Month: August 2021

Alcohol shakes, also referred to as hangover shakes or tremors, are a potential symptom of alcohol withdrawal. When your body gets used to drinking excessively, it can become reliant on alcohol to maintain its balance. Because of this alcohol dependence, suddenly reducing your consumption (whether quitting alcohol cold turkey or practicing moderation), can result in a variety of alcohol withdrawal symptoms including trembling that typically affects the hands. Alcohol shakes can be a sign of mild or severe alcohol withdrawal, most frequently occurring 6-24 hours after alcohol was last consumed before reaching their peak within 24 to 72 hours.¹

Seeking more information about alcohol shakes or tremors is helpful in understanding physical alcohol dependence and identifying safe steps for cutting back on drinking. However, if you believe you are currently experiencing shakes, tremors, or any other alcohol withdrawal syndrome side effects, please contact your health care provider immediately. If this is a medical emergency, please call 911.

For those looking for non-urgent information about shakes and tremors to inform conversations with your healthcare provider and/or loved ones, continue reading to learn more about the causes and signs of these alcohol-induced symptoms. To understand why alcohol shakes occur, let’s dive into the brain chemistry of withdrawal.

The Chemical Explanation Behind Alcohol Withdrawal 

Alcohol can affect brain chemistry while we are drinking and after we stop. Frequently asked questions from my patients include ‘is alcohol a stimulant or depressant?’ and ‘why do I feel so horrible when I stop drinking?’ A sudden cessation or reduction in alcohol intake can lead to alcohol shakes and tremors, among other alcohol withdrawal symptoms. That’s why before you cut back on consuming alcohol, it’s crucial that you connect with a health care provider to discuss your safest course of action. Regardless of your drinking habits, whether you classify them as long-term daily use, binge drinking, or otherwise, it’s always recommended to check in with a professional. Now, let’s dive into the chemistry of alcohol withdrawal.

In a normal state, your brain keeps you alert and calm by keeping what’s called your inhibitory and excitatory systems in balance. This is also known as E-I balance. Alcohol throws off this balance by enhancing the activity of a major inhibitory chemical in your brain called GABA, resulting in you feeling relaxed and drowsy. As you continue to drink regularly and spend more time in the inhibited state, your brain tries to find E-I balance again. The brain seeks this balance by reducing your natural inhibitory activity (because alcohol is already unnaturally increasing inhibitory chemicals) and increasing excitatory activity. 

When you suddenly stop drinking or decrease alcohol consumption significantly, you remove the unnatural inhibitory chemicals, and your inhibitory and excitatory systems are imbalanced. Your inhibitory system is depressed, and your excitatory system is overly enhanced. This leads to an overexcitation of your brain and the development of signs and symptoms of alcohol withdrawal, including the possibility of shakes, tremors, and other symptoms. 

Symptoms of Alcohol Withdrawal 

Alcohol withdrawal can have mild to severe symptoms. Severe withdrawal symptoms can be life-threatening, and it’s crucial to both be aware of them, and discuss potential risks with your healthcare provider.

Alcohol shakes and tremors

One possible symptom is alcohol shakes and tremors, which refers to an uncontrollable shaking or involuntary quivering, commonly in the hands and feet. In addition to alcohol withdrawal shakes and tremors, people may experience anxiety, sweating, agitation, headache, nausea, and vomiting. 

About 80% of people who are dependent on alcohol experience withdrawal symptoms to some degree, though most improve within a week without complications.² However, in more severe cases, people may have auditory, visual, or tactile hallucinations, among other symptoms. A common tactile hallucination is feeling a bug crawling under your skin. If you’re experiencing symptoms, including shaking hands when not drinking alcohol, you should check in with your healthcare provider. They will work with you to provide the safest course of action, and also provide relief by answering your questions.

Hallucinations

Hallucinations can occur without any prior symptoms and are most likely to develop 8 hours after the last drink and peak at 24-96 hours.² If you believe you are experiencing withdrawal symptoms, you should seek medical attention immediately at your local emergency room and call 911 in case of emergency. 

