Two Drugs Can Help Prevent Relapse

Tue., May 16, 2000

Dr. Mitchell Hecht Knight-Ridd

Q. Are there any new drugs that help prevent an alcoholic from drinking? - Anonymous, Macon, Ga.

A. There are two drugs approved by the FDA that help prevent an alcoholic from relapsing.

The first drug, Antabuse (Disulfiram), has been around since 1948. It’s not terribly popular though. That’s because Antabuse blocks an enzyme that breaks down one of the toxic by-products (acetaldehyde) of alcohol.

If you’re being treated with Antabuse and you try to drink, the immediate build-up of acetaldehyde in your system will make you sick as a dog. The hope is that you won’t be tempted to drink while on Antabuse.

While it may be a good choice for some recovering alcoholics, it’s not for every alcoholic.

And some alcoholics fear the violent effects of Antabuse at a stage in their treatment where total and prolonged alcohol abstinence may be very difficult.

The second drug for treating alcoholism, Revia (Naltrexone), was approved by the FDA in 1995. It’s actually a drug that was originally approved for the treatment of opioid (for example, morphine, codeine, oxycodone) addiction.

Unlike Antabuse, it doesn’t cause an alcoholic to become violently ill when mixed with alcohol.

In a number of studies, alcoholics who took Revia had half as many relapses as those who received a placebo (sugar) pill.

How does it work to treat alcoholism? We’re not sure, but it somehow curbs the craving for alcohol.

Revia is not addictive or habit-forming, but does cause nausea in about 10 percent of folks.

It has a small risk of irritating the liver, so liver tests prior to starting the drug and at regular intervals thereafter are advised. Keep in mind, though, that alcoholism is toxic to the liver too.

Both Antabuse and Revia are only one part of a comprehensive treatment program that includes counseling and support systems.

Alcoholism is a disease - a chronic disease. While the disease can go into a remission state, there’s always the potential that some stressor (loss of job, death of family member or close friend, divorce) or a single drink can trigger a relapse even after a number of years.

The good news is that the longer an alcoholic remains sober, the better the prognosis.

Since a recovering alcoholic has a brain that can develop a tremendous craving for alcohol, a single drink or the use of an alcohol-based cough syrup for a cold has the potential to trigger a relapse. There’s a powerful psychological addiction to alcohol that’s perhaps even stronger than the physical addiction to alcohol. For an alcoholic, one drink can be like trying to eat just one potato chip. Once you get started,it’s hard to stop.

For more information on alcoholism, check out the NIH’s National Institute on Alcohol Abuse and Alcoholism Web site http://www.niaaa.nih.gov/.

If you’re an alcoholic or know someone who might be in need of help, contact your local chapter of Alcoholics Anonymous. For meetings of Al-Anon (for spouses and adult friends of an alcoholic) and Alateen (for children of alcoholics), call (800) 344-2666 in the United States or (800) 443-4525 in Canada.

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