Alaska has one of the highest rates of binge-drinking deaths in the United States and those rates increased during and after COVID-19. But there are more options than ever for treating alcohol use disorder in the state, including several medications that can make it easier for some people to reduce or quit drinking.
Katie Schneider, a physician assistant and the clinical director for the detox program at Southcentral Foundation for twenty years, said about half the people in their 14-bed facility on any day are working on alcohol dependence. And in the decades she’s been working there, the options for helping them with medication-assisted treatment have expanded.
“It’s actually really improved a lot,” Schneider said. “When I first started practicing, the only thing that we had was something called Antabuse, which caused people to vomit every time they had alcohol. That is also still an option; it’s just not one that we use a lot.”
Antabuse has been around for about 75 years, but it didn’t help people with cravings and caused severe reactions to food or drink with even tiny amounts of alcohol. Now there are several options of medications that address alcohol dependency, which offer a gentler path to recovery.
Schneider said she encourages anyone in the detox facility to consider medication.
“We encourage everyone to do medication assisted treatment, because we feel that you should put every tool in your toolbox that you can,” Schneider said.
Because drinking is often a coping mechanism, there’s no one path to reducing or stopping. Schneider said medications may also include treatments for underlying disorders. She said drinking can mask mental health struggles and part of recovery is figuring out the root causes of alcohol abuse, not just addressing the drinking itself.
“Nobody wakes up one day and says, ‘I want to ruin my life with drugs and alcohol,’” Schneider said. “There’s always underlying causes. There’s childhood traumas, there’s mental health disorders, there are maladaptive behaviors, all kinds of reasons.”
That’s also something Seth Workentine thinks about in his work. He’s an addiction medicine fellow at Providence Alaska in Anchorage and he said he always asks his patients for more information about when and why they’re drinking and sometimes those patterns reveal depression or anxiety.
He said there are also several longer-term medications to help with alcohol cravings. He said he has had a few patients who prefer antabuse, but it’s not very popular anymore. Acamprosate is a newer medication which helps reduce cravings for alcohol.
“And so patients feel that they’re able to reduce their use, or even go off completely, and find that they’re thinking about alcohol a lot less,” Workentine said.
He said another medication is naltrexone, which can be used for reducing or quitting alcohol or opioids. He said some patients describe naltrexone as “taking the fun out of drinking.”
Workentine said he encourages people using medication-assisted treatment to stay on the medications as long as they’re willing: six months, a year, or even sometimes indefinitely. He said these medications improve success rates for recovery. He also said he’s seen a shift toward more harm-reduction approaches to addiction. Not everyone, he said, is ready to quit drinking completely.
“There’s this general shift in medicine to do more patient centered care,” Workentine said. “We’re a patient’s coach. We’re there to help them achieve the goals that they set out. There’s no longer what we call ‘paternalistic medicine,’ where we describe what goals the patient should have.”
Schneider said she’s also seen this shift in addiction medicine. She said earlier in her career, doctors required patients to stop drinking completely when prescribing medications for alcohol use and that’s changed.
“If someone goes from drinking a fifth a day to having two drinks a day, that is a win and we should celebrate that,” Schneider said.
She said she hopes that anyone who wants to change their drinking reaches out to a healthcare provider.
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Rachel Cassandra covers health and wellness for Alaska Public Media. Reach her atrcassandra@alaskapublic.org. Read more about Rachel here.
