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Dx Alcoholism Treatment: Read More...


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SUMMARY:
Approximately 20 million men and women in the US are considered to suffer with Alcohol Use Disorder (AUC). Treatment of alcoholism starts with daily 125 to 250mg tablets of disulfiram/ Antabuse®. It is inexpensive but the patient will discontinue the medication to drink. A quarterly implant of disulfiram has been under development.

There is no consensus on the best treatment for alcoholism but "brief intervention", doctor inquiry and education, was somewhat effective in men. The failure rate at one year from consulting, use of the two FDA approved medications, oral disulfiram and monthly injections of naltrexone, are less than ideal.
The monthly injection/ implantation of naltrexone as Vivitrol® may reduce the urge to binge drink.


Alcoholism

The Merck Manual Home Edition states:
Genetics, biochemistry, gender and personality characteristics may play a part in the development of alcohol use disorders.
Drinking too much alcohol may make people sleepy or aggressive, impair coordination and mental function, and interfere with work, family, and other activities.
Drinking too much alcohol for a long time can make people dependent on alcohol and damage the liver, brain, and heart. In women, it increases risk of breast cancer.
Doctors may use questionnaires or determine the blood alcohol level to help identify people with an alcohol use disorder (AUD).
Immediate treatment may include assistance with breathing, fluids, thiamine, other vitamins, and, for withdrawal, benzodiazepine.
Detoxification and rehabilitation programs can help people with severe alcohol use disorders.

About 45 to 50% of adults currently drink alcohol, 20% are former drinkers, and 30 to 35% are lifetime abstainers. Drinking large amounts of alcohol (more than 2 to 6 drinks per day) for extended periods can damage a number of organs, especially the liver, heart, and brain. However, drinking a moderate amount of alcohol may reduce the risk of death from heart and blood vessel (cardiovascular) disorders. Nonetheless, drinking alcohol for this purpose is not recommended, especially when other safer, more effective preventive measures are available.

Alcohol Abuse:
Most people do not consume enough alcohol or consume it often enough to impair their health or interfere with their activities. However, 7 to 10% of adults in the United States have a problem with alcohol use (Alcohol Use Disorder). Disorders include at-risk drinking (defined solely by amount consumed), alcohol abuse, and alcohol dependence (the most severe Alcohol Use Disorder). Alcoholism is an imprecise term. It typically refers to excessive drinking, unsuccessful attempts at stopping drinking, and continued drinking despite adverse social and occupational consequences. Men are 2 to 4 times more likely than women to become alcoholics, even though women tolerate excessive alcohol poorly.

Medications Used in the Treatment:
1. Alcohol Antagonist: Antabuse®/Disulfiram
2. Implantable Disulfiram Pellet Research Protocol
3. Benzodiazepines: Klonopin®/clonaepam.
4. Central Alpha Agonists: Catapres® /clonidine
5. Tricyclic Antidepressants: Sinequan®/ amitriptyline, doxepin.
6. Opioid antagonists: Revia®/naltrexone, long-acting injection
7. GABA Analogues: Campral®
8. Amino Acids: Intravenous Infusions

[Editor]: We agree that a medical evaluation should always be sought first. Eliminate other drug use with blood, urine and if needed hair analysis. Start with a complete blood count, metabolic panel, thyroid test, urine culture and hormonal evaluation of the adrenal and sex hormones. (See H.I.S. or H.E.R. Blood panel). Chronic alcoholics develop a deficiency of magnesium, B vitamins, elevated homocysteine (B12, folate and BMG/TMG vitamin deficiency). Magnesium deficiency shows up earlier when measured as 'RBC' magnesium. A pulse oxymeter should check oxygen levels. A chest X-ray and EKG (heart test) should be considered by a competent health professional, ruling out aspiration pneumonitis while completing the history and physical examination.

