SAMHSA Releases New Guidelines for Treating Alcohol Use Disorder

The largest U.S. government agency that deals with public mental health issues has released an updated guide to widely used alcohol addiction and abuse medications. While other large treatment communities have long voiced out their own opinions regarding regulation of medication treatments, the Substance Abuse and Mental Health Services Administration (SAMHSA)'s recent update is an addition to the progress being made within this arena over the past few years.

Along with the updated diagnostic tools found in the current The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), SAMHSA also sends treatment providers "Medication for the Treatment of Alcohol Use Disorder: A Brief Guide," which is a booklet that allows for charting the course of a patient's treatment experience using medications that are increasingly becoming more popular in treating different degrees of alcohol dependence.

Medication-assisted treatment for alcohol abuse and dependence has seen an increase nationwide. One reason for the growth of this treatment protocol are changes in medical insurance. Often, these changes are driven by the need to reduce treatment episodes for each individual as costs for detoxification and treatment program services continue to rise, along with numbers of individuals who require treatment.

Many treatment providers have struggled for decades to meet these increasing needs and create a bridge from patient treatment to long-term recovery for patients. While medication-assisted alcohol abuse management is not new, some of the drugs and their methods of prescription have been receiving new uses.

Currently, there are four medications recognized to be the most appropriate treatment for alcohol dependence. SAMHSA's booklet provides a table with information about the use of these four medications and the DSM-5 criteria for severity of alcohol dependence. When used as suggested, these medications may be used as short-term or long-term tools for recovery.

The four drugs, which have been approved by the U.S. Drug Administration (FDA) for alcohol disorder treatment in the detoxification and oral processes and for preventing relapse, include disulfiram, acamprosate, oral naltrexone and an injectable extended-release form of naltrexone.

  • Disulfiram (Antabuse) has been used for a long time for alcohol use and abuse, mostly as a preventative intervention. This drug causes abdominal discomfort and illness if the patient drinks alcohol while on the medication.
  • Acamprosate (Campral) is a medication used to bridge the brain's functioning in the glutamatergic and GABAergic systems. These are the areas of the brain thought to control mood and nervous system health. When alcohol use and withdrawal disrupts this dynamic, the drinker experiences mild to severe symptoms, both as a result of drinking and of stopping drinking. This drug is primarily used post-withdrawal to alleviate long-term symptoms, such as anxiety and depression.
  • Oral Naltrexone (also known as Vivitrol) is a newer medication used for blocking the opiate receptors, or pleasure-sensing receptors in the brain. Both forms of the drug give the same effect when alcohol is introduced; the patient receives no sensation of pleasure. The oral form of the drug is used to introduce these effects at onset of treatment to provide relief from cravings and withdrawal.
  • Injectable, extended-release Naltrexone is used for long-term purposes of abolishing the cravings for alcohol and a return to drinking behaviors (relapse).

SAMHSA's booklet cuts through the usual challenges that comes with working with various clinical criteria and caters to providers who are not trained in medical settings, such as counselors and other lay persons without medical education.

Along with guidelines for assessing and diagnosing alcohol dependence, SAMHSA also lists other possibly co-existing mental and physical health conditions, which can interfere with alcohol abuse treatment if not addressed. Based on each patient's needs, assessment for medication-assisted treatment begins. SAMHSA has also produced a guide for how much treatment to use as the patient progresses through specific stages of treatment.

Kelly McClanahan has an MSW in clinical social work and a CATC IV in addictions counseling. She teaches meditation and mindfulness, specializing in addiction and trauma. She also leads workshops and seminars on treatment of addictive disorders and stress reduction.

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