Seizures

In addition to hallucinations, seizures are another potentially severe symptom of alcohol withdrawal. Withdrawal-related seizures can occur even if you don’t have other symptoms. Seizures can begin as early as 12 hours after the last drink and can last up to 48 hours.² About 5-15% of people withdrawing from alcohol develop seizures.²

The risk is the greatest for people who previously had seizures and those withdrawing from other sedatives such as benzodiazepines. When navigating alcohol treatment, it’s especially important to accurately share your medical history and alcohol consumption history with your provider, so that they can provide the safest and most appropriate care for you. Hallucinations and seizures can also be part of a severe alcohol withdrawal response known as delirium tremens.

What is the Difference Between Delirium Tremens (DTs) and Tremors?

Delirium tremens (DTs) is among the most severe and potentially life-threatening symptoms of alcohol withdrawal. As the name suggests, the signs of delirium tremens include confusion, disorientation, fever, high blood pressure, rapid heartbeat, and drenching sweats. Withdrawal delirium typically begins between 1 to 3 days after the last drink and peaks on the 4 to 5th day.²

As a physician on the Monument platform, I often hear patients confuse DTs with tremors when first learning about alcohol withdrawal. While DTs symptoms may include alcohol tremors and shakes, DTs is also characterized by other signs of severe alcohol withdrawal, like high blood-pressure and seizures. In comparison, alcohol tremors and shakes are more common than DTs, and can be a sign of mild or severe withdrawal.  

Are Withdrawal Symptoms a Sign of Alcohol Use Disorder or Alcohol Dependence?

Another question I’m often asked by my patients is ‘are withdrawal symptoms a sign of alcohol use disorder or alcohol dependence?’ Many people use the terms alcohol dependence and alcohol use disorder interchangeably, but they are not the same. 

Alcohol dependence and withdrawals

Technically, alcohol dependence refers to having withdrawal symptoms due to the cessation or reduction of alcohol consumption. So, in brief, alcohol withdrawal symptoms are a sign of alcohol dependence. However, if you experience withdrawal symptoms, you may also meet the clinical criteria for alcohol use disorder, or ‘AUD.’ 

Alcohol use disorder and withdrawals

Defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) as “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences,”  experiencing withdrawals is one of the criteria used to diagnose alcohol use disorder. An individual needs to meet two of eleven criteria outlined by the American Psychiatric Association to be diagnosed with AUD, which may or may not include withdrawal symptoms. 

However, having withdrawals is a strong indication that you’ve been drinking heavily for a prolonged period, and that there is a higher chance of developing or having AUD. To take an AUD assessment, you can sign up for the Monument Community. If you do meet the criteria for alcohol use disorder, it’s essential to understand that treating alcohol withdrawals is not a treatment for alcohol use disorder. It’s undoubtedly a critical first step in your recovery, but you will likely want to engage in longer-term treatment and support to treat alcohol use disorder itself. 

How to Treat Alcohol Shakes and Other Withdrawal Symptoms

The safest way to prevent dangerous withdrawal symptoms is to consult with a medical professional to assess your risk and align on the appropriate level of care. Depending on the risk level, medical withdrawal management, commonly known as “detox ,” may be recommended. Supervised alcohol detox may require medication and frequent monitoring to be done safely. Furthermore, other medical conditions can mimic acute alcohol withdrawal or post-acute alcohol withdrawal, so it’s important to get immediate medical attention to receive accurate diagnoses and care.

It’s difficult to predict the course of acute alcohol withdrawal symptoms, which is why it’s recommended to seek expert guidance. Some people have very mild symptoms that resolve quickly, while others have more severe and prolonged courses. There is also the possibility that an individual develops prolonged withdrawal symptoms, also known as post-acute withdrawal syndrome (PAWS), which can last a few weeks to a few months. You can learn more about withdrawal, and PAWS specifically, by taking a closer look at the alcohol recovery timeline.

