Are there any medications that can really help an alcoholic kick the habit?

[Snow Pea]

My brother has finally admitted he has a serious drinking problem and wants to quit, but after 25 years of heavy drinking, he is despondent and scared about the idea of quitting. He will NOT go to AA, first because he lives in a VERY small town and is scared of meeting people he knows. Also because he does not believe in any kind of god or superior being or whatever they call it.

Are there any new (or even old) medications that can curb the cravings and help him stop on his own?

Also, he is worried about his health insurance (its an individual policy, not from his employer). If he is prescribed some drug for alcohol addiction, then is later diagnosed with, say, cirrhosis, he's worried that they will deny coverage since the earlier script "proves" a "pre-existing condition". He's terrified he'll screw up his health coverage by admitting the problem and seeking medical help.

Any advice for him?

[DSeid]

Are there any new (or even old) medications that can curb the cravings and help him stop on his own?
Fairly old: antabuse. (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000726/) Does not stop cravings, just makes him sick if he drinks.

Not a substitute for a support group though.

[Ferret Herder]

Depending on how bad his alcohol addiction is, he may wish to taper off quickly rather than go absolute cold turkey, as there may be potentially dangerous side effects (http://en.wikipedia.org/wiki/Delerium_tremens).

[kambuckta]

Naltrexone is now also used for alcohol addiction as it depresses the effect of drinking, so that when someone does have a drink, they are not impelled to have another one. However, it is generally used in conjunction with medical and social support groups.

Best wishes!!

[Ambivalid]

http://www.google.com/url?sa=t&rct=j&q=topiramate%20and%20alcohol%20dependence&source=web&cd=2&sqi=2&ved=0CDMQFjAB&url=http%3A%2F%2Fwww.alcoholsubstanceabuse.com%2Falcoholism-treatment%2Ftopiramate-and-alcohol-addiction-treatment%2F&ei=iubmTpqkAee60QG814GVCg&usg=AFQjCNEzDAl-5xXGnSPgLP2uEa3McqNvjQ

This is a link to info about topiramate (Topamax) being used successfully with alcoholics.

[Jaledin]

Haven't heard of Naltrexone. Interesting. Didn't know people still used Antabuse.

Valium worked well for me a few years ago -- I was committed to combatting anxiety using something other than alcohol, and wasn't foolish (enough) to mix the two substances. Sort of like (my personal opinion is that nicotine addiction is not really a problem for tobacco addicts) it's *verty* hard to desire a smoke when you're chewing like a cow on nicotine gum -- kind of an Antabuse without the feeling of privation but with enabling one to work through whatever causes the desire to drink.

Disclaimer, I'm not recommending it. It worked for me, though. And "evil benzos" are not necessarily habit forming when taken with caution, and, according to legitimate, person-to-person medical advice I've taken in consultation, they are not necessarily detrimental to one's health, depending on how they're used. I believe they are not generally prescribed long-term to people with (admitted) history of drug or alcohol abuse, but not only have they literally saved my life, I've noticed zero (0) negative side effects. No withdrawal, ever, no craving, no euphoria, no disphoria. Some people seem like they have problems with these drugs, but I've not seen any credible evidence that they are a scourge for all who dabble with them. I'm taking Xanax now -- on busy days, over the course of a day, up to 6 mgs, on ordinary days (most), none at all. And I have been for over a year, and will continue as long as I feel like it -- ideally, I'd not use them, but it keeps me relaxed in a way that I require physiologically, and my GP has both experience prescribing them to many patients over his decades of practice and has expressed no concern whatsoever.

[Sudden Kestrel]

I had a friend who was in a clinical trial for Campral (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000272/). He said it worked very well for him. He is still not drinking and said he never really had to struggle with cravings while on the medication.

[kaltkalt]

I've heard naltrexone helps, which is very interesting since it's an opiate antagonist (reversal agent... given to people who OD on opiates to pull the mu agonists off the mu receptors). I don't think anyone understands why/how it helps with alcohol cravings.

Unfortunately the best way of curing someone from alcohol dependence is replacing the dependency with something else - that's what AA does, same with religion.

[Rilchiam]

He will NOT go to AA, first because he lives in a VERY small town and is scared of meeting people he knows.

