Patients occasionally turn to pharmacists to ask about over-the-counter supplements to help reduce alcohol dependence. Pharmacists should be aware of some commonly used supplements, what is known about them, and the risks associated with using these supplements.
Alcohol addiction is a problem that many in our society face. There are many factors that influence the decision to seek help for alcohol addiction, but shame and embarrassment can drive some to self-medicate.1As with many other conditions, there are over-the-counter herbal supplements that claim to be an effective treatment option. Three herbal remedies that are often seen as self-treatment options for alcohol addiction include St. John's wort (Hypericum perforatum), Ashwagandha (Withania somnifera), en Kudzu (Pueraria lobata). While many pharmacists are familiar with these herbal supplements to some extent, this understanding often involves potential side effects and drug interactions. Its use in the treatment of alcohol dependence and the associated literature are not well known. The purpose of this short article is to review what is known about the use of these supplements to treat alcohol addiction.
1. St. John's Wort: Most pharmacists are familiar with this herbal supplement and its (unapproved) use for depression. Some may not realize that it can be a part of "detox" supplements and used by some to treat alcohol addiction itself. There have been some scientific studies on the use of St. John's wort to treat alcohol addiction in rat models that showed some promise. Taking St. John's wort reduced alcohol intake in rats, but there is little evidence that St. John's wort can have a similar effect in humans.2,3Currently, the known risks of using St. John's Wort far outweigh any potential clinical benefits.
2. Ashwagandha: This herbal supplement is used in traditional Ayurvedic medicine and is used by some to overcome alcohol withdrawal or cravings. Many claim that it has anti-anxiety effects that help prevent alcohol cravings. Research in rats found that ashwagandha reduced anxiety associated with alcohol withdrawal, but its effect on seizure threshold has not been thoroughly established.4,5There is currently no convincing evidence in humans to support its use in the treatment of alcohol dependence.
3. Kudzu: Kudzu is often advertised as a way for drinkers to cut back on alcohol. It is believed to act as an 'aversion agent' that inhibits the clearance of acetaldehyde (a toxic metabolic byproduct of alcohol), which can reduce alcohol cravings. This is similar to how the approved drug Antabus (disulfiram) works in the body.6In one study of young people taking kudzu extract, a modest reduction in alcohol intake was noted.7Other studies did not mirror these findings in humans.8Kudzu has not yet shown a clear benefit for drinkers trying to reduce their alcohol consumption.
As with many other over-the-counter herbal supplements, there is little convincing evidence that the above supplements are clinically effective treatments for alcohol addiction. Some scientific studies have been conducted, but most involve animal models and show modest results that rarely translate into conclusive human trials. The main danger of these supplements in people with alcohol addiction is not necessarily knowing the substance - potential for drug interactions or side effects. The real danger may be the possible delay in seeking professional help for the addiction. If you are asked about herbal treatments for a drinking problem, it is advisable to talk to a professional rather than treating yourself with over-the-counter supplements.
References
1. Dear RL, Stuewig J, Tangney JP. On the importance of distinguishing between shame and guilt: relationships with problematic alcohol and drug use.Addictive behavior.2005;30(7):1392-1404.
2. Rezvani AH, Overstreet D, Yang Y, Clark E. Attenuation of alcohol intake by extract of Hypericum perforatum (St. John's wort) in two different strains of alcohol-preferring rats.Alcohol and alcoholism.1999;34(5):699-705.
3. De Vry J, Maurel S, Schreiber R, De Beun R, Jentzsch K. Comparison of hypericum extracts with imipramine and fluoxetine in animal models of depression and alcoholism.European neuropsychopharmacology.1999;9(6):461-468.
4. Ruby B, Benson MK, Kumar EP, Sudha S, Wilking JE. Evaluation of Ashwagandha in Alcohol Withdrawal Syndrome.Asian Pacific Journal of Tropical Diseases.2012;2:S856-S860.
5. Mohan L, Rao U, Gopalakrishna H, Nair V. Evaluation of the anxiolytic activity of NR-ANX-C (a polyherbal formulation) in ethanol withdrawal-induced anxiety behavior in rats.Evid-based supplement Alternat Med.2010; 2011. pii: 327160. doi: 10.1155/2011/327160.
6. McGregorNR.Pueraria lobataRemedies for (Kudzu root) hangover and acetaldehyde-associated neoplasm risk.Alcohol. 2007;41(7):469-478.
7. Lukas SE, Penetar D, Su Z, et al. A standardized kudzu extract (NPI-031) reduces alcohol consumption in male heavy drinkers who do not seek treatment.Psychofarmacologie.2013;226(1):65-73. to: 10.1007/s00213-012-2884-9.
8. Shebek J, Rindone JP. A pilot study on the effect of kudzu root on the drinking habits of patients with chronic alcoholism.J Alternative supplement Med.2000;6(1):45-48.