Long-term Online Alcohol Treatment

Seeking support to change your relationship with alcohol is something to be proud of, and working with a physician and therapist is a great way to prioritize your health and safety. If in-person supervised alcohol detox is recommended due to the risk of alcohol withdrawal, you are not alone. After safely completing detox and reducing the risk of alcohol withdrawal, many people pursue longer-term care such as online alcohol treatment. Monument connects you to physicians like myself, and licensed therapists who can help you build a treatment toolkit to empower your long-term success. 

That treatment toolkit may include medication to stop drinking, online alcohol therapy, and/or alcohol support groups. In addition to working with an expert Care Team, finding community  with other people with shared challenges and experiences can provide additional encouragement and accountability. Regardless of your pathway to recovery, your experience is valid, and you deserve to feel safe and supported. To connect with a physician to discuss your personal needs and goals, explore your treatment plan options today. 

Sources:

1. National Library of Medicine. “Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes-Beyond Benzodiazepines, https://pubmed.ncbi.nlm.nih.gov/28601135/.” Accessed Aug. 25, 2021.
2. Res World. “Kindling in
   Alcohol Withdrawal, https://pubs.niaaa.nih.gov/publications/arh22-1/25-34.pdf.” Accessed Aug. 25, 2021.

Let’s start with an important reminder. Your relationship with alcohol is not a reflection of your love for your family, and working to make a change is incredibly admirable. If you’ve struggled to manage your drinking while parenting, you may be wondering specifically how a parent’s drinking patterns can impact a child. While the thought of your own struggles affecting your loved ones can be incredibly difficult to face, I often encourage my patients to keep their relationship with their child close at heart while they work to change their alcohol consumption through sobriety or moderation. This is not to instill guilt, but to provide purpose and empowerment as you navigate the changes you’d like to make for yourself and your family. It’s my hope that by reading this article you will better understand how a parent’s drinking habits can affect a child, and learn steps you can take to help your family move forward in a healthy and connected way. 

How exposure to alcohol use disorder can affect children

Alcohol use disorder (AUD) is a medical condition characterized by drinking more than you want and for longer than you want, despite wanting to cut down. AUD is not a moral failing, and it can be treated with tools such as therapy and medication when safe and appropriate. Despite anyone’s best intentions, those close to someone with AUD, whether that’s a young child or older adult, can be significantly affected by their drinking. Children, in particular, face a unique set of challenges. 

One of the largest studies done on childhood trauma is called the Adverse Childhood Experiences Study, or ACES study. This study followed over ten thousand individuals throughout their lifetime, gathering information on their health. A correlation was made between the amount of toxic stress experienced from ages 0-17 and an individual’s health outcomes. Having a parent with alcohol use disorder was one factor of adverse childhood experiences included in the study. This study illuminated that being a child of a parent with a substance use disorder can increase the likelihood of physical and mental health problems (largely due to genetic and learned behavioral factors). 

Depending on how many factors an individual listed, a young person was more likely to later encounter challenges such as depression, anxiety, or experiencing a substance use disorder themselves. Stressors faced in childhood are also closely associated with the development of one’s attachment style, which is the way someone connects with others throughout their lifetime. 

Understanding attachment styles 

Attachment patterns are influenced by the distance or attention caregivers provide to a child’s needs. The four major attachment styles are:

1. Anxious
2. Avoidant-dismissive
3. Avoidant-fearful
4. Secure

Anxious attachment

An anxious attachment is typically indicative of a fear of abandonment due to inconsistency in parenting. 

Avoidant-dismissive attachment

Avoidant-dismissive attachment is characterized by fear of intimacy, commonly driven by a parent being distant or unable to fully validate their child’s needs.  

Avoidant-fearful attachment

Avoidant-fearful attachment forms with inconsistent and sometimes fear-based parenting. 

Secure attachment

A secure attachment is one where most of a child’s needs and emotions are validated and attended to. A secure attachment translates into more trusting relationships in the future, increased self-esteem, and an overall ability to regulate emotions and take care of oneself. 

