Medication-assisted treatment (MAT), combined with counseling and behavior therapies, helps those recovering from alcohol use disorder (AUD) by relieving withdrawal symptoms and reducing cravings. Medications used in MAT are evidence-based treatment options for AUD. These medications are FDA-approved and some are controlled substances. Understanding what MAT is and how it works can help you decide if it is a path you would like to explore with your healthcare provider.
Elements of MAT
MAT models of care are made up of four main components:
- The pharmacological therapy
- Provider and community educational interventions
- Coordination and integration of your alcohol use disorder treatment with care for other medical/psychological conditions
- Psychosocial and behavioral services
Because alcohol withdrawal syndrome can have severe, even life-threatening, health repercussions, MAT begins with a comprehensive assessment of your need for medically managed and monitored treatment, followed by the collaborative crafting of your actual treatment plan. Withdrawal generally begins 24 to 48 hours after your blood alcohol level drops, and effects can last for five to seven days. Symptoms can include:
- Auditory, visual or tactile hallucinations
- Delirium and disorientation
- Grand mal seizures
- Hyperthermia
- Increased heart rate and blood pressure
- Increased sensitivity to sound, light, and tactile sensations
- Insomnia, vivid dreams, and nightmares
- Nausea and vomiting
- Paranoid or persecutory delusions
- Poor concentration, memory, and judgment
- Restlessness, irritability, anxiety, or agitation
- Tremors
Common MAT Medications and How They Work
Acamprosate, disulfiram, and naltrexone are the most common drugs used to treat alcohol use disorder. They do not provide a cure for the disorder but are most effective in people who participate in a MAT program.
- Acamprosate: Acamprosate can be used if you are in active recovery and are no longer drinking. It will not prevent or reduce withdrawal symptoms if you do start drinking again. It is also not effective for people who consume illicit drugs or misuse prescription drugs. Acamprosate is taken in tablet form three times daily, and usage typically begins on your fifth day of abstinence.
- Disulfiram: Disulfiram is taken as a tablet daily and is most effective if you have already gone through detoxification. It works by disrupting alcohol metabolism in your body and causing unpleasant symptoms such as skin flushing, sweating, shortness of breath, nausea, and vomiting. The medication encourages alcohol avoidance. Disulfiram cannot be taken while intoxicated or for at least 12 hours after drinking alcohol.
- Naltrexone: Naltrexone blocks the euphoric effects and feelings of intoxication. It allows people with alcohol use disorders to reduce alcohol use and remain motivated to continue taking the medication, staying in treatment, and avoiding relapses. Oral naltrexone is taken as a tablet once a day. Injectable naltrexone is administered once a month.
Common Side Effects of MAT Medications
Acamprosate: Acomprosate’s side effects can feel disturbing but they usually decrease in intensity as your body adjusts to the medication. Common side effects are:
- Severe depression and discouragement
- Fear and anxiety
- Irritability
- Lack of appetite
- Weakness and fatigue
- Insomnia
- Trouble concentrating
Less common side effects may include:
- Bloating or gassiness
- Dizziness
- Dry mouth
- Itchy, prickling or tingling skin
- Sweating
Disulfiram: Unpleasant side effects can occur within 10 minutes of drinking alcohol and can last for several hours. They include:
- Nausea
- Headache
- Vomiting
- Chest pains
- Difficulty breathing
Minor side effects, which you may experience during the first two weeks of therapy, include:
- Acne or allergic dermatitis
- Drowsiness or fatigue
- A metallic taste
- Impotence
Rare but more severe reactions such as visual disturbances, numbness or tingling, and hepatitis usually require that disulfiram be discontinued.
Naltrexone: Common side effects of naltrexone include:
- Abdominal or stomach cramping
- Anxiety, restlessness
- Trouble sleeping
- Headache and dizziness
- Joint or muscle pain
- Nausea and vomiting
- Weakness and fatigue
Some less common effects are:
- Blurred vision, swollen eyes
- Chills
- Cough, stuffy or runny nose, sore throat
- Fever, hallucinations
- Increased thirst, loss of appetite
- Irritability
- Skin rash
- Sexual problems (in males)
Success Rate of MAT in Treating AUD
There is moderate-strength evidence that acamprosate and oral naltrexone reduce relapse in heavy drinking for patients with AUD. Poor patient adherence regarding oral naltrexone, however, spurred the production of the extended-release injectable form. While it appears to be effective, long-term study data are limited. Injectable naltrexone is also only approved for use in patients who can refrain from drinking for several days prior to starting treatment.
Although disulfiram has been used to treat AUD since the 1950s, few well-controlled studies of its effectiveness have been studied. Those studies that do exist have yielded mixed results. Still, disulfiram is a viable option for patients who cannot take acamprosate or naltrexone or who prefer not to due to the possible side effects.
Studies show that all medications used in MAT are more successful when applied in combination with psychological and behavioral therapies. Research into new, safe and effective medical treatments for AUD is ongoing.
Withdrawal from alcohol can result in serious physical and psychological challenges. Some people with alcohol use disorder find that medication-assisted treatment can help mitigate withdrawal symptoms and curb cravings, which helps prevent relapse. Available medications have different side effects and are not appropriate for all patients. If you have previously struggled with withdrawal symptoms and relapse, contact Casa Palmera today. Located in Los Angeles, California, we offer an interdisciplinary therapeutic drug and alcohol rehab with the highest level of care possible. We will tailor your treatment to your needs and maintain the utmost confidentiality during your stay with us. Casa Palmera offers the advanced clinical techniques necessary for treating both substance use disorders and co-occurring conditions, emphasizing evidence-based drug and alcohol treatment methods. Even after you leave us, rest assured that you will still receive the support and aftercare you need to continue your healing journey. Contact us today.
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