Can a drug designed to treat epilepsy and nerve pain help reduce alcohol withdrawal symptoms? Or should addiction treatment professionals be cautious about prescribing this medication to those who have a history of drug abuse?
According to a new study published in JAMA Internal Medicine, gabapentin was effective in “preventing relapse to heavy drinking and, perhaps more importantly, in promoting abstinence.” And seeing as alcohol is the most common reason people go to rehab, these results could help shape the way psychiatrists, detox facilities, and medical teams treat alcoholism.
Figure 1: Data retrieved from https://www.samhsa.gov/data/sites/default/files/National_BHBarometer_2014/National_BHBarometer_2014.pdf
Gabapentin, which is also prescribed under brand names Neurontin® or Gralise®, first hit the U.S. in the 1990s as an anticonvulsant and then as a treatment for restless leg syndrome and hot flashes. But what makes it of interest to drug and alcohol addiction treatment centers is its chemical structure.
As a GABA analogue, gabapentin is similar in structure to that of GABA, a naturally-occurring amino acid that makes you calm and improves your mood. Because of this, addiction psychiatrists have used it to treat anxiety disorders, bipolar depression, and even insomnia – common co-occurring disorders seen in those with substance use disorders (SUD).
Yet, according to Dr. Raymond F. Anton and his team, gabapentin “might work best in those with a history of more severe alcohol withdrawal symptoms.”
Currently, benzodiazepines like Valium®, Librium® and Ativan® are the gold standard in alcohol detox centers. But this new research begs the question of whether or not benzodiazepines should be phased out in favor of this safer alternative.
What Does The New Gabapentin Study Show Us?
Over the course of 16 weeks, Dr. Anton and his team at the Medical University of South Carolina evaluated the effects of gabapentin on 90 patients detoxing from alcohol. They wanted to see if (a) gabapentin reduced alcohol withdrawal symptoms in heavy drinkers and (b) whether it helped drinkers remain abstinent afterwards.
Why was this of interest? Well, detoxing from alcohol isn’t easy.
More than half of those suffering from alcohol use disorder (AUD) complain of uncomfortable withdrawal symptoms. And although detox helps navigate the majority of these, many symptoms persist for weeks or even months after they’re discharged – tempting users to drink again.
Nagging symptoms like irritability, dysphoria, and insomnia can cause patients to participate less in inpatient treatment. And because of this, the majority of people with AUD relapse.
Luckily, Dr. Anton’s gabapentin study shows some promise from chronic alcoholics.
In their placebo group, 9% of participants reported no heavy drinking days (e.g. drinking more than 13 drinks per day) during the study. But the gabapentin group did 3x better! Of those prescribed gabapentin, roughly 27% reported no heavy drinking days.
Not only did the participants drink less, those on gabapentin actually started putting the bottle down altogether. Roughly 21% of those on the anticonvulsant remained completely abstinent over the 4-week study. That’s more than 5x better than the placebo group.
Participants reported mild side-effects such as dizziness, headaches, and sluggishness. But, thanks to reporting by Healthline, Dr. Anton is on record saying that, “Very few people had significant enough side effects to stop treatment.” And some even reported getting a better night’s rest.
The results of this study are extremely promising for those with severe drinking problems. That’s because individuals who presented with high alcohol withdrawal scores tended to report decreased drinking days and lower relapse rates than the other groups.
What’s even more shocking is that gabapentin’s efficacy in treating severe alcohol withdrawal symptoms may rival that of Naltrexone®, an injectable medication used to treat alcohol dependence. Given gabapentin’s effects on the brain’s GABA and glutamate system, these results could provide detox centers with another effective medication to treat those with AUD.
Will Gabapentin Replace Benzodiazepines as the Gold Standard for Managing Alcohol Withdrawal Symptoms?
Currently, benzodiazepines are the gold standard of care for managing alcohol withdrawal symptoms across the country as they have been effective in preventing severe reactions like seizures or delirium tremens (DT) in many patients.
When you quit drinking, your brain receptors undergo drastic changes in attempt to maintain normal brain function. Your GABA levels decrease and your central nervous system (CNS) becomes less responsive, causing your body to experience alcohol withdrawal symptoms like:
- Elevated heart rate
- Nausea / vomiting
- Mood swings
- Depression & Anxiety
Benzodiazepines are used to safely manage these symptoms and prevent patients from experiencing the more dangerous ones like seizures and DTs. Some of the main benzos used in alcohol detox settings include diazepam, lorazepam, and chlordiazepoxide.
- Diazepam. Diazepam (Valium®) is one of the most frequently used benzodiazepines in detox centers across the U.S. That’s because it works quickly (e.g. within 5 mins) and continues to work in patients for a long time. This allows doctors to administer it if a patient needs immediate treatment. And it helps patients taper off the drug a lot slower, resulting in a smoother withdrawal. Use of diazepam is commonly referred to as the “loading method” since it lasts long and prevents doctors from having to re-administer doses too frequently.