Attachment styles characterized by unmet needs and abandonment can influence the likelihood of an individual developing AUD. If you’re navigating alcohol use disorder, that doesn’t mean your children will necessarily develop any of the above attachment styles, or that responsible drinking isn’t attainable for them. However, any unhealthy drinking behavior can consume our time, energy, and attention, and can create distance between ourselves and the people we love the most. If that rings true to you, you are not alone. 

How to start building a more secure attachment

It’s important to remember that none of this is irreversible. As a parent you can take steps to assess and address any potential strains in attachment that have been linked to your drinking habits. Inevitably, this usually leads to the realization of needing to assess your own attachment style and “reparenting” yourself by building a more secure understanding of your own needs. 

If you catch yourself resenting an aspect of what your child receives from you or another loved one, this is often a cue to reflect on your own childhood memories and learned behavior. This may mean facing unmet needs from your caregivers, recognizing what you have not felt safe to fully experience as a young child, and rebuilding confidence in how well you were able to overcome challenges. In online alcohol therapy, a specialized therapist can help you identify how your experiences have shaped your life, and how to manage your needs and emotions while changing your relationship with alcohol. Cultivating a sense of self-forgiveness in recovery can be a powerful way to reconcile with your past actions, and understand what may have influenced them. Once you start a journey of self-reflection and reconciliation, you become more free to explore who you really want to be as a parent. It also allows you to model unconditional love (including self-love), and create an environment where it feels safe to make mistakes and persevere. 

Many parents have navigated these same questions and challenges when drinking alcohol, and throughout their sobriety or moderation journey. Hearing others’ stories about how drinking alcohol impacted their parenting and how they made a change can provide relief and motivation. Monument contributor Celeste Yvonne shared how she navigates wine mom culture without wine, with tips including how to replace an alcoholic beverage with alcohol alternatives and how to prioritize your own needs. You are not alone. 

Answering your child’s questions 

As you continue to work on understanding your relationship with alcohol, you will gain greater clarity into your ‘why.’ However, these complex, interconnected influences can be challenging for children to grasp. Throughout my years of working with families, I’ve identified common patterns of questions that children, at all stages of development, have about their parents’ relationship with alcohol. Answering these questions can provide reassurance and enable collective healing. Common questions include: What can I do to help? Will things ever change? Is there something I did wrong for my parent to feel they need to drink more? Will they always need to drink? How will I know I can trust they’ll be there when I need them? 

Every parent wants their child to know they can count on them for a sense of safety and trust, so these are hard questions to confront. That said, there can be several long-term impacts to a child’s emotional development if these questions about parental drinking are not discussed. When you’re ready to address your child’s questions, it can be incredibly helpful to have family therapy sessions or prepare with your own therapist ahead of time. If this is not feasible at this time, know that the greatest healing comes from taking ownership of your own health, validating your child’s emotions, and coming up with collaborative next steps for what skills or activities of self care in recovery you can practice individually and together. Creating a space where everyone can voice their emotions, especially when shame, blame, or guilt arises, is so vital for the overall health of the family system. Establishing boundaries is also crucial. This means taking ownership of your own body and health, while modeling ways your child can collaborate on shared healthy habits. This balance reduces the risk of your child feeling isolated, helpless, or left to take on the responsibilities of the parent. 

How stigma influences treatment 

From my clinical practice, I have come to find that those who have a family history of AUD often have an increased sense of stigma around their struggle to find care, because they have previously associated it with something morally wrong. They may have sought out support sooner if they did not have the extra stigma from their past experiences of witnessing loved ones struggle without proper tools to heal. That said, many come to find through their treatment journey that they have not only healed themselves and their younger selves, but have had a positive impact on loved ones who start to seek treatment as well. Never underestimate how much your self-care impacts everyone around you. Especially as a parent, you can break the cycle and heal the generations of the past, while also being a role model for the generations to come. 

