How the Program Works
1st Appointment
We meet through video conferencing and you are given your first one-month prescription for either naltrexone or baclofen. You will be recording your daily intake on a spread sheet I will send you. Recording, while tedious helps to identify exactly how much you are drinking and patterns of use. Excessive alcohol consumption depletes many different vitamins and minerals, it also can give you a "leaky gut". Some targeted lab testing can give us a better understanding of what is going on for you.
2nd Appointment
After a month we review your intake from the spread sheet and trouble shoot any problems you may be having. You are given another prescription for a month and we start to introduce having alcohol free days.
3rd Appointment
By now you will notice your daily intake has reduced, and you may be sleeping better and have more energy during the day. If things are going well, we will meet again in 2 months, and you will get a prescription for that time.
4th & Subsequent Appointments
Generally, we meet every 2 months if you are progressing in reducing your intake. After you have met your goal, we meet every 3 months if you still need prescriptions.
READY TO WORK WITH ME?
Medication for Alcoholism
There are three FDA approved medications to treat alcohol abuse, disulfiram (Antabuse), acamprosate, and naltrexone. The medications topiramate and gabapentin are now used, but can have significant side effects. I have found that naltrexone and baclofen are more effective, easier to use, and have less side effects. The biggest predictor of relapse is the presence of cravings for alcohol, both medications reduce alcohol cravings over time, and therefore reduce intake.
Naltrexone
While this medication has been used to reduce alcohol intake, it was Dr. David Sinclair who pioneered the idea of taking the medication one hour before drinking. Naltrexone works by blocking the opiate receptor sites. By blocking the opiate receptors in the brain, it lessens the reward you feel when you drink. Over time this will allow you to greatly reduce or stop drinking entirely as you aren’t being rewarded each time you drink. I generally start with this medication as it is easy to use, generally has low side effects, and works to lessen intake over a number of months.
HOW TO USE
Take 50mg of Naltrexone one hour to drinking alcohol
In one study 75% of people reduced their alcohol intake from 6/day to 1/day over a 12-month period, 25% of people obtained abstinence.
Baclofen
Baclofen is not FDA approved for the treatment of alcohol abuse. It is a drug that is commonly used in the treatment of cerebral palsy to reduce the spasticity of the muscles. It has become a very popular treatment in Europe and particularly France due to the publication of a book called “Heal Thyself” by Dr. Olivier Ameisen, MD. It is also very popular in Australia and this website by the Perth Hospital is very informative baclofentreatment.org.
This medication works by reducing cravings for alcohol by reducing the amount of dopamine that is produced when someone drinks. The idea is to slowly increase the dose till you reach a point where you are “indifferent” to drinking. The daily dose that will work for someone can range between 80mg to over 300mgs and needs to be taken 2-4 times per day.
HOW TO USE
Start at 10mg three times per day and slowly increase till you arrive at a dose that eliminates cravings for alcohol (80mg-160mg daily). You then stay at your target dose for a few months, and then slowly reduce the dose. The most common side effect is being tired, but that generally goes away after a few days. If at any point the cravings return, then you increase the dose a little till the cravings go away. I have patients who still take anywhere from 20-60mgs daily, and most are able to slow wean off entirely.
I will suggest we start with baclofen if you have a lot of anxiety, your daily intake is greater than 8 drinks a day, or you want to stop drinking quickly.
Please Be Aware
There are only two FDA approved uses of naltrexone, opioid or alcohol substance use disorder. I recently had a client refused health insurance because the insurance company asked her to sign a release that allowed IntelliScript to access all her pharmacy records which showed the use of naltrexone. If this is a concern for you, we can order the medication through www.canadapharmacy.com for $90 per month.
Most of my patients do not want their insurance company to know they are using this medication, so they opt to use a pharmacy that they haven’t ever used before and pay cash. If you chose to use a local pharmacy, but not use your insurance, you can use the app “Good Rx”, this app will give you a list of local pharmacies and the price they charge if you use their coupon. In Fort Collins you can get naltrexone for about $35 per month.
“As a healthcare provider in a small town, you feel trapped seeking assistance with alcohol abuse. I didn’t want to be a detox patient in ICU and have my coworkers care for me. I found Integrative Mental Health. The treatment options and remote tele-visits agreed with my chosen path for recovery. Gail has been incredibly kind and caring while supporting me through this process. She’s beyond knowledgeable and has years of experience to backup her treatments. Gail has helped me navigate setbacks and victories. I don’t miss the daily guilt or lack of energy. I’m beyond thankful for her guidance and highly recommend!”