Medication Treatment for Alcohol Use Disorder

How medications fit into alcohol treatment

Medication treatment is one component of caring for alcohol use disorder, alongside behavioral treatment, counseling, and peer support. NIAAA notes that medications can help some people reduce heavy drinking or maintain abstinence, and that combining medication with counseling is often more helpful than either alone.

Medications are not appropriate for everyone. Whether one is suitable depends on your medical history, other medications you take, liver and kidney function, whether you are pregnant or breastfeeding, and your treatment goals. That assessment requires a licensed clinician.

Naltrexone

Naltrexone blocks opioid receptors, which appear to play a role in the rewarding effects of alcohol. It is available as a daily oral tablet and as a long-acting injection given on a monthly schedule by a clinician.

Because it blocks opioid receptors, naltrexone can interfere with opioid pain medications and with opioid-based treatments. Anyone taking opioids — prescribed or otherwise — needs to discuss this with their prescriber before starting. Liver function is also usually considered before and during treatment.

Acamprosate

Acamprosate is taken orally and is generally used to help support abstinence in people who have already stopped drinking. It is often described as helping to reduce the prolonged discomfort some people feel in early abstinence.

Kidney function matters when this medication is considered, and a clinician will review your history and other medications. The dosing schedule differs from naltrexone and is set by the prescriber.

Disulfiram

Disulfiram works differently from the other two. It interferes with the way the body breaks down alcohol, so drinking while taking it produces an unpleasant reaction — flushing, nausea, vomiting, headache, and a rapid heartbeat. In some cases the reaction can be severe.

Because of that, disulfiram is generally considered for people who are committed to abstinence and who have support monitoring their progress. It requires a careful conversation about medical risks and about every product that may contain alcohol, including some mouthwashes, cough syrups, and foods.

What these medications are not

• They are not a cure, and they do not work identically for everyone
• They do not replace counseling, support, or changes in your environment
• They are not appropriate for every person with alcohol use disorder
• They should not be started, stopped, or changed without a clinician’s guidance

Why clinical evaluation matters

A prescriber considers contraindications, interactions with other medications, organ function, pregnancy status, mental health conditions, and your goals. They also schedule follow-up to monitor how treatment is going and to adjust or stop it if needed. Some people experience side effects, and those need to be reported rather than tolerated in silence.

Questions worth asking your prescriber

• Given my history, is medication an appropriate option for me?
• Which medication are you recommending, and why that one?
• What side effects should I watch for, and which would warrant a call?
• How will this interact with my other medications or conditions?
• What monitoring or lab work will be needed, and how often?
• What happens if I drink while taking this — or if I relapse?
• How long would treatment continue, and how would we decide to stop?
• Will this be coordinated with my counselor or treatment program?

Finding a prescriber

Primary care clinicians, psychiatrists, addiction medicine physicians, and some nurse practitioners prescribe medication for alcohol use disorder. If your clinician is unfamiliar with it, you can ask for a referral to an addiction medicine specialist, or call our recovery team at 602-291-6582 for referral information in your area.