Gabapentin For Alcohol Use Disorder

How Is Gabapentin Used To Treat Alcohol Use Disorder?

Gabapentin is a medication used off-label to treat alcohol withdrawal and as an aid in relapse prevention. The term “off-label” refers to a medication that is not FDA-approved for a specific use but is still prescribed and proven to be effective. Brand names of gabapentin include Horizant, Gralise, and Neurontin.

The first stage of alcohol use disorder (AUD) treatment is managing alcohol withdrawal effects, which can be dangerous and lethal. Common alcohol withdrawal effects include seizures, changes in blood pressure and heart rate, sweating, anxiety, irritability, shakiness, nausea, and vomiting.

Unlike medications such as naltrexone, which reduce alcohol cravings, gabapentin is used to help alleviate alcohol withdrawal side effects. A 2020 study published in JAMA stated that, “41% of participants with high alcohol withdrawal symptoms had total abstinence on gabapentin compared with 1% of participants in the placebo arm.”

The key finding in this study is that gabapentin was successful in helping maintain abstinence in people who experienced alcohol withdrawal symptoms before entering alcohol addiction treatment, meaning that it is a key medication in the alcohol withdrawal phase.

Generally, benzodiazepines are the first-line treatment for alcohol withdrawal as they relieve withdrawal symptoms and prevent seizures and delirium tremens. However, benzodiazepines have a high potential for addiction, are sedating, and can alter physical and cognitive functions. Therefore, benzodiazepines are generally used only for acute alcohol withdrawal that is moderate or severe.

Gabapentin is an alternative option to benzodiazepines to treat alcohol withdrawal and can be continued into the stages of early abstinence. Gabapentin is effective in the transition between mild alcohol withdrawal and early abstinence because it improves mood, sleep, and anxiety, which are known triggers for relapse.

Gabapentin could be a specific treatment for patients who have a history of strong alcohol withdrawal symptoms.

Gabapentin can also be used to help prevent relapse and, therefore, can be a long-term treatment to help maintain abstinence. Although naltrexone and acamprosate are the first-line treatments for relapse prevention in AUD, gabapentin has been shown to be more effective for relapse prevention than placebo in randomized controlled studies. Therefore, it is an alternative method for treating relapse when first-line medications are not successful or cannot be tolerated. Some side effects of gabapentin include dizziness and fatigue, but it is important to note that very few people had significant enough side effects to stop treatment.

How Does Gabapentin Work?

Researchers do not yet fully understand how gabapentin works for alcohol use disorder treatment. Still, it is known that gabapentin acts on chemicals (neurotransmitters) in the brain by blocking the release of excitatory chemicals. Gabapentin, therefore, decreases the excitation of the central nervous system.

Alcohol is a central nervous system (CNS) depressant. It enhances the effects of GABA (an inhibitory neurotransmitter) while reducing the activity of glutamate (an excitatory neurotransmitter), creating an overall inhibitory effect on both the mind and body. This is why consuming alcohol results in slurred speech, impaired coordination, slowed reaction times, and drowsiness. When alcohol consumption is reduced or stopped, the brain is left with a surplus of glutamate, creating a state of rebound excitatory activity. This results in the body’s withdrawal symptoms such as tremors, anxiety, increased heart rate and blood pressure, irritability, and seizures.

Gabapentin reduces glutamate during this hyperexcitatory rebound phase. It increases the concentration of GABA, overall restoring the withdrawal hyperexcitatory state into a more normal state by normalizing the activity of both GABA and glutamate.

Can Gabapentin Help Me Cut Down Or Stop Drinking?

Yes, gabapentin can help you cut down or stop drinking, especially if you have previously experienced withdrawal side effects or are currently in the alcohol withdrawal phase.

Gabapentin can also help improve symptoms of anxiety and sleep, which are key components in alcohol recovery, as many people struggle with both anxiety and insomnia. Clinical experts suggest that gabapentin can be used as part of a comprehensive rehab plan with social supports such as Alcoholics Anonymous, individual and group psychotherapies, and other evidence-based medications to treat AUD.

Research has shown that taking gabapentin with antidepressants is well tolerated, meaning that people with depression being treated with SSRIs can also take gabapentin for alcohol use disorder. However, addiction experts caution against using sedating medications such as opioids and benzodiazepines when taking gabapentin, as this combination can pose mental health risks such as suicidal ideation.

How Long Should I Take Gabapentin?

Research shows that gabapentin is safe and well-tolerated when the dosage is equal to or less than 1800mg/d for up to 12 weeks in duration.

How Do I Get Gabapentin For Alcohol Use Disorder Treatment?

Gabapentin is a prescription medication, and therefore, any licensed healthcare professional who is allowed to prescribe medications can provide gabapentin. This includes family medicine doctors, nurse practitioners, physician assistants, addiction medicine physicians, and psychiatrists.

Addiction professionals are best qualified to prescribe gabapentin for AUD because other treatments, including addiction medications and mental health medications, may also be needed. Therefore, it is important to understand medication interactions and to treat alcohol use disorder from a holistic perspective. In general, gabapentin is usually not the only treatment used for alcohol use disorder, as other treatments such as psychotherapy approaches and medications are often needed.

Additional Treatments For Alcoholism

Alcohol use disorder affects approximately 14% of American adults. Fortunately, AUD can be treated with a multidisciplinary approach, including psychotherapy approaches, treatment medications, and social supports. Treatment medications used for alcohol use disorder include acamprosate, disulfiram, and naltrexone.

There are many evidence-based psychotherapy options to treat alcohol use disorder. One of the most studied and effective options is cognitive behavioral therapy (CBT). CBT focuses on the maladaptive thoughts, actions, and relationships associated with drinking and works to change them into positive coping perspectives to help manage urges and triggers. CBT can also help address co-occurring mental health disorders such as depression and anxiety that commonly co-occur with AUD.

Community social supports such as Alcoholics Anonymous can be effective when used with medications and psychotherapy approaches; however, it is important to note that AA should not be used to replace formal addiction treatment.

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Treatment medications like gabapentin can be helpful components of alcohol addiction treatment programs. If you are interested in learning more about overcoming alcohol addiction, help is available. Explore our rehab directory or contact a treatment provider today to uncover your rehab options and begin your recovery journey.