcohol consumption, and patients cannot drink sooner than a week after stopping disulfiram.
However, it is important that patients are of sound mind and fully understand the risks involved should they drink alcohol when taking this medication. It is not suitable for people with psychosis or cognitive impairment. Patients with heart disease or hepatic disease cannot safely take disulfiram either.
Other medications that can help
There are a few other medications that are still being studied for efficacy in treating alcohol dependency or are used less commonly than those outlined above.
Topiramate is an anti-convulsant that, according to a limited number of studies, appears to be good at helping patients to avoid alcohol consumption. Potential side effects are drowsiness, loss of balance, and weight loss. The drug is therefore not suitable for people who are malnourished. More research is needed before it becomes widely used for alcohol dependency.
Ondansetron is an anti-emetic that has proven to be somewhat effective in helping males to abstain from alcohol. Much more research is required to understand how it might be a helpful tool for sobriety.
Baclofen can help to reduce withdrawal symptoms and cravings. It seems particularly helpful for patients with cirrhosis, but more studies are required to fully understand its efficacy.
SSRIs are used to treat depression and can therefore be useful for people with alcohol dependency who have also been diagnosed with depression. Alcohol dependency can be a symptom of depression, so it makes sense that in treating the depression it is possible to reduce the urge to drink. However, SSRIs should not be prescribed to people who do not have depression in an attempt to reduce their alcohol cravings.
With several different varieties of pharmacotherapies available, there’s a reasonable amount of choice for people to find medications to help them quit alcohol. Some work by reducing the enjoyment of alcohol, others reduce cravings, and some produce unpleasant side effects when taken with alcohol.
Coping with cravings is one of the hardest aspects of quitting alcohol. Pharmacotherapies can certainly reduce cravings to give patients the best chance of staying sober while they undergo a broader treatment plan.
 Noeline Latt, Katherine Conigrave, John B. Saunders, E. Jane Marshall and David Nutt, Addiction Medicine, Oxford University Press, (Oxford, 2009), p. 124.
 Latt, Addiction Medicine, 2009, p. 125.
 Latt, Addiction Medicine, p. 126.