Go to Top

Alcohol Addiction

Integrated Addiction Medicine & Addiction Psychotherapy
A Confidential & Discreet One-on-one Practice

by Stuart Kloda, MD

ID-10043509OUTPATIENT ALCOHOL DETOXIFICATION: Alcohol detoxification is medically supervised withdrawal. Medically supervised withdrawal is accomplished by giving a long acting drug that works on the same receptor system as alcohol. The drug is given in tapering doses down over a period of a few days to a week. The class of drugs called benzodiazepines are used for outpatient detox from alcohol. I like to use Librium, as it is a very long acting. It continues to taper itself down after the medication is stopped due to it’s long half-life. Also, alcohol and Librium are both sedatives, so caution must be used, as combining the two can result in overdose.

DO I ACTUALLY NEED DETOX?: Many patients come to their first appointment asking for detox. Frequently, after doing a history and exam with vital signs, we find that detox is not needed. Alcohol withdrawal is diagnosed for the most part by hand tremors, abnormal vital signs (elevated heart rate and elevated blood pressure), feeling generally ill, anxious, and irritable. In order to develop a withdrawal syndrome, the body needs to have a physical dependence on alcohol. With physical dependence, a characteristic withdrawal syndrome will develop as the blood alcohol level progressively goes down to zero. Physical dependence to alcohol develops when a person drinks throughout the day and evening. Many of the patients that come to see me only start drinking after work. They do not drink during the day, so they do not become physically dependent on alcohol. Isolated complaints of anxiety and irritability are not symptoms that require treatment with a Librium taper. These symptoms do require treatment with other types of medications, which do not have the risk of overdose when combining a benzodiazepine with alcohol in the event of a relapse

ALCOHOL WITHDRAWAL IS A SERIOUS MEDICAL CONDITION: Alcohol withdrawal should be taken very seriously and treated with caution. The first and most important reason for detox is to try and prevent life and limb threatening complications. Two life-threatening complications of alcohol withdrawal are grand-mal withdrawal seizures and delirium tremens (“DT’s”). Delirium tremens is alcohol withdrawal with hallucinations and unstable vital signs. Outpatient medical detox from alcohol is not safe for everyone. If you are interested in outpatient detoxification from alcohol, Dr. Kloda will assess your safety for this type of treatment. Please note that the first appointment is an evaluation only. Medications are never prescribed at the first appointment. Please also note that you must stay with a responsible adult friend or family member for the first 24 to 48 hours of your detox. That person will be administering your medication to you.

STOP OR MODERATE YOUR DRINKING: There are now a different number of medications that are available to help people reduce or stop their drinking.

GABA DRUGS: Baclofen / Neurontin / Topamax / Campral

Drugs that affect the GABA system in the brain can be very effective for the treatment of alcoholism. One of the receptors that alcohol stimulates is the GABA-A receptor. Stimulation of the GABA-A receptor is responsible for the calming and anti-anxiety effects of alcohol. Sedative medications such as Valium also stimulate the GABA-A receptor. In fact, alcohol can be thought of as liquid Valium, and Valium can be thought of as freeze dried alcohol.

BACLOFEN

So far, baclofen is the most effective GABA medication that I prescribe for alcohol addiction. I continue to be amazed by how effective this medication is for many people who identify themselves as alcoholics or heavy drinkers. Many patients who start baclofen describe a complete loss of cravings, as well as a complete indifference to alcohol. About half of the patients for whom I prescribe baclofen stop drinking completely within the first few days of starting the medication. Other patients significantly reduce their drinking to a healthier level. I have found it to be helpful for some patients who want to comfortably moderate their drinking. They control the alcohol, the alcohol does not control them.

Baclofen is actually a muscle relaxant that has been around for a long time. It works for the treatment of alcoholism in two ways. First, it treats anxiety by acting on the GABA-B receptor. Second, baclofen attenuates the brain neurotransmitter dopamine, which is responsible for the euphoric and rewarding effects of alcohol. GABA-B receptors and dopamine receptors in the reward pathway of the brain are intertwined. This gives baclofen a very unique mechanism of action, and is the reason such dramatic results can be seen when treating patients who identify as alcoholics or heavy drinkers.

