• The National Council on Alcoholism and Drug Dependence fights the stigma and the disease of alcoholism and other drug addictions.

Ask Dr. Bob

QUESTION
I have been drinking alcohol most of my life and it's been getting progressively worse. Once I start it goes on for a couple of weeks, morning till night, and the last session lasted for a month. Then I will go dry usually for 2 months, then craving kicks in and grows in intensity till I drink again and the cycle begins anew.

If only I could control the craving, then I would be able to quit - otherwise I will just die one of those drinking days. What can be done?

P.S.: I tried Revia, AA groups, counseling. None of it works. Maybe I should numb the craving down with some strong tranquilizer for a week or so, then the dry cycle will begin?

ANSWER
Your binge drinking is classical: periods of abstinence followed by a period of out-of-control drinking, sometimes predictable but often not, occurring for no obvious "reason" and you seem powerless to prevent it happening. This, then, is followed by remorse and vows to never repeat it again!

As you suggest, removing the craving is the key, and up to now that is something we have not been able to do. With the new science of addiction stimulating research into medications for alcoholics, there are already some medications available. Unfortunately, these drugs do not seem effective for everyone. For example, a patient of mine who was unable to stop drinking over a period of years in and out of treatment, took naltrexone (Revia), finally, and was abstinent for the next two years, like magic. Yet you say it did not work for you. Check with your doctor (who should be knowledgeable about alcoholism as well as this medication). Make sure you've used it properly, taken daily at least 50 mgm dose per day and taken over a period of months, not just when you develop your craving.

Other sometimes useful medications include acamprosate (recently approved for use in alcoholism) and disulfiram (Antabuse). Please see my article on Pharmacological Treatment of Alcoholism on the NCADD website (http://www.ncadd.org/facts/morse.html). If you are sure you wish to stop this drinking, consider Antabuse daily. It will not initially reduce your craving, but will make you sick enough if you do drink that you probably will make some changes!

Most important, do not try to do this alone! Get back to AA or into counseling or medical follow-up. Many alcoholics have kicked this type of drinking long before these medications were available.

Forget the tranquilizer approach. These medicines affect the same brain areas as does alcohol; and if they do dampen your alcohol craving it will likely be at the expense of a craving for the tranquilizer --trading one addiction for another.

Good Luck!

Dr. Bob





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Dr. Bob does not provide specific medical advice or a medical diagnosis for any particular condition described, nor verify the authenticity of any information described in the questions presented. Patients should always consult their physician to discuss any specific symptoms, conditions, or modes of therapy for any particular mental or physical difficulties, diseases or conditions.

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