Don't have an rx suggestion, but I'm curious about this. So what if he does meet someone he knows? They'll be there for the same reason as him. And, not trying to be harsh, but if it's a small town, and if he's been living there for all or most of the 25 years he's been drinking, he probably doesn't have any secrets as it is.

[jjimm]

Don't have an rx suggestion, but I'm curious about this. So what if he does meet someone he knows?It's like bumping into your wife at the brothel. Nobody has the moral highground but it's still awkward.

[FirstLoser]

I've used both Kudzu Root (http://www.anniesremedy.com/herb_detail198.php?gc=198&gclid=CLG7udvz_qwCFcF56wodYngWSA) and Fish Oil (http://www.addictiontreatmentmagazine.com/addiction/alcohol-addiction/fish-oil-cuts-alcohol-cravings/) to control cravings.

With regard to AA....the term that is used is "Higher Power". I would offer to your brother that simply acknowledging that he is powerless over alcohol (step 1 of the 12 steps), is, in fact, acknowledging a "Higher Power". Alcohol is that higher power for him right now. Step 2 is simply acknowledging that only a power greater than ourselves can restore us to sanity.

No one in AA is trying to fool the new-comer...everyone knows the "higher power" we speak of is God. But it is the God of your own understanding. Yes, there is a clearly Christian bent to the whole thing. But again, its about acknowledging a "higher power"...that could be the tree outside your bedroom window, it could be anything or anyone...its not about believing in God, its about believing in a power greater than ourselves.

Please urge your brother to get to a meeting...if not in his home town, in a town nearby. Meetings are easy to find. We are everywhere. I didn't realize how many of us there are until I started going to meetings...the people at my meetings joked that "if you can't find a meeting when you need one, just go to the local grocery store...there's at least 3 of us in there at any given time". And its true. I run into people all the time who are in the program.

I was hesitant to go to my first meeting...when I did, there was a sign on the table at the front. It read "You are not alone". At the beginning of the meeting I read that and thought "yeah, right. I'm not like these losers." Within the first ten minutes I was thinking "I am not alone."

Just urge him to go to 1 meeting...he will be welcomed with open arms...step 12 is to carry the message to others who are suffering. We AA's are always looking for someone we may be able to help.

And, I will add, you said he lives in a small town and is afraid of seeing someone he knows...when he does see someone he knows, his first reaction will probably be "wow, I never knew that guy was a drunk". That's why its called Alcoholics ANONYMOUS. What we hear and who we see remains at the meeting.

He might be surprised how "not alone" he is.

[constanze]

Here (http://www.patheos.com/blogs/slacktivist/2011/11/29/sighs-too-deep-for-words/#more-4991) is an excerpt from a book that describes AA at work:

He had nothing in the way of a like God-concept, and at that point maybe even less than nothing in terms of interest in the whole thing; he treated prayer like setting an oven-temp according to a box’s direction. Thinking of it as talking to the ceiling was somehow preferable to imagining talking to Nothing. And he found it embarrassing to get down on his knees in his underwear, and like the other guys in the room he always pretended his sneakers were like way under the bed and he had to stay down there a while to find them and get them out, when he prayed, but he did it, and beseeched the ceiling and thanked the ceiling, and after maybe five months Gately was riding the Greenie at 0430 to go clean human turds out of the Shattuck shower and all of a sudden realized that quite a few days had gone by since he’d even thought about Demerol or Talwin or even weed. Not just merely getting through those last few days — Substances hadn’t even occurred to him. I.e., the Desire and Compulsion had been Removed.

snip

He wasn’t Grateful so much as kind of suspicious about it, the Removal. How could some kind of Higher Power he didn’t even believe in magically let him out of the cage when Gately had been a total hypocrite in even asking something he didn’t believe in to let him out of a cage he had like zero hope of ever being let out of? When he could only get himself on his knees for the prayers in the first place by pretending to look for his shoes? He couldn’t for the goddamn life of him understand how this thing worked, this thing that was working. It drove him bats.

snip

Gately still doesn’t know why it helped, but somehow it helped when Ferocious Francis suggested that maybe anything minor-league enough for Don Gately to understand probably wasn’t going to be major-league enough to save Gately’s addled ass from the well-dressed Sergeant at Arms, now, was it?

