- Three FDA-approved medications for alcohol use disorder exist: naltrexone, acamprosate, and disulfiram
- Despite strong evidence, these medications are significantly underutilized — fewer than 10% of people with AUD receive them
- Naltrexone reduces drinking pleasure and cravings by blocking opioid receptors involved in alcohol's rewarding effects
- Acamprosate stabilizes brain chemistry disrupted by chronic alcohol use, reducing post-cessation anxiety and discomfort
- Disulfiram (Antabuse) creates unpleasant physical reactions when alcohol is consumed, providing a deterrent to drinking
- Medication works best when combined with behavioral therapy — it is not a standalone treatment but a powerful tool within comprehensive care
FDA-Approved Medications for Alcohol Addiction
Naltrexone (Oral: ReVia, Injectable: Vivitrol)
How it works: Naltrexone blocks mu-opioid receptors in the brain. Alcohol produces some of its pleasurable effects through the endogenous opioid system (endorphin release), and blocking these receptors reduces the rewarding sensation of drinking. Over time, the brain unlearns the association between alcohol and pleasure — a process called pharmacological extinction.
Forms available: Daily oral tablet (50 mg) or monthly injectable (Vivitrol, 380 mg intramuscular). The injectable form eliminates daily adherence concerns.
Evidence: Clinical trials show naltrexone reduces heavy drinking days by approximately 25% and overall alcohol consumption significantly. It is most effective for reducing heavy drinking rather than maintaining total abstinence, making it suitable for both abstinence-oriented and harm-reduction approaches.
Who it helps most: People who experience strong cravings and who find that once they start drinking, they cannot stop. The injectable form is particularly helpful for those with adherence difficulties.
Side effects: Nausea (most common, usually temporary), headache, dizziness, fatigue, and injection site reactions (Vivitrol). Cannot be used in patients currently taking opioids (precipitates withdrawal).
Acamprosate (Campral)
How it works: Acamprosate modulates glutamate and GABA neurotransmitter systems that are disrupted by chronic alcohol use. It reduces the hyperexcitable state that develops during early sobriety — the restlessness, anxiety, insomnia, and dysphoria that drive many people back to drinking.
Dosing: Two 333 mg tablets three times daily (6 tablets per day). This dosing regimen can be a barrier to adherence.
Evidence: Studies show acamprosate significantly increases the number of abstinent days and time to first relapse. It appears most effective for patients whose primary goal is maintaining abstinence (rather than reducing consumption).
Who it helps most: People who have already stopped drinking and want to maintain sobriety. Particularly helpful for those experiencing persistent post-cessation anxiety, sleep disturbance, and restlessness.
Side effects: Diarrhea (most common), nausea, and abdominal discomfort. Generally well-tolerated.
Disulfiram (Antabuse)
How it works: Disulfiram blocks the enzyme aldehyde dehydrogenase, preventing the normal metabolism of alcohol. When a person on disulfiram drinks, toxic acetaldehyde accumulates rapidly, causing an extremely unpleasant reaction: intense nausea, vomiting, headache, flushing, chest pain, and palpitations. This aversive consequence deters drinking.
Dosing: 250-500 mg daily oral tablet.
Evidence: Disulfiram's effectiveness depends heavily on adherence. When taken consistently (particularly under supervised dosing), it significantly reduces drinking days. However, unsupervised adherence is poor because patients can simply stop taking it before drinking.
Who it helps most: Highly motivated patients who benefit from an external deterrent. Supervised dosing (by a spouse, clinician, or pharmacist) dramatically improves outcomes. It works best as part of a comprehensive treatment plan, not as a standalone intervention.
Side effects: Metallic taste, drowsiness, headache. The disulfiram-alcohol reaction can be medically serious — patients must avoid all alcohol sources including certain foods, mouthwash, and topical products containing alcohol.
Why Are These Medications Underused?
Despite FDA approval and strong evidence, fewer than 10% of people with alcohol use disorder receive medication. Barriers include lack of physician training in addiction medicine, persistent stigma around medication for addiction, patients and providers viewing addiction as requiring only willpower, insurance coverage limitations, and the misconception that MAT replaces one substance with another.
This treatment gap represents a significant public health failure. These medications save lives, and every person with AUD should have the opportunity to discuss them with their provider.
FAQ
Can I take alcohol addiction medication while still drinking?
Naltrexone can be started while the person is still drinking — it works by reducing the pleasure and reinforcement of alcohol, gradually decreasing consumption. This makes it suitable for people not yet ready for complete abstinence. Acamprosate is most effective after alcohol cessation and is typically started after detox. Disulfiram must only be started after the person has stopped drinking, as the combination causes a severe reaction.
How long do I need to take medication for alcohol addiction?
Treatment duration varies. Most guidelines recommend a minimum of 3-6 months, with some patients benefiting from longer treatment. Naltrexone and acamprosate can be safely taken for years. The decision to discontinue should be made collaboratively with your provider, considering stability in recovery, coping skills development, and support system strength.
Do these medications cure alcoholism?
No medication cures alcohol use disorder — they are tools that support recovery by reducing cravings, stabilizing brain chemistry, or deterring drinking. The most effective approach combines medication with behavioral therapy, social support, and lifestyle changes. Medications make it easier to engage in the psychological and behavioral work of recovery, but they do not replace that work.
References:
- National Institute on Alcohol Abuse and Alcoholism. (2024). Treatment for Alcohol Problems: Finding and Getting Help.
- Jonas, D.E. et al. (2014). Pharmacotherapy for Adults with Alcohol Use Disorders: A Systematic Review and Meta-Analysis. JAMA.
- Substance Abuse and Mental Health Services Administration. (2023). Medications for Substance Use Disorders (TIP 63).
- FDA. (2023). Approved Medications for Alcohol Use Disorder.
Valley Spring Recovery Center Editorial Team
This article was reviewed by the Valley Spring Recovery Center editorial team, comprising licensed therapists, medical professionals, and addiction specialists dedicated to providing accurate, evidence-based information about substance use disorders and treatment options.