Baclofen basically works by treating anxiety and emotional states of tension and stress. In my medical practice, I treat many high functioning people with stressful jobs who will not drink during the workday. However, drinking will start almost immediately when the workday is over. The alcohol (“liquid Valium”), provides relief from the anxiety, tensions, and stressors from the day. Baclofen works by treating these symptoms without the intoxication of alcohol. With this type of biological treatment for alcoholism, patients are able to stop or reduce their drinking, while feeling good at the same time.

NEURONTIN

Neurontin is a seizure medication that is also used for chronic pain, anxiety disorders, and addiction to alcohol. Neurontin can be thought of as working at the GABA-A receptor. Like all GABA drugs, Neurontin essentially works to put alcohol addiction into remission by treating anxiety and emotional states of tension and stress. So far, I have found Neurontin to be the second most effective GABA drug that I prescribe. Neurontin is prescribed as a medication to be taken three times daily, and it is also taken as an as needed medication for cravings. Neurontin can also be taken as a prophylactic dose for “high risk” situations, such as work or social functions where many people will be drinking. If being able to drink socially is the goal for treatment, some patients are able to moderate their drinking with the help of Neurontin.

TOPAMAX

Topamax is a seizure medication that is also used for weight loss, migraine headaches, and addiction to alcohol. It works at the GABA-A receptor, so it works for alcohol addiction by treating anxiety and emotional states of tension and stress. Topamax also works at glutamate receptors, which are increased in people that are alcoholic or heavy drinkers. Glutamate is a neurotransmitter that is excitatory, so an excess of glutamate contributes to feelings of anxiety and irritability. Topamax can be thought of as blocking the effects of glutamate. Topamax is taken as a nightly or twice daily dose, and a steady blood level of the medication is achieved within a few days.

CAMPRAL

Campral was specifically developed and FDA approved for the treatment of alcoholism. It acts at GABA-A and glutamate receptors. I have found Campral to be the least effective of all of the GABA drugs. This is ironic, as it is one of the few medications that was created and FDA approved specifically to treat addiction to alcohol.

NALTREXONE AND THE SINCLAIR METHOD

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. If a person drinks while taking this medication, the alcohol will have a much less pleasurable effect.

In the United States, naltrexone is prescribed as one 50mg tablet that is to be taken every day. At the same time, patients are told to completely abstain from alcohol. With the Sinclair Method, developed and widely used in Finland, naltrexone is prescribed in a different way. Patients are told to continue drinking as they normally would. At the same time, they must always take one 50mg tablet of naltrexone one hour before drinking Just as important as the one hour rule. the naltrexone must never be taken on non-drinking days. The main goal with the Sinclair Method is to achieve the process of extinction for cravings for alcohol. With extinction, when a behavior which was pleasurable and positively reinforcing, becomes less pleasurable and less positively reinforcing, the behavior gradually and naturally stops occurring. This gradual process eventually leads to less cravings and less desire for alcohol. The goal with the Sinclair Method is to eventually enable people to either stop drinking or to moderate their drinking.

I have found the Sinclair Method to be the most effective way to use naltrexone. The actress Claudia Christian used the Sinclair Method to put her alcoholism into remission. She then founded the C3 Foundation to provide education, support, and resources for use of the Sinclair Method. The C3 Foundation can be found at www.cthreefoundation.org. “One Little Pill”, a documentary movie about the Sinclair Method, and narrated by Claudia Christian, can be found at the C3 Foundation website as well.

If you would like more information about alcoholism treatment, call me directly for a phone consultation at (646) 713-6578. Thank-you.

Addiction Medicine and Addiction Therapy In A Discreet Private Practice

view video gallery...

CTA 1

A Unique Solo Private Practice

Outpatient Drug And Alcohol Addiction Treatment For Working Professionals

CTA 2

Call Now For A Free Phone Consultation: (646) 713-6578

About My Expertise About My Services

Success Stories

Recent Drug and Alcohol Addiction Treatment Success Stories

  • I started seeing Dr. Kloda for alcohol abuse six months ago. I can only say I wish I’d started seeing him sooner. He is extraordinarily thorough in assessing a diagnosis and was able to start me on a course of action that has kept me away from alcohol from the moment I went to his office. And, for me, the process has been surprisingly easy. This will likely not be the same result for everyone, but for those it works for, my goodness, it works well. I have actually not wanted alcohol since I started the treatment.

    I’ve seen comments about cost but I can only ask you to do a cost benefit analysis. The immediate savings I’ve seen from not buying alcohol combined with the longterm savings of reclaiming my health more than make up for the cost of seeing Dr. Kloda. In addition, there are the unseen future costs – court costs, hospital bills, loss of income, etc. – that are too often part of the equation with alcohol addiction. I feel like this was an investment that provide immediate and longterm returns.