[thatguyjeff]

Also, he is worried about his health insurance (its an individual policy, not from his employer). If he is prescribed some drug for alcohol addiction, then is later diagnosed with, say, cirrhosis, he's worried that they will deny coverage since the earlier script "proves" a "pre-existing condition". He's terrified he'll screw up his health coverage by admitting the problem and seeking medical help.

Any advice for him?

Laws vary by state - BUT - once someone already has coverage, any illness occurring during that coverage will not be considered preexisting. It's when you have new coverage (say he changed insurance or something) - then that new coverage may exclude conditions for which previous medical advice, treatment, etc. were received before that new coverage was in effect. Though there are various caveats to this as well, credit for prior continuous coverage and whatnot.

FYI - once/if he's diagnosed an alcoholic, the only preexisting condition applicable would be alcoholism (if at all). Cirrhosis or other conditions are separate.

In addition, alcoholism is considered a chronic illness and could (maybe, maybe not) potentially exclude him from obtaining new/other health/life insurance in the future. The law with respect to preexisting conditions is changing in a year or two, for the employer group market at the very least, due to health care reform. But I don't know how this impacts the individual market.

[Snow Pea]

Don't have an rx suggestion, but I'm curious about this. So what if he does meet someone he knows? They'll be there for the same reason as him. And, not trying to be harsh, but if it's a small town, and if he's been living there for all or most of the 25 years he's been drinking, he probably doesn't have any secrets as it is.No offense taken. Just to be clear, he's not the town drunk or anything, he doesn't got to bars, only drinks at home. People may know he likes his beer, but not how much he really drinks. Also, thanks everyone for the AA info, but I can tell you he will not go that route, period. Well, maybe some day if all else has failed, but right now, no, he is hoping to do this on his own, possibly with the temporary help of some meds if that is possible.

I'll give him the names of those 2 drugs - but can anyone address the issue with the health insurance and the risk of tipping them off that he is an alcoholic and thereby causing him to be denied claims for any future health problems that are either a) caused by the drinking or b) that the insurance company can claim is caused by it? Like diabetes or whatever.

ETA oops thanks jeff did not see your post.

[voguevixen]

This is a link to info about topiramate (Topamax) being used successfully with alcoholics.

Didn't work for me. Also, it makes you very stupid. The side effect is so well-known that the drug is often referred to as "Dopamax". (I actually forgot the word "broom". I was standing in the kitchen asking my husband to pass me the "uh uh sweepy back and forth thing.")

[The Second Stone]

Observant people already know he is a drunk, no matter what others might say, it is really obvious. Secretive behavior is one of the giveaways.

I know many people who were serious drunks who have remained sober for many years due to attending AA and following the steps. Sometimes they start using again, but for the most part they don't.

Sometimes some people find some assistance with medical hypnosis.

I've known a few people who drank themselves to death. Liver failure is a long and painful way to go and is most unpleasant.

Volunteer to go to a meeting with him.

[Indygrrl]

I've heard good things about Campral. And I'm no fan of AA, but at the very least it can be a good place to talk to people when you first seek help. I always found the group therapy aspect of it a lot more compelling than the books and the steps. It can't really take you too far if you are an atheist, but it's a place to start.

[Maastricht]

There's a book for everything. (http://www.amazon.com/s/ref=nb_sb_ss_c_3_7?url=search-alias%3Dstripbooks&field-keywords=alcohol&sprefix=alcohol#/ref=sr_kk_1?rh=i%3Astripbooks%2Ck%3Aalcoholism&keywords=alcoholism&ie=UTF8&qid=1323847688)

[hazynlazy]

After 25 years of heavy drinking, he's done major damage to his body. Alcohol withdrawal from such a serious addiction is a very serious process that could potentially be fatal if not undertaken safely. I strongly suggest you seek out medical supervision for this process. If you can't afford medical advice, then seek out all free external resources you can before he attempts to quit. Prepare for a long, difficult process. He's lucky to have you. Best wishes.

[Crown Prince of Irony]

My brother has finally admitted he has a serious drinking problem and wants to quit, but after 25 years of heavy drinking, he is despondent and scared about the idea of quitting. He will NOT go to AA, first because he lives in a VERY small town and is scared of meeting people he knows. Also because he does not believe in any kind of god or superior being or whatever they call it.

