[MissionInfl]

As I comment on many HN posts, I cannot exaggerate the impact that alcoholism medication has had on my life. It is only tangentially related here, as this comment is not about disulfiram but rather naltrexone, a drug with similar goals but a very different mechanism of action

This is all to say, if you or a loved one is struggling with alcoholism, I highly recommend looking into The Sinclair Method. Check out /r/alcoholism_medication or this accounts recent comment history. That community supports those that use disulfiram as well, but I cannot comment on that medication myself

[hn_user82179]

I'm currently on a naltrexone/wellbutrin combo. I started it to try to finally end an infinite binge/purge cycle I find myself stuck in (an eating disorder). I also have depression/insomnia and had been self-medicating with alcohol (really, I just drank to relax -> drank to fall asleep -> didn't fall asleep -> drank more). I wouldn't say it was a lot compared to what you think of when you think of an alcoholic but it definitely fell under the category of binge drinking nightly (~3 beers a night). I had reached a point where I figured it'd be good to stop (after reading about how easily one can develop a Thiamine deficiency) but found it... not easy. I could go a few days but living alone, wfh, etc made me really enjoy my post-work/before-bed beer ritual - it felt like the only thing distinguishing night and day.

The medication has helped all 3 issues, a lot. How much it's worked is incredible. I don't know how hard it would've been to stop alcohol without it, but I'm sure I would've failed more before succeeding. Honestly, I'm more impressed by how it's helped me manage my relationship with food. I've spent the last 15+ years obsessing over food. I still think about it far more than people without eating disorders, but my self-worth is not tied to whether or not I eat. I think my mood was better managed on my old antidepressant but things now feel... how I think "normal" is?

That said, I do need to get a medical bracelet of some sort. My doctor didn't mention exactly how naltrexone worked and it wasn't until I stumbled across /r/alcholism_medication that I realized that if I got hit by a car or had some other accident, was unconscious and administered opiates - they wouldn't work, and being on naltrexone could have harmful effects if I underwent emergency surgery if the medical personnel were unaware of my prescription.

[refurb]

Probably good to have an alert bracelet, but if you were undergoing emergency surgery, the anesthetist would monitor close enough to know something is off and respond appropriately.

[aaaaaaaaata]

How? By upping the pain medication?

[refurb]

Pretty much. Naltrexone is a competitive antagonist against the opioid reception (u being the important one).

They would give the standard amount of opioid (say fentanyl) and if they don't see the desired response they'll up it. Eventually you can "out compete" the naltrexone for the opioid receptor and get an effect.

If they do give 2-3x the dose, they'll be sure to monitor closely after to make sure everything goes well.

[locusofself]

Good to hear it .. I've been sober 12 years (cold turkey after years of attempts) and when I was struggling I tried to get a prescription for Antabuse and doc said no. I see no reason not to try whatever tools are available to save someone from a terrible life (or death).

[tom899]

Antabuse can lead to death or dangerous healh problems. The doctor is and will be responsible for that, so he wont take the risk.

[Broken_Hippo]

"Antabuse can lead to death or dangerous health problems."

So can a slew of other drugs. You should see the drug risks for stuff folks take for autoimmune disorders. It isn't just up to the doctor to mitigate the risks: Patients must do their part as well (blood tests and so on).

And most importantly: So can alcoholism. Alcoholism kills slowly. Withdrawal can kill not-so-slowly. Somehow, do you think the doctor is not responsible for refusing help when the alternative risks include death as well?

That said, I'm not a doctor and there are generally (but not always) good reasons to avoid a drug or another. The risk of drugs by itself usually isn't it, though, as it depends on effectiveness compared to other drugs/methods and comparing the risk of cure to the risk of continued disease.

[MissionInfl]

Sorry if you already know this, but the difference with disulfiram/Antabuse is that these side effects are intentional and are supposed to act as a deterrent to consuming alcohol. The fact that it can kill you if you mix it with booze is why people take it, as far as I understand it

[aaaaaaaaata]

> So can a slew of other drugs

Dr isn't legally liable for drugs you find on your own.

[dragonwriter]

Dr. isn't legally liable if they act within the norms of the profession with with informed consent. Almost any drug can cause death or dangerous health problems.

[Broken_Hippo]

I was speaking of prescription drugs here, the very ones you have to visit the doctor to get. I thought with the context that would have been clear.

[beeboop]

I just wanted to say thanks for you mentioning this. I had never heard of naltrexone before and it's something I'm going to talk to my doctor about next week. I've been drinking way more than I want to and I'm finding it difficult to tone it down.