Can Suboxone Help with Alcohol Withdrawal?

No, Suboxone is not a treatment for alcohol withdrawal.

If you’ve consumed large amounts of alcohol for a long time, withdrawal from alcohol can be potentially fatal, unlike withdrawal from opioids, which is extremely unpleasant but rarely life-threatening.

Suboxone is an FDA-approved medication for opioid use disorder and can help ease opioid withdrawal symptoms and cravings while reducing the risk of relapse. [1] Taking Suboxone for alcohol withdrawal will not help any of your symptoms.If you are withdrawing from opioids as well as alcohol at the same time, it can be hard to distinguish which symptoms are from opioids and which might be from alcohol. Therefore, in such cases, taking Suboxone may help to make you feel better overall, but is still primarily treating the opioid withdrawal, not the alcohol withdrawal.

What Is Alcohol Withdrawal?

Alcohol withdrawal is a constellation of symptoms that occur when people who are dependent on alcohol stop drinking abruptly. Unlike opioid withdrawal, which is unpleasant but not life-threatening, alcohol withdrawal can produce dangerous symptoms. Thus, withdrawing from alcohol is actually more medically risky than withdrawing from opioids.

Symptoms of alcohol withdrawal typically start within about eight hours of the last drink, and they usually peak at about 24 hours. They can last up to five days, after which point most patients are usually out of the window for any dangerous complications of alcohol withdrawal. [2]

Common alcohol withdrawal symptoms may include:[2]

• Depression
• Irritability
• Anxiety
• Mood swings
• Shakiness or tremors
• Nightmares
• Fatigue
• Insomnia
• Sweating
• Rapid pulse and heart rate
• Nausea and vomiting
• Pale skin or complexion

In serious cases, people begin to hallucinate, and they grow increasingly agitated and confused. In time, you can develop life-threatening seizures. Anyone who has a history of seizures or hallucinations with alcohol cessation (delirium tremens) should ideally be monitored in the hospital while withdrawing from alcohol, and may even require intensive care. 

Medications Used in Acute Alcohol Withdrawal

The safest, most effective, and most-researched medication used for alcohol withdrawal is a benzodiazepine, such as lorazepam, chlordiazepoxide, or diazepam.[3] 

Benzodiazepines boost levels of GABA, an inhibitory neurotransmitter, calming your overactive nervous system and preventing seizures.[4] 

These medications are ideal for alcohol withdrawal because they:[3]

• Prevent delirium tremens
• Prevent alcohol withdrawal seizures and agitation
• Are cross-tolerant with alcohol
• Have a wide margin of safety
• Have a low potential for dependence when used short-term

Treatment teams typically administer benzodiazepines early in your alcohol detox program and then taper you off of them slowly so that, at the end of your detox, your symptoms have resolved and you don’t experience benzodiazepine withdrawal symptoms. In this way, benzodiazepines are far more effective than buprenorphine for alcohol withdrawal.

Medications Used Long-Term for Alcohol Use Disorder 

When you’re done with detoxification, you have no alcohol in your body and you are medically stabilized. But your cravings for a drink may remain. In these cases, you may benefit from long-term medication to help prevent relapse to alcohol use.

The U.S. Food and Drug Administration has approved four drugs for alcoholism treatment, including: [4]

• Acamprosate (Campral): This medication greatly reduces alcohol cravings and can manage protracted withdrawal symptoms like anxiety and insomnia. 
• Disulfiram (Antabuse): Drinking while taking disulfiram results in unpleasant symptoms like rapid heart rate, vomiting and shortness of breath—effectively demotivating people to drink alcohol.
• Naltrexone (oral): This daily medication, sold as Revia, binds to opioid receptors in the brain, decreasing alcohol cravings and reducing the feeling of pleasure associated with drinking.
• Naltrexone (Vivitrol injections): This monthly naltrexone injection reduces the reward of drinking just like the oral medication, but you only need to take it once a month, as an intramuscular injection. This can increase treatment adherence. 

What Does The Research Say About Suboxone For Patients with OUD and Concurrent Alcohol Use Disorder?

Suboxone is a highly effective treatment for opioid use disorder, not alcohol use disorder (AUD). Clinicians are not using Suboxone to treat alcohol addiction at this time. That said, it’s common for people with OUD to have another substance use disorder, such as AUD. 

As such, some researchers have looked into whether or not Suboxone also might reduce alcohol consumption: [4],[5],[6],[7]

• One study with rats published in 2007 suggested that buprenorphine could be helpful in treating excessive alcohol use. But people aren’t rats, and researchers must learn more about the connection between Suboxone and alcohol. Still, studies like this suggest that, if the research translates from rats to humans one day, some people could benefit from taking Suboxone to curb their drinking. 
• One study on buprenorphine for alcohol consumption found that low doses increased drinking while higher doses reduced it.
• A study in humans found positive results with Suboxone. People given the medication drank less, and some stopped drinking altogether. It isn’t clear whether or not Suboxone is simply helping to reduce the use of opioids which then also helps people to stop drinking, or if Suboxone may actually act on cravings for alcohol directly.
• Another study on OUD medications and the risk for alcohol-related injuries, falls and poisonings found that MAT for OUD was associated with fewer hospital admissions for alcohol-related consequences in people with co-occurring OUD and AUD.

In general, the best medications for alcohol use disorder at this time are naltrexone and possibly acamprosate and disulfiram as second-line agents.

If you’ve tried to stop drinking and can’t make the change stick, talk with your doctor about Medication for Addiction Treatment (MAT) for alcohol use disorder. You may also want to enter a professional treatment program, on an inpatient or outpatient basis, in order to receive comprehensive care and therapy.

Frequently Asked Questions About Suboxone for Alcohol Withdrawal