Considering Naltrexone
April 15, 2011 4:00 PM Subscribe
I am attempting to curb my alcoholism, and I'm wondering if taking Naltrexone might be a good aid.
I've been a heavy drinker since I was 16, and I'm 30 now. I used to only binge drink on a roughly weekly basis - maybe a bottle of spirits over the course of an evening. Nowadays I still frequently do this, but also drink no less than a bottle of wine per day. Plus beers as I feel the need.
Needless to say, I'm an alcoholic. I've self-identified as such for the past five years or so. And it must stop, before I do any more damage to myself or seriously hurt someone I care about (or indeed anyone.)
I've been looking into a medication called Naltrexone. As I roughly understand it, Naltrexone removes the "buzz" that comes from drinking, and with it the urge. I went to a local GP to ask for a prescription, but was flatly denied and essentially told to go to an AA meeting.
Is this something I should be pursuing further? Should I see a different GP and ask again? Do any MeFites have experience with this medication?
I've been a heavy drinker since I was 16, and I'm 30 now. I used to only binge drink on a roughly weekly basis - maybe a bottle of spirits over the course of an evening. Nowadays I still frequently do this, but also drink no less than a bottle of wine per day. Plus beers as I feel the need.
Needless to say, I'm an alcoholic. I've self-identified as such for the past five years or so. And it must stop, before I do any more damage to myself or seriously hurt someone I care about (or indeed anyone.)
I've been looking into a medication called Naltrexone. As I roughly understand it, Naltrexone removes the "buzz" that comes from drinking, and with it the urge. I went to a local GP to ask for a prescription, but was flatly denied and essentially told to go to an AA meeting.
Is this something I should be pursuing further? Should I see a different GP and ask again? Do any MeFites have experience with this medication?
AA is an enormous help for many people who want to stop drinking, but if you're drinking spirits at the level you say, a medical detox might be necessary to avoid, as lalex says, the DTs.
By all means go to another doctor, but also be aware that, as well as treating the physical issues that arise from heavy drinking, if you want to stay stopped, you'll probably also need to address the psychological and emotional issues that are behind your drinking.
posted by essexjan at 4:20 PM on April 15, 2011
By all means go to another doctor, but also be aware that, as well as treating the physical issues that arise from heavy drinking, if you want to stay stopped, you'll probably also need to address the psychological and emotional issues that are behind your drinking.
posted by essexjan at 4:20 PM on April 15, 2011
If you're not into the whole AA thing, this site can be helpful (many who participate eschew AA).
posted by telstar at 4:40 PM on April 15, 2011
posted by telstar at 4:40 PM on April 15, 2011
Response by poster: For various reasons I'd rather avoid AA. I understand that part of the process involves turning one's will over to a higher power and that's not something I'm psychologically compatible with.
I do get the shakes pretty badly after heavy drinking, and a mild hallucinatory 'strobing' effect, but I don't have the impression that if I were to go cold turkey I'd be at any serious medical risk.
I believe the roots of my drinking are in anxiety and depression, and there is some family history of alcoholism. I have considered that were I to go on some kind of anti-depressant medication that might remove the major cause of my drinking. And in the long term yes, essexjan, I recognise that these issues must be addressed.
posted by chmmr at 4:46 PM on April 15, 2011
I do get the shakes pretty badly after heavy drinking, and a mild hallucinatory 'strobing' effect, but I don't have the impression that if I were to go cold turkey I'd be at any serious medical risk.
I believe the roots of my drinking are in anxiety and depression, and there is some family history of alcoholism. I have considered that were I to go on some kind of anti-depressant medication that might remove the major cause of my drinking. And in the long term yes, essexjan, I recognise that these issues must be addressed.
posted by chmmr at 4:46 PM on April 15, 2011
As lalex said, ! That was pretty rubbish of your GP if you ask me. Has anybody who has ever been told to go to an AA meeting actually gone?
