Many people who complete treatment for alcohol dependency blame relapses on unbearable cravings for alcohol.  The dependent person has usually been drinking for a reasonably long time and has a conditioned response to the alcohol cravings.  When actively drinking, the cravings were easy to deal with but what do you do now that you have been detoxed and treated for alcohol abuse?  One drink will virtually always culminate in a full blown relapse.  Some are short in duration and are caught prior to redeveloping physical alcohol dependence, others land the person back in the hospital for yet another detox. There are many tools available to help with cravings.  This article will discuss some of the methods and products available.   

Therapy – Traditional treatment rarely includes any therapy to modify behavior other than the twelve steps of Alcoholics Anonymous.  More contemporary and progressive treatment centers use psychotherapy and incorporate cognitive behavioral therapy.  Much of the alcohol dependence mechanism is controlled by repetitious or habitual behavior.  Most alcoholics have specific drinking conditions where the reward of alcohol has been used daily.  Modifying these conditions and helping the brain to learn a new behavior is extremely effective in remaining sober.  Cognitive Behavioral Therapy is used to help the dependent person learn new ways to react and behave that do not include alcohol. 

Medications – There are pharmaceuticals available which are effective in helping deal with alcohol cravings.  Among them are Naltrexone, Vivatrol, Campral and there are some early indications that Chantix may also be an effective anti-craving medication.  All of these drugs are used to occupy specific neuro-receptors that are responsible for the cravings.   

Naltrexone is an oral medication that occupies the opiate receptors in the brain and is also available in an injectible form known as Vivitrol.  This drug has proven very effective in helping reduce cravings in the majority of problem drinkers.  Many report that substantially all cravings have been abated but a small percentage of the people who have tried these medications report that they notice no reduction. 

Campral (acamprosate calcium) is another oral medication available to help reduce cravings.  The manufacturer states that the mechanism of Campral is not totally understood.  Alcohol inhibits activity of receptors called NMDARs (N-methyl-D-aspartate receptors) in a way which overproduction of these receptors is caused by excessive and prolonged alcohol consumption.  When alcohol is suddenly not present, these NMDARs become more active than normal.  Withdrawal from alcohol creates a surge in the release of neurotransmitters such as glutamate.  Campral is believed to help reduce this glutamate surge.  Again, it is effective in reducing cravings in some and in others it seems to have no effect. 

Some recent studies have indicated that promise is shown for a tobacco cessation medication called Chantix in treating alcohol cravings.  Chantix (varenicline) is a nicotinic receptor partial agonist that reduces the cravings and pleasurable effects of nicotine.  This drug is not currently indicated for alcohol cravings.  

Education – Most alcoholics have no idea what is going on with their body and brains as a result of their continued alcohol consumption.  Every attempt should be made to educate these individuals on the neurochemistry of alcohol addiction.  The more one knows about the effects that the abuse creates the more likely they are to make the difficult decision not to resume drinking. 

Nutrition – Nutrition plays a critical part in recovery from alcoholism.  Alcoholics tend to neglect nutritional needs in favor of alcohol.  The caloric content of alcohol often satisfies hunger and the dependent individual drinks rather than eating.  Alcohol contains no nutritional value and the body immediately converts any alcohol consumed into sugar.  The rapid introduction of sugar into the system raises blood sugar levels and gives the alcoholic a feeling of well being.  Rather than consuming protein and carbohydrates that are more gradually metabolized, the alcoholic drinks.  The alcohol burns rapidly and blood sugar drops dramatically causing the dependent person to feel weak, anxious and shaky, similar to the feeling a normal person gets when they are extremely hungry.  The metabolism of alcohol also depletes many vitamins and minerals.  Most alcoholics that enter treatment are severely deficient in many areas that are necessary in normal bodily functions.  Many are also pre-diabetic or hypoglycemic.  During early sobriety it is critical to address these deficiencies and resume a diet high in quality nutrients.  Supplements are also recommended to aid in the healing process.  Blood sugar irregularities are often confused for alcohol cravings. 

After accessing the individual’s specific needs, we use a combination of any or all of these components in early sobriety.  Psychotherapy, cognitive behavioral therapy, medications, education and nutrition can all play critical parts in recovery.  Often Campral and Naltrexone are used in combination to deal with cravings.  Pharmaceutical intervention and being nutritionally sound can virtually eliminate physiological cravings.  Psychological factors such as changing destructive behavior, dealing with issues that drive the addiction and understanding what is happening with your brain and body are the other often to frequently overlooked components.  Long term sobriety is rarely achieved by pharmaceutical intervention alone and must be accompanied by physiological and cognitive behavioral therapy.

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