It takes a village to raise a child, and there is no shame in needing support to change your relationship with alcohol. There’s community and expert resources to get your drinking habits and relationships to where you want them to be and our online alcohol treatment is available whenever you need it. Having the courage to reflect on your habits and envision a better life for yourself requires a tremendous amount of determination, vulnerability, and bravery. What could be a greater gift to your child than to set that example?

Sources:

Ainsworth, M. S., & Bowlby, J. (1991). An ethological approach to personality development. American Psychologist, 46(4), 333–341. https://doi.org/10.1037/0003-066X.46.4.333

https://www.cdc.gov/violenceprevention/aces/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Ffastfact.html

Tsabary, S. (2010). The Conscious Parent: Transforming Ourselves, Empowering Our Children. 

https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.53.8.1001

As a physician on the Monument platform, one question many of my patients have is if alcohol is a stimulant or a depressant. While alcohol may replicate a stimulant in the short term, alcohol is officially considered a depressant.

The human body is incredibly complex, and oftentimes its initial response to substances and circumstances may not fully represent their long-term effects. The physiological response to alcohol can be especially misunderstood. Understanding that alcohol is actually a depressant can help illuminate the long-term effects of alcohol on the body and the benefits of sobriety or alcohol moderation. 

What is the difference between a depressant and a stimulant?

To understand why alcohol is a depressant, it’s important to make this distinction.

• A depressant is a chemical that slows the central nervous system. The slowing of the central nervous system in turn slows down brain function and brain activity, which can cause a lack of concentration, coordination, and alertness. A drug or substance that has a depressant effect or sedative effect on the central nervous system is called a CNS depressant.
• A stimulant is a chemical that speeds up central nervous system activity, causing an increase in alertness, attention and energy. A stimulant also often leads to an increased heart rate and increased brain activity or brain function.

When assessing if a substance is a stimulant or a depressant, it’s important to look beyond just the immediate, often euphoric, effects. Whether a substance is classified as a stimulant or a depressant is based on its long-term, cumulative impact on nervous system tissues.

The common misconception that alcohol is a stimulant

Some people falsely assume that alcohol is a stimulant because the initial effect of drinking can include becoming chatty, more confident, or more assertive. This ‘stimulating’ phenomenon is explained by a surge in the release of dopamine in the tissues of the brain after the first few sips of alcohol. Dopamine can be thought of as a “feel-good” or pleasure chemical. As more alcohol is consumed, dopamine is continuously released, and has a stimulating effect that can make it especially challenging to stop drinking. Dopamine also causes a chain-reaction that stirs up a rush of chemicals called ß-endorphins, which are more “feel-good” chemicals. Drinking alcohol and the resulting dopamine and ß-endorphins rush can also cause an increased heart rate and stimulant effect. This flood of dopamine and ß-endorphins is very short-lived (approximately 30-75 minutes) depending on the amount and potency of alcohol consumed.

This dopamine reaction is also the reason people can develop alcohol cravings and why others might take naltrexone to combat them. Naltrexone benefits include indirectly decreasing the release of dopamine, and helping to weaken the association between alcohol and pleasure.   Naltrexone is a medication to stop drinking that can be prescribed by a physician on the Monument platform if safe and appropriate.

It’s also crucial to speak to a healthcare provider before cutting back on your alcohol intake due to the potential risk of alcohol withdrawal. Alcohol withdrawal symptoms can include alcohol shakes, ‘hangxiety,’ and more, and can be dangerous and even life-threatening. These symptoms are signs of alcohol dependence and can be an indication of alcohol use disorder.

Is alcohol ever considered a stimulant?

Alcohol is only considered a stimulant when paired with stimulating substances. There have been many examples of this through time. From the “hot toddy” liquor paired with coffee to recent caffeine-alcohol beverages (CAB’s) or energy drinks like Four Loko. These drinks are a dangerous mix of caffeine (a stimulant) and alcohol (a depressant)), and can have a stimulating effect. This combination of substances sends your central nervous system very mixed messages, and can have significant health consequences 

So alcohol is classified as a depressant, what does that mean?