You need, also as lalex said, to keep pushing until you get a proper treatment plan.
posted by tel3path at 4:47 PM on April 15, 2011
You need, also as lalex said, to keep pushing until you get a proper treatment plan.
posted by tel3path at 4:47 PM on April 15, 2011
Response by poster: thankyouforyourconsideration: I am in Melbourne, Australia.
posted by chmmr at 4:47 PM on April 15, 2011
posted by chmmr at 4:47 PM on April 15, 2011
Response by poster: The GP was one I'd never seen before, at a large clinic with a number of doctors on a rota. So we had exactly zero personal relationship, and I honestly wasn't too surprised that my request was dismissed and the advice I received wasn't particularly useful. I'll next see a GP that I have been to previously that operates an independent clinic.
The main thing I was trying to establish in that visit was simply whether the medication was available simply by asking for it, much as say sleeping meds seem to be. But that appears to not be the case.
posted by chmmr at 4:57 PM on April 15, 2011
The main thing I was trying to establish in that visit was simply whether the medication was available simply by asking for it, much as say sleeping meds seem to be. But that appears to not be the case.
posted by chmmr at 4:57 PM on April 15, 2011
Best answer: Naltrexone can be very helpful for some—which is why it is FDA approved for alcoholism treatment and is certainly worth checking out. It's not psychoactive and basically seems to reduce craving. It is not a "substitute" or maintenance drug. It shouldn't be insanely expensive—the pill form has been on the market for years now.
There's also a somewhat experimental medication (though widely prescribed for other conditions and FDA approved for years) called baclofen may also be helpful both in terms of reducing craving and treating withdrawal symptoms. It's generic, so should be cheap. Some are seeing it as a miracle cure in high doses, I certainly wouldn't go that far based on existing research, but there's enough to suspect it may help some. It's supposed to be especially effective for those who are also anxious. You can google around for more, it's been written up by a French doctor who swears by it.
Another medication that is also potentially worth checking out is Campral or acamprosate.
This is all by way of saying that there are many options now that do not involve 12 step programs and if you don't want 12 step involvement, look for the above-listed medications and also cognitive behavioral therapy or motivational enhancement therapy. Most treatments for addiction will involve not just meds but also getting a strong social support network so that you have friends and people in your life who aren't at the bar or encouraging of drinking. That can be family, can be other social activities, can be a support group, whatever: basically, you need supportive people in your life to be able to be healthy, and this is especially true when you are giving up drinking.
I co-wrote a book, Recovery Options: The Complete Guide, which might be of use. It has stuff on all the talk therapy options and my co-author actually pioneered the use of naltrexone for treating alcoholism so it is extensively covered. Acamprosate is also mentioned but not baclofen because that was before the research on that started coming out.
posted by Maias at 5:15 PM on April 15, 2011 [8 favorites]
There's also a somewhat experimental medication (though widely prescribed for other conditions and FDA approved for years) called baclofen may also be helpful both in terms of reducing craving and treating withdrawal symptoms. It's generic, so should be cheap. Some are seeing it as a miracle cure in high doses, I certainly wouldn't go that far based on existing research, but there's enough to suspect it may help some. It's supposed to be especially effective for those who are also anxious. You can google around for more, it's been written up by a French doctor who swears by it.
Another medication that is also potentially worth checking out is Campral or acamprosate.
This is all by way of saying that there are many options now that do not involve 12 step programs and if you don't want 12 step involvement, look for the above-listed medications and also cognitive behavioral therapy or motivational enhancement therapy. Most treatments for addiction will involve not just meds but also getting a strong social support network so that you have friends and people in your life who aren't at the bar or encouraging of drinking. That can be family, can be other social activities, can be a support group, whatever: basically, you need supportive people in your life to be able to be healthy, and this is especially true when you are giving up drinking.
I co-wrote a book, Recovery Options: The Complete Guide, which might be of use. It has stuff on all the talk therapy options and my co-author actually pioneered the use of naltrexone for treating alcoholism so it is extensively covered. Acamprosate is also mentioned but not baclofen because that was before the research on that started coming out.
posted by Maias at 5:15 PM on April 15, 2011 [8 favorites]
Best answer: I've worked in substance abuse and will say that no responsible practitioner should prescribe Naltrexone, Antabuse, acamprosate and the like without also making sure that their patient is in some form of treatment. Some medications can be very dangerous if drug/alcohol use continues, some folks learn to drink/use "on top" of their meds. These medications can require monitoring beyond the capacity of a GP. That said, he/she erred in their failure to refer you to a reputable treatment center and sloughing you off to AA was careless. When someone seeks professional help for substance abuse they deserve a more deliberate and thoughtful response.
