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My Son, An Alcoholic Who Was In Treatment For 3

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Posted on Wed, 12 Jun 2019
Question: My Son, an alcoholic who was in treatment for 3 out of the last 4 years came home with his medications. It seems like an awful lot and seems to make him out of it, he has an appointment but can't get in for 4 weeks looking to see if any of these pills could be removed or recommendations . 20mg Fluoxetine at night, 2mg Aripiprazole at night, 10mg buspirone morning and night, 50mg naltrexone night, 300mg bupropion morning,
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Follow up: Dr. Dr. Matt Wachsman (6 minutes later)
Just to let you know he has been home 2 months and was not taking them as prescribe and just recently we took over and giving him what he is prescribe and that is when we noticed since then he has been out of it he feels its too much as well
doctor
Answered by Dr. Dr. Matt Wachsman (53 minutes later)
Brief Answer:
There is a lot of trial and error

Detailed Answer:
in finding the right medicines for psychological conditions. The fundamental mistake everyone makes is mixing up positives and negatives. You'd think that would be easier.
POSITIVELY, we thought the chemicals in the brain INCREASED by the drugs should predict what works if we know people lack them in certain conditions (dopamine seeking in addiction... give a drug that increases dopamine). Giving MORE drugs for EVERY symptom to stomp that symptom! It was sometimes better than nothing, but wasn't a good predictor.
NEGATIVELY, taking away things that are causing problems OR giving drugs with knowledge of their side effects worked much more reliably.
and therefore, some general information with TWO WARNINGS!
1) it's trial and error and nobody can know ahead of time. and 2)
cannot say in your particular case, but generally, this is some valid information on the drugs positive and negative effects:
Naloxone is FDA approved to lower the addictive fun from alcohol. It makes someone less likely to abuse alcohol but is under a 50% improvement.
Buproprione is very effective for anti-depression. Somewhat helpful for anxiety AND somewhat helpful on addiction. While it is well over 50% likely to significantly improve depression, and a bit over 50% likely to help anxiety, it is under 50% likely to help with addictions. It's action is separate from naloxone and they are often/usually combined and work a bit better together.There is a STRONG suspicion in the particular people where having a cigarette triggers wanting alcohol...buproprione will help lower alcohol. In non-smokers, not so much.
Fluoxetine is an anti-depressant. It's action is basically the same as buproprione. It is not clear why anyone would have the two together. Their toxicity combine due to acting the same way so it is like doubling up on an antidepressant. Generally would increase side effects and not be more helpful. It is not clear that it can help addiction, while buproprione is FDA approved for cigarettes and food abuse.
Aripiprazole is a drug for schizophrenia. It can be used for sleep. SLEEPING PILLS LIKE VALIUM/ALPRAZOLAM/Ambien are quite dangerous in alcoholics while Aripiprazole isn't. Fluoxetine often hurts sleep. So, if nothing other than a drug can work on sleep, you could do worse than Aripiprazole. AND.. it is useful in crazy. If someone is having thoughts beamed into their heads by the space aliens, Aripiprazole is quite good. If someone has disturbing thoughts about "I'm worthless from the alcohol, everyone hates me, nothing good will ever happen" and these thoughts are somewhat crazy, then Aripiprazole is somewhat helpful. If someone isn't crazy...it's an expensive sleeping pill that while better than abusable drugs, has long term side effects you should avoid. And it causes zombification.
Buspar helps shakes. That's it. No shakes, no use. Might cause zombification but it is not likely.

None of the medicines are crazy. None of the doses are crazy EXCEPT naloxone is generally used more than once a day after someone gets used to it, and the wellbutin might have less side effects and work better if the same dose is split into giving twice a day BUT some wellbutin pills are wax coated so they get in very slowly and breaking them in two messes with it, so don't break it in two until you are advised by someone who knows that particular pill.

But medicines that give too much sedation have to be adjusted. The one most likely to cause sedation, Aripiprazole, might have been given specifically to cause sedation--either for sleep or to calm thoughts and anxiety. cannot say in your particular case, but generally, these are some facts about the medicines.

THEN on the alcohol, all the drugs used to treat it work in under 50% of those taking them. AA has comparable success BUT, AA is likely to be more effective with time/situation/finding the right group/making more connections and commitment to the group. If you could commit to a drug the way you can to AA lifestyle, the drug would be more effective. That may seem an odd statement but people who went into clinical trials to get the medications sought out the drug, had to come many times to the clinic for the study drug, they had to have questionaires, tests, physicals all to get the drug. They had high committment to the drug. They had an over 50% response..EVEN IF IT WAS A FAKE DRUG WITHOUT ANY CHEMICALS IN IT. Consider AA, and group/family counseling in order to make a public commitment to overcoming alcohol.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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My Son, An Alcoholic Who Was In Treatment For 3

Just to let you know he has been home 2 months and was not taking them as prescribe and just recently we took over and giving him what he is prescribe and that is when we noticed since then he has been out of it he feels its too much as well