15.3 Alcohol Use Disorder Drugs

Alcohol use disorder is a complex condition affecting brain chemistry and behavior. Chronic alcohol exposure leads to neurotransmitter imbalances, tolerance, and dependence, causing physical and psychological symptoms that can be challenging to overcome.

Treatment for alcohol addiction involves medications like disulfiram, naltrexone, and acamprosate. These drugs work by discouraging alcohol use, reducing cravings, and modulating neurotransmitters. Combining pharmacological approaches with behavioral therapies and support systems offers the best chance for recovery.

Alcohol Use Disorder

Biological mechanisms of alcohol addiction

Top images from around the web for Biological mechanisms of alcohol addiction

• 

  Frontiers | Gut-brain peptides in corticostriatal-limbic circuitry and alcohol use disorders ... View original

  Is this image relevant?

• 

  Frontiers | Alcohol Intoxication and Cognition: Implications on Mechanisms and Therapeutic ... View original

  Is this image relevant?

• 

  Frontiers | The Biology and Pathobiology of Glutamatergic, Cholinergic, and Dopaminergic ... View original

  Is this image relevant?

• 

  Frontiers | Gut-brain peptides in corticostriatal-limbic circuitry and alcohol use disorders ... View original

  Is this image relevant?

• 

  Frontiers | Alcohol Intoxication and Cognition: Implications on Mechanisms and Therapeutic ... View original

  Is this image relevant?

1 of 3

Top images from around the web for Biological mechanisms of alcohol addiction

• 

  Frontiers | Gut-brain peptides in corticostriatal-limbic circuitry and alcohol use disorders ... View original

  Is this image relevant?

• 

  Frontiers | Alcohol Intoxication and Cognition: Implications on Mechanisms and Therapeutic ... View original

  Is this image relevant?

• 

  Frontiers | The Biology and Pathobiology of Glutamatergic, Cholinergic, and Dopaminergic ... View original

  Is this image relevant?

• 

  Frontiers | Gut-brain peptides in corticostriatal-limbic circuitry and alcohol use disorders ... View original

  Is this image relevant?

• 

  Frontiers | Alcohol Intoxication and Cognition: Implications on Mechanisms and Therapeutic ... View original

  Is this image relevant?

1 of 3

• Neurotransmitter imbalances lead to changes in brain function
  • Increased dopamine release in the reward pathway reinforces alcohol-seeking behavior (nucleus accumbens)
  • Decreased GABA activity reduces inhibition and increases impulsivity (prefrontal cortex)
  • Increased glutamate activity contributes to alcohol withdrawal symptoms (hyperexcitability)
• Neuroadaptations occur with chronic alcohol exposure
  • Brain structure and function are altered, leading to tolerance and dependence
    • Tolerance develops, requiring higher doses to achieve desired effects
    • Dependence occurs, causing withdrawal symptoms when alcohol use is stopped (tremors, seizures)

Signs and symptoms of alcohol addiction

• Behavioral changes indicate problematic alcohol use
  • Drinking larger amounts or for longer than intended (binge drinking)
  • Unsuccessful attempts to cut down or control alcohol use despite negative consequences
  • Neglecting responsibilities due to alcohol use (work, school, relationships)
• Physical symptoms reveal the body's adaptation to alcohol
  • Tolerance necessitates increased amounts of alcohol to achieve desired effects
  • Withdrawal occurs when alcohol use is stopped, causing tremors, sweating, nausea, and anxiety
• Psychological symptoms reflect the mental impact of addiction
  • Craving or strong desire to drink alcohol persists despite adverse outcomes
  • Continued alcohol use despite negative consequences (legal issues, health problems)

Pharmacology of alcohol addiction treatments

• Disulfiram discourages alcohol use through aversive therapy
  • Inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation and unpleasant symptoms when alcohol is consumed (flushing, nausea, headache)
• Naltrexone reduces craving and relapse risk by targeting opioid receptors
  • Opioid receptor antagonist blocks the rewarding effects of alcohol (mu-opioid receptors)
• Acamprosate helps maintain abstinence by modulating neurotransmitter activity
  • Modulates GABA and glutamate activity to reduce alcohol withdrawal symptoms and promote abstinence (NMDA receptors)

Side effects of addiction medications

• Disulfiram may cause adverse reactions
  • Headache, drowsiness, metallic taste, skin rash are common side effects
  • Interactions with alcohol, metronidazole, and warfarin require caution
• Naltrexone may lead to gastrointestinal distress
  • Nausea, vomiting, dizziness, headache are potential side effects
  • Interactions with opioids and thioridazine should be avoided
• Acamprosate has a relatively mild side effect profile
  • Diarrhea, nausea, abdominal pain may occur
  • Minimal drug interactions make it a safer choice for some patients

Nursing considerations for addiction treatments

• Assess for contraindications and precautions before administering medications
  • Pregnancy, liver disease, kidney disease may preclude certain treatments
• Monitor for side effects and adverse reactions during therapy
  • Provide supportive care and symptom management as needed
• Encourage adherence to medication regimen for optimal outcomes
  • Educate on the importance of consistent use and proper administration
• Promote lifestyle changes and support systems to enhance recovery
  • Refer to counseling and support groups for comprehensive care

Patient education for addiction medications

• Explain the purpose and mechanism of action of the prescribed medication
  • Disulfiram: Discourages alcohol use through aversive effects
  • Naltrexone: Reduces craving and relapse risk by blocking rewarding effects
  • Acamprosate: Helps maintain abstinence by modulating neurotransmitter activity
• Discuss potential side effects and how to manage them
  • Provide strategies for coping with common adverse reactions (rest, hydration)
• Emphasize the importance of avoiding alcohol while taking the medication
  • Highlight the risks of combining alcohol with addiction treatments (disulfiram reaction)
• Provide instructions on proper dosing and administration
  • Ensure patient understanding of medication schedule and any special instructions
• Encourage open communication with healthcare providers about treatment progress and concerns
  • Regularly assess patient response to therapy and adjust as needed
• Offer resources for additional support, such as counseling and support groups
  • Recognize the value of comprehensive care in addiction recovery

Effectiveness of pharmacological approaches

• Disulfiram is most effective in highly motivated individuals
  • Requires close monitoring due to potential adverse reactions (hepatotoxicity)
• Naltrexone reduces craving and relapse risk, particularly when combined with behavioral therapies
  • Cognitive-behavioral therapy (CBT) and motivational interviewing enhance outcomes
• Acamprosate helps maintain abstinence and reduce withdrawal symptoms
  • Most effective when initiated early in the treatment process (first 7 days of abstinence)
• Combination therapy using multiple medications with different mechanisms of action may improve treatment outcomes
  • Tailoring medication choice to individual patient needs and characteristics is crucial (genetics, comorbidities)

Comprehensive Approach to Alcohol Use Disorder Treatment

• Detoxification is often the first step in treating severe cases of alcoholism
  • Medically supervised withdrawal management to ensure safety and comfort
• Abstinence is the primary goal of alcohol use disorder treatment
  • Complete cessation of alcohol consumption to prevent further health complications
• Relapse prevention strategies are crucial for long-term recovery
  • Identifying triggers, developing coping skills, and ongoing support to maintain sobriety