*[Editor]: The mainstay of medical treatment of chronic alcoholism is
* Oral disulfiram. Fuller reported approximately half the drinking days for those who took 250mg of disulfiram versus the control or no treatment. "There was a significant relationship between adherence to drug regimen and abstinence in all groups."
* Disulfiram superior to Naltexone: De Sousa showed disulfiram is superior to naltrexone in preventing a relapse among alcohol-dependent men with family support." [The key here is family support]
* Naltrexone trials. Only the high-adherence trials with two using thrice-weekly oral dosing of 50mg of naltrexone, and two used extended-release injectable formulations of naltexone administered once monthly had correlations of significant p=.025 [Editor: similar to, not significantly better than disulfiram].
* Antipsychotics did not work.
* Of alcohol prevention programs implemented as school, 6 of 11 showed some signs of efficacy, and 14 of 39 induced a significant reduction. [Editor] a 12 step program with regular attendance can make a difference; the problem is the high fall out rate and alcohol recidivism].
*"Librium/chlordiazepoxide in considered the best form of management of alcohol withdrawal and the kindling effect" reports the United Kingdom's National Health Services.

*[Editor]: The medical literature is clear: the 1000 milligram disulfiram implant available has no effect different from placebo implant. The lack of pharmacological effect,we find, is that the implant is not metabolized through the liver and there is low resultant serum level of disulfiram metabolites and therefore, no significant effect other than the 'fear of vomiting.' Therefore, we are initiating a test program to determine 1)the blood metabolites of disulfiram implants versus oral, and 2) establish the dosage necessary to reach clinical results (not drinking). In preliminary clinical studies, the dosage necessary to maintain the aversion reaction is 2000 to 4000mg every two months with a combination of rapid and slow release pellets. The program is evaluating the use of week day intravenous vitamin supplementation (Myer's cocktails). A vitamin and amino acid oral supplementation is recommended; others have suggested separate 8-hour infusions of amino acids for two weeks. Pellet placement of disulfiram and testosterone is repeated every two to three months depending on laboratory assessment. While additional B-vitamins, magnesium, glutathione, and lithium are added to the intravenous infusions, adjustments are made to balance other hormonal parameters [FSH, Total testosterone (TT), Sex hormone binding globulin (SHBG), Estradiol]..

*[Editor]: Metadoxine for 30 days was superior to placebo in the maintenance of abstinence: less anxiety, depression, insomnia the first week and reduced requirement for benzodiazepines and neuroleptics. But, other authors show that SAMe is needed more "Thus, SAMe rather than methionine is the compound that must be supplemented in the presence of significant liver disease."

*[Editor]: Glutathione deficiency is a known fact in alcoholism. Alcoholism is associated with increased risk of endotoxemia-induced acute lung injury. They suggested adding glutathione to the ethanol-free diet to reduce chronic oxidative stress and altered cellular and lung function.

*[Editor]:There is no consensus on the cause of alcoholism: epidemiology studies show environmental factors while geneticists show genetic abnormalities in the SNCA, GRM3 and MBP genes.
There is no question that these individuals have disruption of normal hypothalamic-pituitary-gonadal axis function and low bioavailable testosterone leading to an inflammatory if not autoimmune-like condition.

*[Editor]: IV Amino acids: A comprehensive review was undertaken of oral and intravenous amino acids; however, there was only antedotal evidence and no double-blind scientific publication. Whether intravenous amino acids can reduce alcohol recidivism is yet to be determined.

*[Editor]: The potential benefit of the Implantable Disulfiram Pellet is to keep a number of state correctional institution inmates out of jail.
Understanding disulfiram metabolism.

*[Editor]: Reviewed are the supplements that need to be replaced regularly in alcoholism. They may prevent a hangover. The Myer's cocktails are the yellow 'banana' bags available in Las Vegas to allegedly curb the alcoholic hangover.
D-phenylalanine, L-glutamine and 5 HTP are suggested to be used in the alleviation of alcohol withdrawal symptoms.

*[Editor]: "the modest effect... for naltrexone... may be attributable, at least in part, to variability in naltexone adherence rates. [Low adherence... low significance].

*[Editor]: Read about Antabuse.


*[Editor] An excellent reference for disufiram oral side-effects. Copyrighted 2020©