Chances are, unless you are currently taking it, the medication Spironolactone’s uses are a mystery. In fact, it is used to address heart problems and high blood pressure. But a recent study published in Molecular Psychiatry suggests another use: treating alcohol use disorder (AUD). For the 14.5 million people ages 12 and older who, according to the 2019 National Survey on Drug Use and Health (NSDUH), had AUD, this might be very good news.
The recent study identifying Spironolactone, by researchers at the National Institutes of Health and their colleagues at the Yale School of Medicine, involved mice, rats, and humans. The evidence is said to be significant because it converged across three species and involved different kinds of studies.
At SMART Recovery (SMART), the use of medication for treating AUD is seen as a valid way to seek, as we say, Life Beyond Addiction. It fits right in with our science-based approach, where the latest addiction research keeps us evolving into an even stronger pathway for recovery.
The use of doctor-prescribed medication is called Medication Assisted Treatment, or MAT. There is also a growing trend to call it Medication Assisted Recovery, (MAR), since that is the positive and desirable state for those who seek to address their AUD.
SMART is all for combining different practical approaches to recovery: our mutual support group meetings, tools based on Cognitive Behavioral Therapy (CBT) principles and practices, personal reflection, and MAT.
It’s not that Spironolactone is the first medication identified as a potential help. There are currently three medications approved to treat AUD: Naltrexone, Acamprosate, and Disulfiram.
In simple terms, Naltrexone blocks the brain receptors related to craving alcohol; Acamprosate lessens negative symptoms of prolonged abstinence; Disulfiram causes unpleasant conditions like nausea and flushing of the skin after someone drinks.
What Spironolactone does is work to block mineralocorticoid receptors, which, in higher concentrations, seem to play a part in increased alcohol consumption. Blocking them decreases the “signaling” action of the receptors, lowering their impact.
Since SMART participants are in charge of their own recovery, i.e., self-empowered, choosing to use any of these medications is not frowned upon. Just like SMART doesn’t use labels such as addict or alcoholic, there is no reason for judging or, worse, ostracizing, individuals who are availing themselves of this science-based approach.
This is also the view of a powerful voice in the recovery community, Dr. Nora Volkow, director of the National Institute on Drug Abuse, “Just like for any other medical condition, people with substance use disorders deserve to have a range of treatment options. In addition, we must address the stigma and other barriers that prevent many people with alcohol use disorder from accessing [treatment].”
With ongoing research into medications like Spironolactone, there is the hope that more people will get treatment. SMART stands ready to help.
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How often does the use of medications replace CBT practices and conventional cognitive restructuring?
That is, instead of treating causes, how often is MAT used for merely controlling symptoms?
One problem I see here is that ER nurses in the local hospital have never even heard of naltrexone. I got into an argument with one who thought I was referring to naloxone and who kept trying to bait and humiliate me for getting the terminology wrong until one of the docs came in who clearly knew about the uses of naltrexone and put a stop to it. I was there to try to try to help a friend in withdrawal and had zero tolerance for some ignorant, arrogant nurse with probably only a couple of years of experience with drug withdrawal. Thank goodness the doc was more knowledgeable. There’s definitely a big educational vacuum among support staff in the local ER about naltrexone, which seems to be more widely used outside the US.
Thanks for your comment, this sounds like a very unfortunate situation. It is certainly a must that ER personnel, whether nurses or others, to know about Naltrexone!
This is encouraging news and a caveat about getting medications like this to address heavy drinking. Right now prescribing it to reduce drinking is considered an “off label” use.This means that prescribing it is up to the judgment of your primary care doctor.
The same can be said for naltrexone to reduce heavy drinking. It is FDA approved for Alcohol Use Disorder but with a goal of abstinence. Yes it’s ironic that reduced heavy drinking is the primary outcome and its effectiveness is clinically significant. Still some physicians can be suspicious if you ask for it to reduce you heavy drinking rather than to “achieve abstinence.”
It is important to note that all human studies published to the present were done with subjects who drank various amounts of alcohol regularly, but not on a cohort of people with Alcohol Use Disorder. Reductions in amounts of alcohol consumed consumed by those taking spironolactone were slightly greater than those who were matched on several parameters but not taking spironolactone.
Although medical providers may use FDA-approved drugs, such as spironolactone, for purposes other than explicitly authorized by the FDA, I don’t think prescription of this drug strictly for the purpose of treating AUD is prudent at this time.
Joe Gerstein, MD
It appears this medication is designed to treat various secondary symptoms that possibly occur as a result of a severe alcohol use disorder including low potassium, high blood pressure, and fluid retention. So it would make sense that there would be some benefit for those already showing signs of the addiction medically.