If someone is an alcoholic and in poor health due to the liver damage, but can’t stop drinking what is the standard treatment offered them? Like heroin addicts are offered methadone.
I was googling this and I see some experimental studies and that some European countries use GHB or did. What would be the standard treatment offered in the USA or elsewhere?
In my experience, the doctors tell the patient to stop drinking. What the patient does, is up to them. There are drugs such as antabuse and others, that will make the patient sick, if they drink. Of course this depends on the patient actually taking the pills, and hardcore alcoholic will still drink on antabuse. There are no FDA approved drugs for alcoholism, that would be equivalent to methadone. Currently alcoholics who quit, either use a peer support group (AA etc), some type of rehab, or go it alone.
You can get a monthly injection called naltrexone that is suposed to help with cravings.
There are some situations where IV alcohol is used as a medical intervention - methanol/glycol poisoning, for example (where the aim is to saturate the liver with ethanol so as to reduce the rate of metabolism of the other alcohol, which has toxic byproducts). This is maintained until there is none of the other alcohol in the bloodstream.
Similarly, it may be used to manage acute alcohol withdrawal for a short period of time. But the level of physical dependency for alcohol is much shorter than for opiates, so these measures are not used as a longterm management tool for alcoholism in the same way as methadone.
Finally, in general, people have safe access to safe alcohol - this is not the case with opiates, where the only supply is via criminals and the product is often not safe. Methadone treatment provides a much safer alternative to this for people who want to work on withdrawing from opiate dependence. This is (not generally) required for alcoholics, because it is harder to find unsafe alternatives to ethanol at a lower price-point (without being a commercial buyer, although there has been a rise in adulterated counterfeit alcohol recently). In some places, managed shooting galleries for heroin users are provided, giving a safe place to use, clean needles and test kits to check the quality of the drugs. These are controversial, but provide a part-way point between unsafe illegal drug use and safe legal methadone programs.
Alcohol detox uses other medication as a substitute during the withdrawal phase. Unfortunately I can’t remember what. I work in mental health with some contact with specialist drug and alcohol services. It’s been a few years since I was working with anyone actively detoxing, but I seem to recall the medication used began with L. Lithium? Or it could be diazepam or benzos more generally they use.
Important to note, this is only for a period of stabilisation. It’s not a great idea to keep up the use after the alcohol detox is done. You do a slow withdrawal from the substitute.
Just looked it up - it’s benzodiazepines. Controlled over a month or so, then withdraw the benzo use.
This is in the UK by the way.
Somewhat related, but in some cities there’s wet houses, which are basically longer-term housing for homeless people that don’t make sobriety or being in rehab a condition of residency like most shelters and even let residents drink on the premises. They’re primarilly a harm reduction measure and have been quite effective at reducing mortality rates in chronic homeless alcoholics and reducing the impact on the surrounding community. Proponents also argue that the non-coercive approach works better for getting people to seek and continue treatment in some cases, and also that some residents in wet houses who aren’t able to stop completely are able to moderate their drinking. They are definitely controversial, though, especially when they propose opening one in your neighborhood.
Librium is likely what you’re thinking of… It and other Benzos are used in medical alcohol withdrawal.
Chlordiazepoxide (Librium) is the drug of choice for a person going through acute alcohol detox. They go to injectable Valium or Ativan if the person seizes or has DTs.
And for a person who can’t or refuses to stop drinking and goes into liver failure, there’s that wonderful lactulose. It’s gross, and does gross things to people.