This is Dr. Stuart Kloda, and I am an Addiction Medicine physician in New York City. I have a solo private practice located at Columbus Circle. I offer outpatient treatment of addiction in working professionals from New York, New Jersey, Connecticut, and Philadelphia. One part of my practice is the treatment of alcoholism. Outpatient medical detoxification from alcohol is not safe for everyone. There is always a risk of seizure, and/or development of hallucinations with unstable vital signs. If you are interested in outpatient detoxification from alcohol, Dr. Kloda will assess your safety for this type of treatment. Please note that you must stay with a responsible adult friend or family member for the first 24 hours of your detox. That person will be administering your medication to you.
There are now a different number of medications that are available to help people reduce or stop their drinking.
GABA drugs: Baclofen / Neurontin / Topamax
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.
Baclofen is an old muscle relaxant, and I have found it to be an extremely useful drug for the addiction to alcohol. Baclofen stimulates the GABA-B receptor. So in a way, it can be though of as acting as a parallel agonist to GABA-A receptors, with the same positive psychological effects. I have seen remarkable results with this medication when it is prescribed for the right person. In my personal experience in private practice, it has been the most effective medication I have seen in the treatment of alcoholism so far.
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 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.
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. If a person drinks while taking this medication, the alcohol will have no effect, or it will have 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.
If you would like more information about alcoholism treatment, call me directly for a phone consultation at (646) 713-6578. Thank-you.