If alcoholism was simply about cravings and buzz and recovery was simply a matter of eliminating those cravings and blocking the high, there would be no need to treatment programs and sober support groups of any stripe. There are huge constellations of emotional, behavioral, and relational adaptations that come with drinking almost half your life. You can't unlearn all of that in a few months and no medication can teach you how to live well without alcohol. Medications can certainly help and I'm all for them, but not without more comprehensive care.
That you suffer from anxiety and depression in my mind makes the need for treatment more acute. Alcoholism will worsen these conditions. However, in early sobriety folks usually experience a lot of emotional volatility that can be difficult parse out even for pros. Again, medications can help, but the combo of alcohol dependence, mood/anxiety issues and family history makes for a complex case beyond the scope of a GP.
Alcohol can be a damn effective coping mechanism for a good while, until it starts creating the symptoms it relieves. Take away the booze and you'll still have a lot to struggle with. Good care should attend to all of it.
Best of luck.
tl;dr....If you look long enough you'll probably find a GP who will dole out substance abuse treatment meds like sleeping pills or antibiotics. They shouldn't, but they will. You will not be well served by the ones that do.
posted by space_cookie at 5:21 PM on April 15, 2011 [6 favorites]
If alcoholism was simply about cravings and buzz and recovery was simply a matter of eliminating those cravings and blocking the high, there would be no need to treatment programs and sober support groups of any stripe. There are huge constellations of emotional, behavioral, and relational adaptations that come with drinking almost half your life. You can't unlearn all of that in a few months and no medication can teach you how to live well without alcohol. Medications can certainly help and I'm all for them, but not without more comprehensive care.
That you suffer from anxiety and depression in my mind makes the need for treatment more acute. Alcoholism will worsen these conditions. However, in early sobriety folks usually experience a lot of emotional volatility that can be difficult parse out even for pros. Again, medications can help, but the combo of alcohol dependence, mood/anxiety issues and family history makes for a complex case beyond the scope of a GP.
Alcohol can be a damn effective coping mechanism for a good while, until it starts creating the symptoms it relieves. Take away the booze and you'll still have a lot to struggle with. Good care should attend to all of it.
Best of luck.
tl;dr....If you look long enough you'll probably find a GP who will dole out substance abuse treatment meds like sleeping pills or antibiotics. They shouldn't, but they will. You will not be well served by the ones that do.
posted by space_cookie at 5:21 PM on April 15, 2011 [6 favorites]
I was in your shoes 23 years ago. Out of options, I joined AA and have not taken a drink since. The dismissive tone in this thread toward AA is pretty common these days, partly because AA does not promote itself and flies pretty much under the radar screen; I just thought I'd speak up for it because, what the heck, it works for me. I don't have to drink today. To each his own.
Having said that, the concept behind OP's initial question scares me. Adding more chemistry / pharmaceuticals to an already high regimen of alcohol strikes me as a very dangerous idea. Please get competent guidance before taking such a step. Good luck.
posted by charris5005 at 6:10 PM on April 15, 2011 [2 favorites]
Having said that, the concept behind OP's initial question scares me. Adding more chemistry / pharmaceuticals to an already high regimen of alcohol strikes me as a very dangerous idea. Please get competent guidance before taking such a step. Good luck.
posted by charris5005 at 6:10 PM on April 15, 2011 [2 favorites]
CHMMR
After drinking for more than a year at the level you mention I went cold turkey, had seizures and as a result had a heart attack. Please please please consult a doctor who has had experience with helping people detox before you undertake doing it yourself. I am a member of AA and find it helps me quite a bit, but results certainly do vary.