Are there any new (or even old) medications that can curb the cravings and help him stop on his own?

Also, he is worried about his health insurance (its an individual policy, not from his employer). If he is prescribed some drug for alcohol addiction, then is later diagnosed with, say, cirrhosis, he's worried that they will deny coverage since the earlier script "proves" a "pre-existing condition". He's terrified he'll screw up his health coverage by admitting the problem and seeking medical help.

Any advice for him?

I'm not the sort to be snarky, or insulting, when someone is asking for help (either for themselves or on behalf of another). So I say in all seriousness: rather than being terrified of someone in town finding out he has a drinking problem, or his insurance not covering something, he should be terrified, first and foremost, of drinking himself to death.

While I'm not a huge fan of AA (I am not an alcoholic, but I practically grew up in AA meetings and in rehab centers and halfway houses, as my mom is in recovery, and and was a substance abuse counselor when I was a kid), I know their methods can work for those who can work within the whole "surrender to a higher power/admit you are powerless" framework. And he'll never know if you can work within that framework unless he tries.

And so what if someone he knows shows up to a meeting/sees him leaving one? If his problem is as bad as you say, I guarantee you everyone in his small town already knows he's a drunk - I'd rather be known as the "drunk guy trying to get better" than just "the drunk guy".

Whether he can work with AA or not, he absolutely needs to discuss his addiction with his doctor, and follow any and all medical advice. If he's insured, he's one of the lucky ones - why worry about something not being covered down the road, when you're killing yourself today?

Also, he should investigate whether his insurance would cover in-patient rehab, and whether he can get a short-term disability leave from work. If his employer is compassionate (and has any biusiness sense), they'll understand that letting him begin to get better without the added pressure of a daily job will give him a better chance at recovery, and ultimately give them a better, more productive worker.

Sorry this all sounds so harsh, it's just that I've heard a lot of this before, from a lot of people - a lot of addicts focus on their fears before trying to quit, and at the end of the day these fears are really just excuses to put off quitting just a little bit longer.

That said, I do wish your brother all the strength he needs to get through this - it's not easy.

[irishgirl]

He needs to speak to his doctor.
I say this as a doctor.

His doctor can:
1) Assess how much he is drinking
2) Assess how much damage the drinking has caused him
3) Assess his personal risks for detox
4) Assess his motivation to detox
5) Discuss the implications regarding his work, benefits, insurance etc of his issues.
6) Keep all discussion confidential unless there is serious risk to the public (let's say he's a train driver or piloting 747s whilst drinking).
7) If he is motivated AND suitable for home detaox, can arrange the appropriate medications and supervision.
8) If he is not suitable for home detox, can arrange inpatient detox.
9) Regardless of his motivation, can give him advice and signpost him towards local resources for subtance misuse and abuse, so that he can access a range of service when he IS motivated.


Nobody with a physical dependence on alcohol should withdraw from it without medical supervision. The risks are serious- seizures and death being the main ones.

There are medications for acute withdrawal (Librium, Ativan, Diazepam), medications to reduce cravings (Acamprosate, Disulfiram) and medications designed to reduce the damage that alcohol can cause (Thiamine, multivitamins, medications to reduce the risks of heart attack and stroke).

Only an individualised assessment by his doctor can tease out what he needs, when it needs it and how best for him to get it.

There is no safe second best option to this.

[Bloodless Turnip]

I deleted what I wrote to ditto what Crown Prince of Irony wrote:

Sorry this all sounds so harsh, it's just that I've heard a lot of this before, from a lot of people - a lot of addicts focus on their fears before trying to quit, and at the end of the day these fears are really just excuses to put off quitting just a little bit longer.

And what irishgirl wrote, withdrawal from alcohol can be fatal. Something else you may want to be aware of, very few alcoholics are honest with their doctors.

[DSeid]

Well of course his hope for a quick med script solution may be what gets him to the doctor. He can't even hope to get that mythical quick fix without telling his doctor why he wants it. And I certainly don't know of any doctor who is going to treat serious alcohol dependency with a medication alone let alone as first line. So let him go there in hopes of getting the script. Perhaps his doctor is good enough to convince him of a more likely to be safe and effective more comprehensive solution, once he's there talking about it.