Alcohol is classified as a neurocognitive depressant because it “depresses” the central nervous system. This means it slows down communication between the brain and the body, which causes impairment such as speech slurring, motor incoordination, brain fog, delayed reaction time, disorientation, intoxication, memory loss, and black-outs. As alcohol is consumed more and more, the depressant effects also become more likely to develop. While some may seek the sedative effect of alcohol in an effort to relax, alcohol consumption is also proven to exacerbate anxiety (or ‘hangxiety‘) and depression in the long-term. 

How does alcohol consumption interact with depression?

Another common question I get is “how will a depressant affect my pre-existing depression?” Research shows that if a person has been diagnosed with major depressive disorder and they also meet the criteria for alcohol use disorder, continuing to consume alcohol will worsen and intensify their depression, and make them less responsive to mental health treatment. Another concern can be the interaction between alcohol and the pharmaceutical medication prescribed to treat mental health conditions. Mixing alcohol with commonly prescribed depressant drugs (such as Xanax and Valium) can be dangerous or even life-threatening. Speaking with your health care provider directly can provide the most clarity on what is safe for you. Additionally, with a patient’s permission, the physicians at Monument can coordinate care with psychiatric prescribers to ensure your mental health care and substance health care are coordinated and well-managed.

Exploring Treatment for Alcohol Use Disorder

For anyone navigating depression and seeking relief through drinking alcohol, you are not alone. You deserve healthier coping mechanisms. Tools like online alcohol treatment can help you navigate intense emotions, restructure negative thought patterns, and so much more. Therapy is a great tool for addressing unhealthy alcohol use and depression simultaneously. Meeting with a licensed therapist that specializes in addiction therapy and substance use disorders (like alcohol use disorder) can help you treat co-occurring conditions like depression and anxiety. You deserve support and relief, and it’s within reach.

Understanding the effect alcohol has on your body and your life is a major step towards cultivating a happier and healthier version of you. Learning more about this topic today is already something to be proud of. There are many options to help you change your relationship with alcohol and its depressant effect. These include medication, specialized online alcohol therapy, and therapist-moderated support groups. There’s great relief and healing that comes with freedom from substances, and we’re here to help you get there.

Disclaimer: Our articles and resources do not constitute health care services. If you’re interested in medication to stop drinking, please consult your healthcare provider or enroll in a Monument treatment plan to discuss what tools are best for you. This article is intended to help inform conversations with your provider.

As a physician on the Monument platform, my patients often remark that they wish they had known about medication to stop drinking sooner. Alcohol use disorder is a medical condition, and it’s important that alcohol treatment options like medication are well-known so that more people get the care that they deserve. There are two medications that physicians on the Monument platform prescribe when deemed safe and appropriate: naltrexone and disulfiram. Disulfiram is also commonly known by its brand name, Antabuse. There are several factors taken into account in order to determine which medication, if any, is appropriate for each individual. 

The best way to understand what medication is right for you is to discuss your sobriety or moderation goals with a physician. Monument’s online alcohol treatment connects you to expert physicians and therapists from the comfort of your own home. Your physician will thoroughly explain naltrexone vs Antabuse (disulfiram) in the context of your needs and answer any questions. If appropriate, your physician can then prescribe you naltrexone or disulfiram online. In the meantime, here is some background information to keep in mind when considering medication to stop drinking alcohol or medication to help reduce your alcohol consumption. Before we dive in, I also want to remind you that there is no shame in using medication as a tool in your toolkit. Taking care of yourself is something to be proud of, and like many other medical conditions, medication can be very effective. While medication is not a ‘silver bullet,’ it can address the biological influences on our drinking habits and help empower behavioral change. 

How Do Physicians Determine Which Medication is Right For You?