posted by Divine_Wino at 6:20 PM on April 15, 2011 [8 favorites]
After drinking for more than a year at the level you mention I went cold turkey, had seizures and as a result had a heart attack. Please please please consult a doctor who has had experience with helping people detox before you undertake doing it yourself. I am a member of AA and find it helps me quite a bit, but results certainly do vary.
posted by Divine_Wino at 6:20 PM on April 15, 2011 [8 favorites]
Also yes my username ha ha! Irony she is a no such a nice lady.
posted by Divine_Wino at 6:25 PM on April 15, 2011 [1 favorite]
posted by Divine_Wino at 6:25 PM on April 15, 2011 [1 favorite]
I do get the shakes pretty badly after heavy drinking, and a mild hallucinatory 'strobing' effect, but I don't have the impression that if I were to go cold turkey I'd be at any serious medical risk.
That is a mistaken impression. Death due to acute alcohol withdrawal is unfortunately common.
posted by buka at 7:50 PM on April 15, 2011 [1 favorite]
That is a mistaken impression. Death due to acute alcohol withdrawal is unfortunately common.
posted by buka at 7:50 PM on April 15, 2011 [1 favorite]
Response by poster: charris5005:
It has occurred to me that solving one substance dependency problem by getting another one may not be the best move. However, I'm not under the illusion that I'll be successful simply through effort of will. It seems to me that needing to take Naltrexone would be a step up from needing to drink. But, I'm by no means settled on the point, and I note (and appreciate) your concern.
As I do w/r/t the DTs. I drank last night, to the point of being sick but fortunately without committing any great atrocity. Today I feel ill and shaky, and I'm tempted to have a drink just to "level myself out" as I have to write an essay today, but I'm aware I shouldn't. Just the nature of the problem I guess.
I will most certainly visit a GP I've been happy with in the past, and see if I can work out a more comprehensive plan of treatment, whether including medication or not. Thank you all very much for your advice in this thread.
posted by chmmr at 8:12 PM on April 15, 2011
It has occurred to me that solving one substance dependency problem by getting another one may not be the best move. However, I'm not under the illusion that I'll be successful simply through effort of will. It seems to me that needing to take Naltrexone would be a step up from needing to drink. But, I'm by no means settled on the point, and I note (and appreciate) your concern.
As I do w/r/t the DTs. I drank last night, to the point of being sick but fortunately without committing any great atrocity. Today I feel ill and shaky, and I'm tempted to have a drink just to "level myself out" as I have to write an essay today, but I'm aware I shouldn't. Just the nature of the problem I guess.
I will most certainly visit a GP I've been happy with in the past, and see if I can work out a more comprehensive plan of treatment, whether including medication or not. Thank you all very much for your advice in this thread.
posted by chmmr at 8:12 PM on April 15, 2011
One of the things about delirium tremens, though, is that it might not start until you're already 3-7 days into withdrawal.
posted by Adventurer at 11:45 PM on April 15, 2011 [2 favorites]
posted by Adventurer at 11:45 PM on April 15, 2011 [2 favorites]
Best answer: Please, please, please check out this forum, it is devoted entirely to the use of Naltrexone via The Sinclair Method and is full of supportive and informative threads devoted to this subject. It is the most valuable internet resource I have ever found in assisting me with my own binge drinking. There are some lists of GPs there willing to prescribe Naltrexone.
In my own experience, this drug is extremely powerful and certainly helped me to regain a measure of control over my own drinking. However, like so many pharmaceutical solutions, the very fact of its efficacy can become a reason to stop taking it if you do not simultaneously make efforts to overcome the environmental and psychological contributors to your addiction.
It has changed my life and the lives of many anonymous people I have met (online) via that forum. I hope your experience is similarly positive and, if not, please don't stop trying. I had almost given up when I tried Naltrexone and now I'm SO glad I came across it.
Good luck.
posted by Weng at 12:45 AM on April 16, 2011 [1 favorite]
In my own experience, this drug is extremely powerful and certainly helped me to regain a measure of control over my own drinking. However, like so many pharmaceutical solutions, the very fact of its efficacy can become a reason to stop taking it if you do not simultaneously make efforts to overcome the environmental and psychological contributors to your addiction.
