Primary Docs Wary of Alcoholism Meds

Alcohol use disorder is the modern-day term used to identify the symptoms of alcohol abuse and alcoholism.

Experts in the field of addiction treatment recommend addressing this disorder with the help of any one of four alcoholism meds: disulfiram, acamprosate, naltrexone or topiramate.

However, the results of a study published in January 2014 in the journal Alcoholism Treatment Quarterly indicate that this recommendation is not typically acted upon by non-specialist primary physicians who treat a broad range of health problems in addition to alcohol use disorder.

What Is Alcoholism?

The alcohol use disorder diagnosis was put in effect in May 2013 by the American Psychiatric Association, an organization that has long provided the basic U.S. definitions for conditions that seriously damage mental health. A person affected by the disorder has symptoms that were once ascribed to either a destructive pattern of non-addicted alcohol abuse or a destructive pattern of alcohol addiction (alcoholism). A minimum of two of these symptoms must appear within a single year; at most, an individual can have 11 distinct symptoms of the condition. In order to help determine the extent of any given person’s alcohol-related problems, doctors use the number of symptoms present to distinguish mild, moderate and severe cases of the disorder.

Alcoholism Meds – Treatment Options

Disulfiram is marketed under the brand name Antabuse. It plays a role in alcohol use disorder treatment by interfering with the chemical/biological process normally used to eliminate alcohol, which has a poisonous effect inside the body. When a person taking disulfiram drinks alcohol, this interference produces an unnatural buildup of alcohol’s main breakdown product. In turn, the accumulation of this breakdown product produces highly unpleasant versions of symptoms such as nausea, heart palpitations and skin flushing, which together act as a strong deterrent to further alcohol consumption. Acamprosate is marketed under the brand name Campral. It plays a role in alcohol use disorder treatment by making changes in brain chemistry that lead to a reduction in the intensity of the symptoms that typically accompany alcohol withdrawal. This reduction can make it much easier for a person in recovery to abstain from drinking and maintain sobriety for longer periods of time.

Naltrexone is available in an oral form (ReVia) and a longer-acting injectable form (Vivitrol), both of which can play a role in alcohol use disorder treatment. The medication achieves its effects by reducing both the amount of pleasure gained from alcohol consumption and the severity of cravings for further alcohol intake. Topiramate (Topamax) is a seizure medication not approved by the U.S. Food and Drug Administration for the treatment of alcohol-related problems; still, doctors sometimes adapt it for this purpose. Like acamprosate, it alters the brain’s chemical mixture and can lessen the severity of alcohol withdrawal symptoms.

Non-Specialists Miss Medication Options

Current guidelines issued by the National Institute on Alcohol Abuse and Alcoholism urge all doctors to develop treatment plans for alcohol use disorder that include one of the three FDA-approved medications or (in some cases) topiramate. However, many people in the U.S. affected by alcohol use disorder are diagnosed by a primary care physician, not by a specialist trained in dealing with alcohol abuse and alcoholism. Since primary care physicians see many different types of patients and don’t focus specifically on alcohol-related issues, they may not be as knowledgeable about current treatment options as an addiction specialist.

In the study published in Alcoholism Treatment Quarterly, researchers from the Medical University of South Carolina, Charleston used an examination of 149 patients drawn from 19 primary care practices to assess how often non-specialist doctors prescribe recommended treatments for people affected by alcohol use disorder. These researchers found that slightly less than one out of every 10 people diagnosed with the disorder receives a prescription for one of the four potential medication options from a primary doctor. Non-specialist doctors most likely to prescribe one of these medications are fairly well-educated about alcohol-related issues, have few opportunities to refer patients to a specialist, have patients willing to try unfamiliar treatments, employ oral naltrexone (a relatively inexpensive medication) as a treatment, know about topiramate and/or have previously had positive results from prescribing an alcohol use disorder medication.

The authors of the study published in Alcoholism Treatment Quarterly believe that their findings could potentially prove useful for the future development of improved alcohol-related training for primary care physicians. In turn, improved training could lead to much more consistent use of recommended alcohol use disorder treatments.

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