When I discuss medication with patients, I first ask them how much and how often they consume alcohol. This is important because it allows me to understand where they might fall on the alcohol use disorder spectrum. Depending on a patient’s history drinking alcohol and risk for alcohol withdrawal symptoms, detox may be necessary before starting any medications. I also ask about if their personal goal is to achieve sobriety or to drink in moderation, their potential drinking triggers, if they have participated in treatment programs before, and if they’ve ever taken naltrexone or disulfiram. All of these factors and more are taken into account when a patient and physician are assessing if medication is an appropriate option, and if so, which one.  

While they are both FDA-approved for the medication assisted treatment of alcohol use disorder, naltrexone and Antabuse (disulfiram) are completely different medications and act in very different ways. If medication is the right treatment option for you, the decision of which one is often a matter of your previous alcohol consumption patterns, medical history, and your personal goals for changing your drinking habits. Understanding how each medication works will help illuminate why. 

If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare  provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911.

What is Naltrexone and How Does it Work?

Naltrexone is an FDA-approved medication that has been found to help support sobriety or moderation. A meta-analysis of 50 randomized clinical trials with 7793 participants concluded that oral naltrexone was effective at reducing the amount and frequency of drinking.¹ Naltrexone works by blocking the effects of dopamine, a ‘feel-good’ hormone released during alcohol consumption, so that the brain’s association between alcohol and pleasure weakens. As a result, when drinking on naltrexone, you’re less likely to want to continue drinking after having your first alcoholic drink. This can also help curb the feeling of alcohol craving over time. To better understand naltrexone benefits, you can learn more about how naltrexone works and the science behind alcohol cravings. Some people use oral naltrexone to begin their sobriety or moderation journey, while others use it as a tool to help maintain long-term sobriety. Many of my patients also begin naltrexone without knowing their end goal, and that’s completely valid.

What is Antabuse and How Does it Work Differently?

While naltrexone can be used to support moderation or sobriety, disulfiram, also known as Antabuse, is exclusively for those looking to practice alcohol abstinence. But how does disulfiram work? Disulfiram inhibits alcohol from metabolizing. After taking disulfiram, the body doesn’t break down alcohol the way it normally would. This leads to accumulated ethanol in the body, which can cause a negative response to alcohol consumption called the “disulfiram reaction” or the “Antabuse reaction”. This response can include flushing, headache, nausea, vomiting, sweating, shortness of breath, dizziness, and other symptoms. Because of how disulfiram works, it can be dangerous to drink any amount of alcohol while taking disulfiram. Many people who are interested in taking disulfiram believe they would benefit from the strong biological reinforcement not to drink. Others may start on naltrexone, and for a variety of reasons choose to switch to disulfiram (or vise versa). The alcohol recovery timeline looks different for everyone, and all pathways are valid. 

If you consume alcohol while taking disulfiram and experience symptoms such as trouble breathing, seizures, loss of consciousness, and chest/jaw/left arm pain, you should seek medical attention immediately and call 911 in case of emergency. 

Naltrexone or Antabuse: How Do You Know Which Is Right For You?

To answer this question, I’d recommend spending some time reflecting on your current relationship with alcohol and your goals for what you want to change. Engaging in alcohol therapy or joining a therapist-moderated alcohol support group are great ways to receive support and guidance as you explore what you want out of your journey. 

Ask yourself these questions to help discover what’s right for you:

• Are you hoping to achieve long-term moderation, long-term sobriety, or sobriety with a return to moderate alcohol use later on? 
• Are you looking for a gradual start or a strict reminder to practice alcohol abstinence? 

Your Monument Care Team can help provide guidance that aligns with your medical history and needs as you answer these questions. Both medications can be effective in helping people to stop drinking. You don’t have to figure it all out at once, but engaging in personal reflection and discussion with your physician and therapist can help clarify which medication would be the best place to start. 

Why is it Important to Keep in Contact With Your Physician?