It has changed my life and the lives of many anonymous people I have met (online) via that forum. I hope your experience is similarly positive and, if not, please don't stop trying. I had almost given up when I tried Naltrexone and now I'm SO glad I came across it.
Good luck.
posted by Weng at 12:45 AM on April 16, 2011 [1 favorite]
Response by poster: That's an extremely interesting forum, Weng. It seems to contain a lot of the specific advice I've been seeking on the medication. Thank you for pointing me towards it.
posted by chmmr at 2:35 AM on April 16, 2011 [1 favorite]
posted by chmmr at 2:35 AM on April 16, 2011 [1 favorite]
Adventurer is correct. I care for detoxing alcoholics in my practice All The Time and every one is absolutely sure they will not have issues with DTs, even after they've seized repeatedly and been picked up by emergency medical services multiple times in past admissions. You may go a whole day or two feeling only mild withdrawal symptoms, but by the time you are truly in need of medical attention for those symptoms, you will not be able to have the presence of mind to call for the help you need. Please, please do not attempt this stuff without medical help.
posted by takoukla at 5:51 AM on April 16, 2011
posted by takoukla at 5:51 AM on April 16, 2011
Response by poster: Okay takoukla, I'll take your advice on that seriously. My lack of concern was based on a time about two years ago when I did manage to go cold turkey for a period of two weeks after a particularly shameful episode. I spent the initial few days feeling extremely sick and depressed, then was okay until I next relapsed. However, my regular intake has somewhat increased since then. While I have drank today, I haven't done so heavily (relatively speaking). But I will speak to a GP before attempting this for the sake of medical oversight when I make the attempt. Thank you.
posted by chmmr at 6:06 AM on April 16, 2011
posted by chmmr at 6:06 AM on April 16, 2011
Btw, naltrexone is not dangerous to use while drinking (some people use it for moderate drinking) and it is *not* "substituting one drug for another" unless by that you mean substituting a drug that produces a high with one that blocks a high!!!
Even methadone and buprenorphine—which are used in opioid treatment and can cause a high in naive/irregular users—do not simply substitute one drug for another. What people don't understand about maintenance with these drugs is that taken steadily, they produce tolerance—and therefore, no high.
The person continues to be physically dependent—AKA needing a drug to function—but not addicted. Why not addicted? Because by medical consensus definition, addiction is compulsive use despite negative consequences (read your DSM). If drug use is at a stable dose and producing positive consequences, it's not addiction.
Why not define addiction by physically needing a drug to function? Well, that makes blood pressure meds, antidepressants and some other non-fun drugs addictive— and it also makes cocaine (which doesn't cause physical withdrawal symptoms like puking) not addictive.
So, if you want to believe maintenance is just "substitution" not "recovery" you have to believe crack isn't addictive, too.
posted by Maias at 4:00 PM on April 16, 2011 [1 favorite]
Even methadone and buprenorphine—which are used in opioid treatment and can cause a high in naive/irregular users—do not simply substitute one drug for another. What people don't understand about maintenance with these drugs is that taken steadily, they produce tolerance—and therefore, no high.
The person continues to be physically dependent—AKA needing a drug to function—but not addicted. Why not addicted? Because by medical consensus definition, addiction is compulsive use despite negative consequences (read your DSM). If drug use is at a stable dose and producing positive consequences, it's not addiction.
Why not define addiction by physically needing a drug to function? Well, that makes blood pressure meds, antidepressants and some other non-fun drugs addictive— and it also makes cocaine (which doesn't cause physical withdrawal symptoms like puking) not addictive.
So, if you want to believe maintenance is just "substitution" not "recovery" you have to believe crack isn't addictive, too.
posted by Maias at 4:00 PM on April 16, 2011 [1 favorite]
This thread is closed to new comments.
I would recommend trying to find an addiction medicine specialist, as most GP's are pretty ignorant about alcoholism and addiction. If you let me know your general location I may be able to help you locate someone or at least tell you where to look.
If you plan to stop drinking abruptly please seek medical attention as it can be very dangerous. Good luck.
posted by thankyouforyourconsideration at 4:18 PM on April 15, 2011