- Lorazepam. Also known as Ativan®, lorazepam is also a short-acting agent (i.e. works within 30 mins) like diazepam. But what makes it different is that it doesn’t last in your system as long. Using this drug is referred to as the “symptom-triggered” method since it allows doctors to administer doses in real time and prevents them from underdosing or overdosing. By doing so, patients on lorazepam have shorter durations of treatment in detox facilities. On the other hand, critics of lorazepam state that doctors have to monitor patients more frequently, and users are at greater risk of becoming dependent.
- Chlordiazepoxide. Chlordiazepoxide (Librium®) is administered to lessen the uncomfortable withdrawal symptoms. It lasts for roughly three days in the body, helping patients feel much better during their stay in detox. This medication has been shown to lower feelings of anxiety and muscle spasms as well as improve appetite in patients. CAUTION: Pregnant women and people with liver problems should avoid Librium® since it can be very toxic to the body if mismanaged.
Although there are potential complications to using benzodiazepines to treat alcohol withdrawal symptoms and alcohol withdrawal syndrome (AWS), we continue to use them because their effects are well-researched. Now, gabapentin is showing promise for those detoxing from alcohol. However, scientists need to do a lot more research before a general consensus is reached.
That’s why addiction treatment professionals at detox facilities aren’t kissing benzos goodbye.
One theory is two use the two together to assist substance abuse patients with their withdrawals. For instance, other anticonvulsants like carbamazepine reduced withdrawal severity in those who abused multiple drugs at a time (e.g. opioids, alcohol, and benzodiazepines). By joining a benzodiazepine regimen with gabapentin, detox patients may get the benefit of both drugs with limited side-effects.
So, the future of addiction treatment may look hopeful. But whatever the case, patients need to be aware of the potential downside to using a drug like gabapentin…
Potential Dangers of Taking Gabapentin
The most common side-effects of gabapentin include dizziness, sleepiness, trouble walking, dry mouth, and weight gain. Loss of sexual libido and slight tremors are also seen in some patients. And for users who have psychiatric issues, adverse side effects like anxiety, anger, and even suicidal ideation have been observed.
Although gabapentin has its benefits, it’s important to understand the risks involved when taking it. Therefore, we encourage you to consult a medical professional before you add it to your medication regimen.
Unfortunately, people struggling with substance use disorders (SUD) may be at increased risk when it comes to gabapentin due to new evidence suggesting that this multifaceted drug can be abused. According to the Cleveland Clinic Journal of Medicine, patients shouldn’t be prescribed gabapentin if they have a history of opioid or prescription drug abuse.
Well, based on some reports, opioid addicts are using it in tandem with prescription pills or heroin in order to achieve stronger highs. And with many states cracking down on opioid prescriptions and clinicians fearful to administer them, gabapentin is becoming a popular option for addiction treatment professionals, making it more readily available.
It’s many off-label uses, low-cost, and classification as a non-controlled substance make it much easier to get than prescription opioids. Unfortunately, that makes it an attractive alternative for opioid users to take advantage of in order to get more out of their limited drug supply.
But taking gabapentin and opioids in conjunction is extremely risky.
When combined with opioids, the risk of respiratory depression increases by 400%. And seeing as respiratory failure is the leading cause of death in opioid-related overdoses, this fact could put many lives in danger.
What’s important to note is that these effects occur when users abuse gabapentin and take more than necessary, not when users abide by dosage instructions recommended by their physician. Because of this, the FDA warns users to not exceed recommended dosage instructions because the side-effects could be dangerous.
Can I Take Gabapentin in Drug Rehab?
More than likely, yes!
Most rehab centers across the U.S. do not have gabapentin on its disallowed medications list. Currently, the general consensus is that gabapentin does more good than bad. And most treatment centers prescribe it to patients if it meets their treatment needs.
Regardless, it is not administered freely and to everyone. Physicians tightly monitor how patients react to the anticonvulsant and make sure not to prescribe too much. Facilities like Stonegate Center, a drug and alcohol addiction treatment center just west of Fort Worth, Texas, allow clients to take gabapentin. However, their medication regimens are tightly monitored and constantly reviewed.
“Gabapentin has positively impacted a lot of our clients here at Stonegate, and we’ll continue administer it as long as the research studies show its efficacy,” says Alison Reeves, President of Stonegate Center in Azle, Texas. “Whatever one’s view on the drug, our medical team does a phenomenal job of making sure it’s prescribed to the right client. For instance, we won’t freely prescribe it to individuals who have a history of opioid abuse or who have previously abused gabapentin in the past.”
If you or a loved one is suffering from alcohol abuse or opioid abuse, give our inpatient residential treatment center a call at (817) 993-9733. Our Admissions Specialists are in recovery themselves and are free from 6:30am to 12:00am to take your call. If not, feel free to email them at firstname.lastname@example.org.
We look forward to having you as part of our recovery community!
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction as well as the pharmacology of drugs. He hopes to bolster Stonegate Center’s status at the forefront of addiction medicine through bold, innovative content creation. He is currently pursuing his MBA in Finance from Texas Christian University.