Why Medicines Belong in Alcohol Care
Behavioral care and AUD medicines can be used together as part of the patient's overall plan for recovery. The first step is to talk with your primary healthcare provider about treatment options, including whether to consider medications.
For example:
- Behavioral care alone, such as cognitive behavioral therapy (CBT) plus mutual support groups
- CBT plus naltrexone
- CBT plus disulfiram or acamprosate
Behavioral therapies are often used with medicines to improve treatment outcomes. Behavioral therapies include brief interventions, motivational enhancement therapy (MET), cognitive behavioral therapy, family behavior therapy, and mutual-support groups like AA or Women for Sobriety. Brief interventions help a person recognize their alcohol use problem and reduce their drinking by changing their behaviors. In motivational enhancement therapy (MET), the therapist helps motivate an individual to seek treatment.
Medicines can be used to treat alcohol use disorder along with behavioral care in a variety of settings, including:
- Outpatient - A patient visits a clinic or other outpatient setting for medical attention.
- Residential - A patient lives in a facility while receiving treatment.
- Hospital-based programs (inpatient) - A patient is admitted and treated at a hospital.
Three medicines are currently approved by the Food and Drug Administration to treat alcohol use disorder. Naltrexone, acamprosate, and disulfiram may be used alone or with behavioral treatments.
It is important to remember that these medications do not cure AUD, but they are tools to help people stop drinking or stay away from alcohol so that they can begin their recovery process. Medicines should be used only under the care and supervision of your health care provider.
Oral and Injectable Naltrexone
Oral naltrexone is taken as a tablet, and it is usually taken once daily.
Injectable naltrexone is injected by a healthcare provider into the muscle of the buttocks once a month.
Oral naltrexone is a daily tablet, while injectable naltrexone is an injection given every month. In clinical trials for both forms of naltrexone, people who took the medication were less likely to relapse than those who did not take it. The oral and injection forms work in similar ways to block opioid receptors and reduce cravings.
The two forms of naltrexone have some differences:
- Oral naltrexone can be taken with or without food.
- Injection naltrexone should only be injected into your buttocks.
Oral naltrexone can be used to help prevent alcohol relapse. To work effectively, oral naltrexone must be taken daily, which can make adherence difficult for some people.
Injectable naltrexone is injected once per month and helps prevent relapse in people who are already abstinent from alcohol.
Because extended-release naltrexone is an injection, it may be easier for some people to adhere to a medication regimen than oral forms of naltrexone. However, in clinical trials comparing long-acting injectable naltrexone with oral naltrexone, no significant differences were found between the two formulations.
Naltrexone reduces the urge to drink alcohol. It is not habit-forming. When people take naltrexone as prescribed, they have fewer cravings and feel less pleasure when they drink alcohol.
Acamprosate for Abstinence Maintenance
Unlike withdrawal medicines, acamprosate supports abstinence rather than addressing physical discomforts. Acamprosate helps people who choose to abstain from alcohol by decreasing cravings and reducing anxiety that may accompany the decision to quit drinking. Although acamprosate does not work in everyone, it can be helpful for individuals who remain motivated to stay sober.
Acamprosate is usually well tolerated. The most common side effects of acamprosate are skin rash or itching, diarrhea, and flatulence (excess gas). Less frequently reported are abdominal pain, nausea, sleep disturbances, dizziness, headaches, and changes in mood (for example, anxiety, depression, aggression).
Acamprosate can be used to maintain abstinence from alcohol by reducing cravings.
Acamprosate may help prevent relapse by restoring the balance between brain chemicals that promote alcohol drinking (glutamate) and those that reduce alcohol intake (gamma-aminobutyric acid [GABA]). This medication does not block or reverse the effects of a relapse.
Acamprosate is taken by mouth three times per day at mealtimes. Patients who are able to maintain abstinence will remain on acamprosate for as long as they choose to continue treatment.
Acamprosate may cause mild gastrointestinal side effects, including nausea, vomiting and diarrhea. These can often be reduced by taking the medication with food or after meals. If severe or persistent, these symptoms should be discussed with a prescriber.
Acamprosate is for people who have already stopped drinking but may be at risk of returning to heavy or binge drinking. Acamprosate is a pill taken three times a day while eating or drinking to help prevent relapse during abstinence from alcohol.
Acamprosate helps you maintain abstinence from alcohol.
Disulfiram and Alcohol Reaction Risks
Disulfiram does not reduce craving for alcohol. It is taken by patients who have been treated for alcoholism (usually with group or individual psychotherapy) and are trying to avoid relapse.
The following are symptoms of disulfiram-alcohol reaction:
- Nausea and vomiting
- Headache
- Sweating, flushing, throbbing headache, blurred vision, chest pain, thirst, weakness, difficulty breathing, confusion, lightheadedness
- Choking sensation
- Anxiety
In some individuals, these reactions can lead to circulatory collapse. Severe reactions include respiratory depression, convulsions, cardiopulmonary collapse, cardiac arrhythmias, hypotension (abnormally low blood pressure), death.
