Behavioral treatments are the most effective way to treat alcohol dependence. Led by health professionals, these treatments are backed by studies that show they can be beneficial. The SAMHSA National Helpline is a free referral service that connects people to state services or other appropriate intake centers in their states. It is available in English and Spanish and also offers a text messaging service in English.
Those without health insurance can still access the service, as it will refer them to state-funded treatment programs. For those with health insurance, it is recommended to contact the insurer for a list of participating providers and healthcare facilities. Alcohol and drug addiction affects the whole family, and substance abuse treatment works best when family interventions are used as a first step to recovery. To help children from families affected by alcohol and drug abuse, SAMHSA offers additional resources on their website.
Medications to treat alcohol dependence have been primarily adjunctive interventions, and only three medications have been approved for this indication by the U. S. Food and Drug Administration: disulfiram, naltrexone, and acamprosate. Disulfiram has significant adverse effects and compliance difficulties with no clear evidence that it increases withdrawal rates, decreases relapse rates, or reduces cravings.
Naltrexone reduces relapse rates and cravings and increases withdrawal rates, while acamprosate reduces relapse rates and increases abstinence rates. Serotonergic and anticonvulsant agents also promise to play a greater role in the treatment of alcohol dependence. Naltrexone is an opioid receptor antagonist approved for use in the treatment of alcohol dependence along with psychosocial interventions. The recommended dose of naltrexone is 50 mg daily in a single dose, but there is mixed evidence for its long-term use.
Long-term opioid therapy for chronic pain or heroin dependence is a contraindication for naltrexone because the drug could precipitate withdrawal syndrome. Naltrexone has been shown to have dose-related hepatotoxicity, although this usually occurs at higher doses than recommended for the treatment of alcohol dependence. Disulfiram inhibits acetaldehyde dehydrogenase and has been used to treat alcohol dependence for more than 40 years, but evidence of its effectiveness is weak. An evidence report from the Agency for Health-Care Research and Quality concluded that studies using disulfiram implants show serious methodological weaknesses, and that the four placebo-controlled RCTs using oral disulfiram produce results that are mixed.
Patient compliance with oral disulfiram is low, and it is usually given at a dose of 250 mg per day with a maximum dose of 500 mg per day. Drinking alcohol after taking disulfiram causes symptoms such as palpitations, hot flashes, nausea, vomiting, and headache.