    I thank Dr. Kloda every time I see him and I do it publicly here as I am truly thankful for the help he has given me. I have my life back and I owe it to him.

    Paul N, New York NY

  • Dr. Kloda is an experienced and well versed doctor. He is very empathetic with his patients and understands their needs. He has helped me a great deal with a slow Valium taper. He constantly monitors your progress. He is available by phone anytime and a great doctor.

    Chris H, New York NY

  • Dr. Kloda has been treating me with Suboxone for the past six months. My addiction to Percocet was getting worse, and I was becoming scared. I tried 12-step AA and NA meetings, but they were definitely not for me. I was eventually referred to Dr. Kloda by a co-worker, who is also a current patient of his. He came highly recommended, and I have been delighted with my treatment. Most importantly, I have found him to be extremely competent. He is also a nice guy who seems to genuinely care about me. When he says that he is available by phone seven days per week, he really means it! I have zero complaints – praises only!

    M Pryce, New York NY

  • Ok so some of the reviews are still skeptic and yes it is not cheap. But Dr Kloda is helping my wife. Her original dr who put her on the Rx drug did not know how to fix it and another Dr who had years of experience wanted to up her dose and give her more addictive drugs. Then there was the rehab places that wanted to take her out of state without her family. So that wasn’t working for us. We had serious trust issues with every Dr that we talked to.

    With lots of internet research she found Dr Kloda. After a few conversations with him she studied the Ashton method and found she wanted to go down this road.

    We find Dr Kloda to be extremely knowledgable about this method and about the chemical interactions on the various drugs that replaced her addictive drug. She has been doing well with his help and is almost done with the addictive drugs. Each session is an analyst of her well being and if she can reduce that week. Scripts are written and med boxes are filled. Outside of the sessions Dr Kloda is always available by phone for emergencies or if we have questions big or small. Other reviewers stated he only cares about the money and the TV fame. We found Dr Kloda cares a great deal about the person. He totally understands what we both are going through and is always there for my wife and I.

    Jeffrey R, Brooklyn NY

  • As much as I tried to quit cigarette smoking on my own, I had always gone back to it. It’s a horrible habit and I know it has terrible health consequences so I finally decided to get some professional help from someone who knows how to deal with all sorts of addictions from both the medical and psychological standpoint. Dr. Kloda helped me finally kick the cigarette habit; without him, I would have still being smoking myself to death. I really liked the fact that he spends a lot of time with you during his visits; I never felt rushed.

    Helen A, New York NY

  • I do not usually write many online reviews but on occasion I find a retailer or service provider that really is exceptional or is horrible enough that I feel I need to write a review.

    The reason I am writing this particular review is because Dr. Kloda is an exceptional Doctor.

    My background as an addict is extensive , and for these reasons I feel that I have a certain level of authority when if comes to Doctors and recovery. I’ve been in recovery in one form or another on and off for almost 20 years and I have been on Suboxone for about five years, I spent most of this time in recovery directed by two other doctors that prescribe Suboxone.

    Thomas V, Fulton NY

  • I was surprised to see a two star review for Dr. Kloda, so I am writing a five star review in response. Dr. Kloda was recommended to me by another patient of his, and he has been treating me for the past two years. I have found him to be extremely competent, genuinely caring, and available for questions and concerns.

    His office charges are in line with many other physicians in Manhattan, and you definitely get your money’s worth. He does not just write prescriptions. In addition to meds, He talks to you and does addiction counseling, as well as give you general advice and support.

    Joseph B, New York NY

  • As a patient, I can attest to Dr. Kloda’s expertise and practice and excellence. He is a remarkable physician. He is attentive, supportive, and is at the cutting edge of addiction medicine. He is broad minded in his approach and treats each of his patients with understanding and concern. He is extremely thorough and appreciates differences, both physiological and psychological. I found him remarkably intuitive and he means it when he says he is available by phone–and boy sometimes you need that. I found out recently that he is sometimes called on to speak to other doctors and psychiatrists about all kinds of addictive treatments and meds, including benzo’s–which so few doctors know about. I was fortunate to find him. I highly recommend him. And no, I have no affiliation with him or his practice other than as a patient.

    Jon F, Manhattan NY