Can Medications Help You Get Sober?

by Michael Walsh

In this post we’re going to explore pharmaceutical medications for alcohol cravings when trying to cut back or stop drinking altogether.[updated March 2023]

Alcohol misuse is a complex issue, often impacting many areas of a person’s life. And for this reason, tackling alcohol problems often requires a multi-pronged approach.

As a seasoned Recovery Coach, people periodically ask me whether I recommend using medications for alcohol cravings.

My answer is always something along these lines:

“There’s no magic pill out there that’s going to rescue you from the hard work that’s required to tackle an alcohol problem. BUT, I think medications can be helpful for some clients, as part of a larger program of recovery that includes a combination of other support types such as counselling, recovery coaching, and/or community-based supports. What I find most helpful for my clients is getting to the root-cause of why they’re drinking in the first place. And if medications can help them along the way, then great.”

Coming up with an effective recovery plan is a very individual process. What’s going to work for you, isn’t necessarily going to work for someone else.

For this reason, I encourage my clients to be their own recovery boss, and create a custom recovery roadmap that works for them.

In this same vein, deciding to use medications for alcohol urges and cravings is a very personal choice. I follow Dr. Jeff Harries's work in Canada as a trailblazer for using medications to augment a persons recovery plan. Here is a great table of Pharmacotherapy Options for Alcohol Use Disorder from the British Columbia Centre on Substance Use.

I have some clients who achieve long-term sobriety without any medication at all, and others who find medications really helpful in their recovery journey.

Most often, I see clients use medication on a short-term basis, to help curb alcohol urges and cravings, while adjusting to their new sober way of life and laying the groundwork necessary to stay sober for the long haul.

Despite having been sober for many years now, I still remember how tough the urges were to manage in the early days. And while I didn’t use medication myself, I may have if I had known about their potential benefits.

The intense urges and cravings keep many people stuck in a loop of quitting, only to give into the cravings and start again.

So, today I’m going to cover three of the medications some clients have found helpful when trying to cut back or stop drinking:

Naltrexone
Acamprosate
Gabapentin

But before we go on, it’s important to note that I’m not a medical expert, and the information I’m sharing here is not intended to serve as medical advice.

OK, let’s dive in.

Naltrexone for Alcohol Cravings (Revia)

Marketed as Revia (in pill form), Naltrexone works by blocking the “high” that people experience when drinking alcohol.

By blocking the pleasure you experience from alcohol, the drug has shown to reduce cravings.¹

It’s as though your brain learns that it can’t get what it wants from alcohol anymore, and therefore the cravings go down.

It’s important to note that naltrexone has no dangerous interactions with alcohol, so it can be used while a person is still trying to cut down or moderate their drinking.

One person shared that drinking “simply became less enjoyable”. Over time, he found himself not only drinking less, but also thinking about alcohol less. Another person said that instead of thinking about how soon she could order her second drink, she noticed how hard it was to finish her first.

Of course, the medication is going to work differently for everyone, but reports like these are promising.

The main drawback my clients have shared with me about naltrexone is that it’s really easy to just stop taking the pill. While the pill may help lower their cravings, there are still parts of them that miss the things alcohol used to provide to them, and they know if they stop taking the pill, the alcohol buzz will quickly return.

This is why I strongly recommend using medication as part of a larger recovery plan, where you’re able to peel back the layers, unpack the reasons why you drink in the first place, and create lasting lifestyle adjustments to support your desire to stay sober.

In some countries, naltrexone is also available in an injectable form, marketed as Vivitrol. While it’s not currently available in Canada, it is available in the U.S. This form is given as a monthly injection, staying in your system for much longer, and requiring less willpower compared to the pill-form of naltrexone.

Acamprosate for Alcohol Cravings (Campral)

Unlike Naltrexone, acamprosate should only be used once you’ve stopped drinking.

