Pills to quit drinking
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Pills to Quit Drinking: An Overview of Pharmacological Treatments
Naltrexone for Alcohol Use Disorder
Efficacy of Naltrexone
Naltrexone, an opioid antagonist, has been extensively studied for its efficacy in reducing alcohol consumption. Research indicates that naltrexone can significantly reduce heavy drinking rates among individuals attempting to quit smoking, particularly in heavy drinking smokers (HDS)4 6. In a randomized clinical trial involving women with HIV and unhealthy alcohol use, naltrexone was associated with a greater reduction in drinking at 1 and 3 months, although the difference was not significant at 4 and 7 months1. Another study found that naltrexone significantly reduced weekly heavy drinking rates in nonalcoholic social drinking smokers4.
Combined Treatments
Combining naltrexone with other medications has shown mixed results. A study comparing the combination of varenicline and naltrexone against varenicline alone found that while varenicline alone was more effective for smoking cessation, the combination was more beneficial for reducing alcohol consumption during the treatment phase2. Another study highlighted that naltrexone combined with medical management resulted in decreased heavy drinking among men and increased smoking abstinence in the overall sample3.
Mechanisms and Side Effects
Naltrexone works by blunting the subjective effects of alcohol, such as feeling "drunk" or "impaired," which can reduce the craving for alcohol10. However, its effectiveness can vary based on individual factors such as gender and drinking patterns8. Side effects of naltrexone are generally comparable to those of other medications like benzodiazepines and disulfiram, although concerns about the risk of developing addiction or misuse have been raised7.
Varenicline for Dual Treatment
Efficacy in Reducing Alcohol and Smoking
Varenicline, primarily used for smoking cessation, has also been studied for its potential to reduce alcohol consumption. A randomized clinical trial found that varenicline, when combined with medical management, resulted in decreased heavy drinking among men and increased smoking abstinence in the overall sample3. However, the combination of varenicline and naltrexone did not show a significant advantage over varenicline alone for smoking cessation, although it did favor drinking reduction2.
Gamma-Hydroxybutyrate (GHB) for Alcohol Withdrawal
Efficacy and Safety
Gamma-hydroxybutyrate (GHB) has been evaluated for its efficacy in treating alcohol withdrawal syndrome (AWS) and preventing relapse. Studies suggest that GHB is effective in reducing withdrawal symptoms and maintaining abstinence in previously detoxified alcoholics7. However, the risk of developing addiction or misuse, especially among polydrug abusers, remains a significant concern7.
Conclusion
Pharmacological treatments like naltrexone, varenicline, and GHB offer promising options for reducing alcohol consumption and aiding in smoking cessation. Naltrexone, in particular, has shown efficacy in reducing heavy drinking rates and blunting the subjective effects of alcohol. Combining medications may offer additional benefits, although individual responses can vary. While these treatments provide valuable tools in managing alcohol use disorders, considerations around side effects and the potential for misuse are crucial in their application.
Sources and full results
Most relevant research papers on this topic
Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo.
Reducing unhealthy alcohol use in women living with HIV improves HIV viral suppression, regardless of medication use.
RCT
Very Rigorous JournalEfficacy of Combining Varenicline and Naltrexone for Smoking Cessation and Drinking Reduction: A Randomized Clinical Trial.
Combining varenicline and naltrexone may be more effective for smoking cessation and drinking reduction in heavy-drinking smokers than varenicline alone.
RCTEffect of Varenicline Combined With Medical Management on Alcohol Use Disorder With Comorbid Cigarette Smoking: A Randomized Clinical Trial
Varenicline combined with medical management effectively reduces heavy drinking days in men and has a smaller effect in women, but both treatments lead to prolonged smoking abstinence.
RCT
Highly CitedNaltrexone decreases heavy drinking rates in smoking cessation treatment: an exploratory study.
Naltrexone may reduce heavy drinking in nonalcoholics attempting to quit smoking and may improve smoking quit rates in heavy drinkers who smoke.
RCT
Rigorous JournalSixty seconds on . . . the end of hangovers?
Myrkl, a Swedish probiotics pill, claims to effectively break down alcohol into CO2 and water before it reaches the liver, reducing the chance of a nasty hangover.
Rigorous JournalNaltrexone improves quit rates, attenuates smoking urge, and reduces alcohol use in heavy drinking smokers attempting to quit smoking.
Naltrexone improves quit rates, reduces smoking urge, and reduces alcohol use in heavy drinking smokers attempting to quit smoking, but not in moderate-to-light or nondrinking smokers.
RCT
Large Human TrialRigorous JournalGamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses.
GHB is an effective and safe treatment for alcohol withdrawal and relapse prevention, with better results than NTX and Disulfiram.
Meta-AnalysisVery Rigorous JournalHighly CitedNaltrexone and brief counseling to reduce heavy drinking in hazardous drinkers.
Daily naltrexone and brief counseling did not show the same degree of improvement in heavy drinking outcomes as placebo-treated individuals.
RCTMedications for alcohol use disorders: An overview
This review highlights the current and emerging medications for alcohol use disorders, highlighting their potential for reducing alcohol cravings and supporting abstinence.
Highly CitedWithin- and between-person effects of naltrexone on subjective response to alcohol and craving: A daily diary investigation.
Naltrexone reduces intense subjective effects like "drunk" and "impaired" in young adults, but does not affect cravings.
RCTVery Rigorous Journal