If and when a medication is chosen as part of a personalized medication assisted treatment plan, it’s crucial to keep a close relationship with your physician. This allows your physician to determine if the medication is working the way it should, if your drinking habits are changing in accordance to your goals, and if you need a change in dosage or the medication itself. Your physician can also help guide you through any challenges you may experience throughout your journey, and address any adverse side effects. Like we often say at Monument, changing your relationship with alcohol is a non-linear journey, and your physician is there to provide support at every turn. 

It’s also important to note that based on your past medical history, it’s possible that a certain medication may not be safe and appropriate at this time. Your physician will provide you with this information.

What Are the Side Effects of Antabuse and Naltrexone?

Both naltrexone and Antabuse are generally well-tolerated, with minimal side effects. When taking naltrexone, the most common side effects are nausea and headaches. For those taking Antabuse, the most common side effects are headaches and drowsiness. It’s also important to note that alcohol should never be consumed while taking Antabuse. Given its chemical properties, drinking on Antabuse can cause severe or even life-threatening side effects. However, taking Antabuse while abstaining from alcohol has very minimal risk. If you experience side effects while taking naltrexone or Antabuse (also known as ‘disulfiram’), it’s important to speak with your physician who can help you make adjustments to minimize symptoms. 

What is the Cost of Naltrexone vs Antabuse?

Without any insurance coverage, daily naltrexone or Antabuse pills typically cost around $40 per month for 30 days. Both naltrexone and Antabuse can be a fraction of the cost with insurance coverage.

Does Monument Offer Naltrexone and/or Antabuse?

Both naltrexone and Antabuse can be prescribed at Monument. All Monument treatment plans begin with a call with a licensed physician to discuss your health history, preferences, and sobriety or moderation goals. Based on your conversation, your physician will prescribe medication if safe and appropriate for you. Pending a prescription, you can get your medication delivered directly to your door, or at your local pharmacy if preferred. Medication is 100% optional.

Medication to help stop drinking can be an incredibly impactful way to make progress towards your goals. Receiving additional support can also empower sustainable behavioral change. Alcohol therapy and therapist-moderated support groups can help you develop new coping mechanisms, establish boundaries, restructure negative thought patterns, and much more. Your Care Team also recognizes that your goals and circumstances can change and ensure your treatment plan responds to your needs and preferences. It is their hope to create a flexible, shared decision-making process to help you achieve success. This journey is your own, and you should feel empowered to engage in any and all tools that can help you get to where you want to be. 

Sources:

1. Cochrane Library. “Opioid antagonists for alcohol dependence, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001867.pub3/information.” Accessed Aug. 3, 2021.
   

Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use for a patient with active liver disease must be carefully considered in light of its hepatotoxic effects.

In the treatment of alcohol dependence, adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness, and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list.

The most common side effects of Disulfiram may include drowsiness, tiredness, headache, acne, and metallic-like taste in the mouth. Call your doctor if you have signs of serious side effects such as decreased sexual ability, vision changes, numbness of arms or legs, muscle weakness, mood changes, seizures, or confusion. Do not take Disulfiram if you are allergic to any of the ingredients. If you begin to have signs of an allergic reaction, then seek immediate medical attention. Avoid consumption of alcohol while taking this medication, as it may lead to adverse side effects. Talk to your doctor about the history of your medical conditions including if you have or have had diabetes, underactive thyroid, brain disorders, liver or kidney disease, personal or family history of regular use/abuse of drugs. Certain drug interactions may lead to serious adverse side effects. Let your doctor know about any other medications you are taking. This is not a complete list of potential adverse events associated with Disulfiram. Please see Full Prescribing Information for a complete list.*Monument Inc. provides administrative and business support services to independent medical and clinical practices and providers. Monument Inc. does not provide medical or clinical services and does not own medical or other clinical practices. All medical services are provided by Live Life Now Health Group, PA d/b/a Live Life Now Medical Group. All counseling and therapy services are provided by independent licensed practitioners including licensed clinical social workers (LCSW) and licensed mental health counselors (LMHC). Individuals should contact their physician or therapist with any questions about their treatment.