This is Dr. Stuart Kloda. I am an addiction medicine physician in New York City, and I have a solo private office located at Columbus Circle.
Today, I am going to be talking about medications that are used in the treatment of alcohol dependence. One of the receptors that alcohol stimulate is the mu opioid receptor. This is the receptor that narcotic pain medications such as Percocet and Oxycontin also stimulate. When this receptor is stimulated, it causes a release of dopamine into the brain. Dopamine is a neurotransmitter that is responsible of feelings of pleasure, reward, and euphoria. Naltrexone is a medication that is a mu-opioid receptor antagonist, meaning that it blocks the receptor. It can be given daily as a pill, or it can also be given monthly as an injection. Patients that take naltrexone tend to have a decrease in cravings for alcohol. In addition, if a patient drinks while taking this medication, the patient either will not get drunk or will have a much less pleasurable effect. So, in my opinion, naltrexone can be behaviorallly reinforcing in that if the reward from drinking is not there, patients are less likely to drink. In addition, I feel that naltrexone can be helpful in that if a patient does have a lapse or relapse while taking naltrexone, this can be used as a learning experience and not as a punishment. So thoughts, feelings, and behaviors before, during and after drinking can be analyzed and broken down, and then these things can be used as a learning tool to prevent or decrease the chance of another episode of drinking.
Another receptor that alcohol affects is the GABA-A receptor. Gaba-A receptor is responsible for relief of anxiety and for sedation. There are a lot of patients that drink alcohol, in part, to relieve anxiety. So if a patient that is alcohol dependent stops drinking, the original anxiety will come back as well as alcohol withdrawal anxiety.
Topamax is a seizure is a seizure medication that actually acts, in part, as a GABA-A agonist. So it can relieve the anxiety and irritability that can occur when patients stop drinking.
Another medication, called Neurontin, also acts at the GABA-A receptor. Neurontin is a seizure medication as well. I also use Neurontin in high doses for sleep. A lot of patients with alcohol withdrawal complain of insomnia that can persist for months after their last drink. So, in addition to being sedating, patients will fall asleep because of the anti-anxiety effect and there will also be carryover of the night time dose of the medication into the daytime.
The last medication that I use is called baclofen. Baclofen is an old muscle relaxant, that is used to treat spasticity in neurological diseases. Baclofen acts as a GABA-B agonist, so it acts as a parallel agonist to GABA-A, and again, it is very helpful in relieving anxiety and irritability.
Anyhow, if you would like more information, you can take a look at my website at stuartklodamd.com or you can call and speak to me directly at 646-713-6578. Thank you.