Marketed as Campral, acamprosate is a medication that has also shown to reduce alcohol cravings. The medication has also shown to reduce the physical and emotional discomfort people often experience when they quit drinking.²

It’s not entirely understood how acamprosate works to reduce alcohol cravings. Researchers believe that it helps restore a chemical imbalance in the brain's reward system that can be thrown off by long-term alcohol misuse.

One woman shared that she was prescribed acamprosate during her stay at an inpatient treatment center, and found it helpful in maintaining her sobriety after she was discharged.

It’s usually prescribed as 3 time-released pills a day for those who have already stopped drinking. And, because the side effects are mild and well tolerated, it’s usually prescribed for up to a year after someone stops drinking.²

Gabapentin and Alcohol (Neurontin)

Gabapentin was originally approved to treat seizure disorders, and has been found to be effective for a number of disorders in neurology and psychiatry.

But, in recent years, evidence has been mounting for its effectiveness in treating Alcohol Use Disorder (AUD).

In a 2014 study⁴ gabapentin was shown to:

Reduce cravings
Increase rates of abstinence
Decrease rates of binge-drinking
Decrease the number of drinks per week
Improve sleep, even in the presence of alcohol
Improve mood disturbances associated with alcohol use

When an excessive amount of an inhibitory neurotransmitter such as GABA is activated in response to alcohol use, the brain tries to regulate by either reducing the number of receptors, or turning down the sensitivity dial on the receptors.

Then, when the chronic use of alcohol stops, the brain is suddenly left in a hyper-aroused state, often causing anxiety, insomnia, and in severe cases, seizures. And this is where gabapentin becomes especially useful - essentially helping to mimic the effect alcohol had on the brain while the brain works to rebalance itself in sobriety.⁵

Adding Support to Your Recovery Roadmap

Dr. Michael Berry, Clinical Psychologist based in Victoria British Columbia Canada, reminds us of the importance of piecing together many forms of support when creating our personalized recovery roadmap.

“Rarely is medication alone a sufficient solution for those struggling with alcohol or other forms of addictions. It’s most effective when combined with other support systems such as a Medical Physician experienced in substance use concerns, recovery coaching and/or clinical counselling/psychotherapy (as a first line of intervention) and then for some, adding in community-based supports or even a formal treatment program where appropriate.

Everyone wants that magic bullet and there really isn’t one. My advice is always to approach medications with reasonable expectations and the understanding that they aren’t the full solution.”

As Dr. Berry mentions above, a great place to start is with a Medical Physician experienced in substance use concerns or Recovery Coach or Counsellor, who can help you triage your needs and create a plan.

Getting Started With Recovery Coaching

I’m an accredited Addiction Recovery Coach with extensive knowledge in the field of substance use disorders. I’ve been trained by some of the best in the field and continue to remain active in various recovery communities both in Canada, and internationally.

If you’re looking for help to stop drinking, help to moderate drinking, or support in dealing with a substance use concern of any kind, please feel free to reach out to me. I offer one-on-one recovery coaching, family support, and drug and alcohol intervention services in Canada and Internationally.

I offer a no-charge consult call to anyone who has questions about their own substance use, or the substance use of a family member. These calls are completely confidential with no pressure to make a decision before you feel entirely ready.

If you’re ready to explore the potential of working together, I’d love to chat. Michael is based in Victoria British Columbia Canada. The other Recovery Coaches on the team are based in Nanaimo, Vancouver British Columbia Calgary, Edmonton Alberta, Toronto Ontario, Montreal Quebec, and Halifax, Nova Scotia. Because we all work virtually — we can work with anyone no matter what city, province or country around the world. We have clients all across Canada and the USA, Seattle, Los Angeles, Dallas, Miami, New York City, Denver, Nashville, Berlin, Tel Aviv, London, Singapore and Australia.

Phone or Text: 250.896.8494
Email: Coach@MichaelWalsh.com
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References

About the Author

Michael Walsh

When I say I’ve been there, I mean it. I am a different person now, and I am fired up about helping other people get to the place where they, too, are living better, healthier, and bigger lives.

Contact Michael