One of the receptors that alcohol stimulates is the mu-opioid receptor. This is the same receptor that is stimulated by narcotic pain medications such as Percocet and Vicodin. Activating this receptor causes a release of dopamine in the brain. Dopamine is a neurotransmitter that is responsible for 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 taken daily in pill form, or it can be given as a monthly injection that lasts up to one month. Alcoholics that take naltrexone tend to have a decrease in cravings for alcohol. In addition, if a person drinks while taking this medication, the alcohol will have no effect, or a much less pleasurable effect. So, naltrexone can be behaviorally reinforcing in that if the reward from drinking is not there, people are less likely to drink. In addition, if a person does have a lapse or a relapse while taking naltrexone, it can be used as a learning experience, and not as a punishment. Thoughts, feelings, and behaviors before, during, and after an episode of drinking can be analyzed and broken down. These things can then be used as a learning tool to prevent or decrease the chance of another episode of drinking.
GABA drugs: Topamax / Neurontin / Baclofen -
Drugs that affect the GABA system in the brain can be very effective for the treatment of alcohol abuse. Another receptor that alcohol affects is the GABA-A receptor. Stimulating this receptor causes relief of anxiety, and a general sense of relaxation. There are many people that drink alcohol, in part, to relieve symptoms of anxiety. I also see a number of working professionals that are unable to control their drinking that starts after work. They describe an inability to relax after the stresses of the workday. However, instead of just having one or two drinks, every evening is an experience of uncontrollable compulsions to drink more alcohol. If a person that is addicted to alcohol stops drinking, their original anxiety will manifest itself, along with alcohol withdrawal anxiety. If the anxiety and irritability are treated in this group of people, it can be very effective as an alcohol abuse treatment.
Topamax is a seizure medication that acts, in part, by stimulating the GABA-A receptor. It can relieve anxiety and irritability, and can be a very good alcohol treatment option. Topamax is taken as a nightly or twice daily dose, and a steady level of medication builds up in the bloodstream. Topamax also modulates glutamate receptors. These receptors are increased in people addicted to alcohol. Glutamate receptors are responsible for irritability and dysphoria. Topamax can be thought of as blocking the effects of glutamate as well.
Neurontin acts as a GABA-A analogue. This means that it causes the same effects of GABA-A stimulation. Neurontin is a seizure medication as well. It can be used with scheduled dosing, or it can be used as needed for alcohol cravings. It can be a very effective medication in the treatment for alcoholics. Some patients find it to be effective for end of the workday cravings, or to prevent cravings before attending a social function.
Baclofen is an old muscle relaxant, and it has been found to be useful as an alcoholic treatment. Baclofen stimulates the GABA-B receptor, so it acts as a parallel agonist to GABA-A receptors, with the same effects. I have seen remarkable results with this medication when it is prescribed for the right person. Patients will literally tell me, “If I take the baclofen I don’t drink, if I do not take it, I drink”. The results can be remarkably very black and white in nature.
If you would like more information about alcoholism treatment, call me directly for a phone consultation at (646) 713-6578. Thank-you.