How Medication-Assisted Therapy Can Decrease Alcohol Use and Cravings

Let’s start by asking a few honest questions about your relationship with alcohol:

• Is your drinking impacting your work performance, personal relationships or your self-esteem?
• Do you feel fuzzy some days?
• Are you experiencing increased anxiety or depressive symptoms, such as excessive worry, sadness, poor sleep quality, fatigue, and less interest in your hobbies?
• Have you noticed whether your alcohol consumption impacts your libido and how you experience sex?

If any of these questions resonate, re-thinking your relationship to drinking may be a useful exercise.

Reconsidering how much, when and what you drink doesn’t necessarily translate into jumping headfirst into an AA program, or 100% abstinence, though it might down the road. Abstinence included, there are many harm reduction approaches to drinking that can help you live a healthier and more fulfilling life, free from many of the physical and mental stressors that you’re currently experiencing.

For example, psychotherapy, specifically cognitive behavioral therapy, helps individuals identify social triggers related to alcohol use and develop more insight into behaviors that lead to excessive drinking. A more mindful approach to decision making, especially around drinking, has been shown to curb potentially harmful drinking patterns.

This may include a personal meditation practice or more conscious choices aligned to our interests and life goals. For more information about the connection between developing a meditation practice and curbing alcohol use check out this study.

Psychiatric Treatment For Alcoholism

And, as I discuss in this post, combining psychiatric medications with psychotherapy and mindful choices can significantly reduce your daily drinking, binge drinking and alcohol cravings. For those curious about how psychiatric treatment can help reduce your drinking, I outline below what this treatment may entail:

1. Before pulling out the prescription pad, most psychiatric providers will want to get a clear understanding of your drinking patterns. S/he would likely ask you to keep a daily tally of what you drink and together you’d look for patterns over the course of a week or two. This exercise will help you develop insight into how much you actually drink, when you drink and what situations, if any, are associated with your heavy drinking days.
2. After that, together you would identify what motivates you to drink. In what ways does alcohol benefit you? What does it bring to your life? Together, you will likely examine what’s keeping you from drinking less. You’ll identify the tangible and intangible costs associated with your drinking, such as how much actual money you’re spending on alcohol weekly or how drinking has impacted your most prized relationships.
3. Armed with data and your readiness to experiment with change, you and your provider would likely consider medications that can help curb your alcohol cravings and/or decrease the amount of alcohol you consume in one day.
4. There are a number of psychiatric medications that can help with alcohol cravings or decrease the amount of alcohol you consume. These medications, generally speaking, also have a safe side effect profile. Here are just a few medications amongst many that you may want to consider with your provider.

What Medications Help With Alcohol Cravings?

Gabapentin: Originally indicated for neuropathic pain and epileptic seizures, this medication is frequently used to help decrease anxiety associated with alcohol withdrawal. Additionally, this medication has been found to decrease the number of heavy drinking days and the severity of alcohol-related sleep disturbances, alcohol cravings and overall discomfort related to your drinking.

Topamax: Also initially indicated for seizures and other neurological issues, this medication has been shown to significantly reduce heavy drinking days and increase the number of abstinent days. Patients taking a therapeutic dose have also been shown to experience fewer alcohol-related problems, such as blackout drinking.

Naltrexone/Vivitrol: (Note: This is one of my “go to” medications for individuals seeking to reduce cravings. Clinically I’ve had the most success with this medication in relieving individuals from the desire to binge drink.) According to the FDA and National Institute on Alcohol Abuse and Alcoholism (NIAAA), this new(er) medication can significantly reduce cravings in between drinking. Vivitrol, a monthly intermuscular injection, is the same medication as Naltrexone and a great option for those who aren’t interested in taking a daily oral medication.

Finding the right person to help

Lastly, it’s important to mention that you will benefit most from a psychiatric provider who looks at your potentially excessive drinking not in isolation, but rather as a symptom of what might be a separate mental health condition. You and your provider will want to determine if there is underlying depression, or possibly an anxiety or mood disorder that is causing you to self-medicate with alcohol.

If this is the case, I encourage you to partner with your provider in treating this condition while developing a strong harm reduction program (ideally a combination of psychotherapy, mindfulness practice and medication) to keep you safe, feeling healthy and at ease.

About the Author

Jeff Leininger is a Psychiatric Mental Health Nurse Practitioner at Well Clinic who believes that there can be better living through chemistry … sometimes: His goal is to help clients utilize psychiatric medications judiciously and safely so they can experience deeper, more connected and satisfying lives.

For more information about Jeff’s work at Well Clinic or to schedule a session, click here.