Medication is one of the more misunderstood parts of alcohol treatment. Some people assume it is a shortcut; others assume it is only for severe cases. Neither is accurate.
This article explains, at a general level, what the three medications most commonly used for alcohol use disorder in the United States do — and why the decision belongs with a licensed clinician.
This is educational information only. It contains no dosing guidance and is not prescribing advice.
How medication fits into treatment
NIAAA notes that medications can help some people reduce heavy drinking or maintain abstinence, and that combining medication with counseling is often more effective than either alone. Medication is a component of a treatment plan, not a replacement for one.
Whether it is appropriate depends on your medical history, other medications, liver and kidney function, whether you are pregnant or breastfeeding, and what you want to achieve. That assessment requires a clinician.
Naltrexone
Naltrexone blocks opioid receptors, which appear to play a role in alcohol's rewarding effects. It comes as a daily oral tablet and as a long-acting injection given monthly by a clinician.
Because it blocks opioid receptors, it can interfere with opioid pain medications and opioid-based treatments. Anyone taking opioids — prescribed or not — needs to discuss that with a prescriber before starting. Liver function is typically 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 easing the prolonged discomfort some people feel in early abstinence.
Kidney function matters when it is considered, and the dosing schedule differs from naltrexone. A clinician sets that.
Disulfiram
Disulfiram works differently: it interferes with how the body breaks down alcohol, so drinking while taking it causes an unpleasant reaction — flushing, nausea, vomiting, headache, and a rapid heartbeat. In some cases the reaction can be severe.
Because of that, it is generally considered for people committed to abstinence and with support monitoring their progress, and 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 never be started, stopped, or adjusted without a clinician's guidance
Questions worth asking a 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 warrant a call?
- How will this interact with my other medications or conditions?
- What monitoring or lab work is needed, and how often?
- What happens if I drink while taking this — or if I return to drinking?
- 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 contact SAMHSA's National Helpline (1-800-662-4357) for referral information in your area.
Where medication fits with the rest of treatment
Medication works alongside behavioral treatment, peer support, and — for people with physical dependence — medically supervised withdrawal management. If you are still choosing a level of care, compare options on our treatment directory, and read our full medication treatment page.
Frequently asked questions
Are these medications effective? Research summarized by NIAAA indicates certain medications can help some people reduce heavy drinking or stay abstinent, particularly with counseling. Response varies.
Do I have to take medication to recover? No. Many people recover through therapy, peer support, or both without medication.
Where can I read official information? The FDA publishes approved labeling for each medication, and MedlinePlus offers plain-language summaries — both are linked on our medication page.
Educational notice
This article has not been individually reviewed by a licensed clinician. It is educational information only and is not medical advice, diagnosis, or treatment. Speak with a qualified healthcare professional about your own situation. For a medical emergency, call 911. For crisis support, call or text 988.