Do not drink alcoholic beverages or apply them to the skin during treatment with disulfiram. Alcoholic beverages include wine, beer, and even small amounts of alcohol found in sauces, vinegars, cough syrups, mouthwashes, or other over-the-counter products.
Avoid products such as paint thinners, varnishes, and aerosol sprays that may contain alcohol.
The reactions produced by the use of disulfiram with alcohol can vary considerably among patients and may range in severity from a slight flushing of the skin to severe reactions involving respiratory difficulty and cardiovascular collapse (hypotension, shock). In some cases, these effects may last 2 weeks or longer.
Disulfiram should never be given blindly, without a thorough explanation of the warning signs of disulfiram-alcohol reaction. If patient has been drinking and then decides or is persuaded to take disulfiram, he/she must be warned to wait 12 hours after the last drink in order to avoid reactions with disulfiram.
Pairing Medicine With Counseling
Counseling paired with an AUD medicine can help you stop or cut down your drinking. The counseling and the medication work together to improve your chances of being successful. Some medicines are used to prevent relapse when you have stopped drinking (for example, naltrexone).
Naltrexone works by decreasing your craving for alcohol and the "pleasure" you get when you drink it. It reduces the rewarding effects of alcohol.
Disulfiram interferes with how your body processes alcohol. Its use causes unpleasant effects when you drink alcohol, including flushing in the face and chest, dizziness, nausea, vomiting, or headache.
Motivational enhancement therapy sessions help build your confidence to manage the challenges you will face when you stop drinking. The focus is on helping you to resolve some inner conflict about whether or not you want to change and to identify what it would be like if you changed your drinking behavior. During this time, you also may work on how to reduce or eliminate some of the reasons that you drink such as stress. You may have a chance to talk with family members who support your efforts to quit.
Counseling sessions for cognitive-behavioral therapy can help you develop more effective coping skills and give you an opportunity to practice them. It also can help you deal with any additional problems that may arise during this time in your life, such as financial difficulties or marital tensions.
Behavioral treatments such as counseling are often used in combination with medications to help you stay in treatment and keep drinking at manageable levels. Behavioral therapies for alcohol use disorder include motivational interviewing, cognitive-behavioral therapy (CBT), family involvement, couples counseling, and community-based interventions.
Motivational interviewing - This approach helps you identify your ambivalence about changing or maintaining change. It helps you see both the pros and cons of drinking or not drinking. You learn how to balance those and make a decision to either quit or drink more moderately.
Cognitive-behavioral therapy (CBT) - This form of treatment teaches you ways to cope with cravings, avoid alcohol, and deal with stress. It also helps you identify your triggers and figure out what to do when you're faced with them.
Family involvement - Family members can be a major influence on whether someone with alcohol use disorder continues or stops drinking. Some couples find it helpful to work with a therapist who understands the addiction and can help them build healthy communication skills.
You may get behavioral counseling in individual sessions, in groups, or through a combination of these approaches. The number and frequency of visits depend on your situation.
Getting a Prescription in Georgia
Talking with a primary care provider in Georgia is an important first step for getting treatment for alcohol use disorder. Primary care providers can evaluate your drinking pattern, help craft a treatment plan, and assess whether medications for AUD are appropriate. They can also refer you to other resources such as mental health specialists.
Medications for alcohol use disorder (AUD) are available by prescription in Georgia. They are prescribed by doctors, psychiatrists, and other licensed health care professionals.
To obtain a prescription, talk with your doctor about medications to treat AUD and the role these medications can play as part of a complete treatment program.
Community Service Boards in Georgia can help connect individuals to behavioral health services, including medication for AUD.
Naltrexone may be taken as a pill once per day. It can also be injected every four weeks (once per month) to help people stay in treatment and reduce their risk of relapse.
Acamprosate is taken as a pill three times per day.
Insurance and Medicaid Notes for AUD Medicines
Georgia Families members choose among Amerigroup, CareSource, and Peach State Health Plan.
The medication coverage information in this guide is general information. It does not take the place of the plan's Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC). For complete details about your health care plan's specific benefits and costs, please refer to your SBC or EOC.
Under Georgia Medicaid parity rules, financial requirements and treatment limitations apply to MH/SUD benefits no more restrictive than the predominant requirements and limitations applied to M/S benefits.
The state also has a mental health parity law (HB 1013) that covers treatment limitations.
Currently Amerigroup, CareSource, and Peach State Health Plan serve as the CMOs for Georgia Families.
- The treatment limitations should not be more restrictive than those applied to other medical or surgical services.
Georgia's mental health parity law is HB1013. A member can file a complaint about mental health benefits with DCH if they think their plan is not following the law.