Medications for Alcohol Use Disorder

Medications for alcohol use disorder can play an important role as part of a complete treatment plan.

If your loved one drinks alcohol often, you may wonder if they are struggling with an alcohol use disorder (AUD), commonly known as alcoholism.

In 2021, about 28.8 million adults (11.2% of people 18 or older) had an alcohol use disorder, according to the 2022 National Survey on Drug Use and Health. Among teenagers, about 750,000 (2.9% of people between 12 and 17 years old) had this disorder in 2021.^[1]

Treating alcohol use disorders with either the goal of cutting back on alcohol or stopping use completely can improve a loved one’s mental and physical well-being.

What can I do if my loved one has an alcohol use disorder?

Alcohol use disorder can be prevented and treated. Studies show that about 50% of the disorder is passed down through families, and 50% comes from the environment where people grow up and live.^[2]

Typically, a healthcare provider meets with loved ones in person to diagnose alcohol use disorder, although it is possible to use telehealth. They may also check for other mental health problems. People with substance use disorders often have higher rates of anxiety and depression than those without one.^[3]

If a healthcare provider diagnoses your loved one with alcohol use disorder, it’s time to think about treatment options.

Treatment for alcohol use disorder can vary depending on what the person wants to achieve. Do they want to quit drinking altogether or cut back? Many loved ones may want to try first cutting back on their heavy drinking, which is defined as having 5 drinks or more per day for men and 4 drinks or more for women.^[4] They often find that cutting back is hard and decide to stop because it’s easier than the effort it takes to moderate.^[5]

What are the medications for alcohol use disorder?

In addition to talk therapy, inpatient or outpatient programs, and support groups, medications to treat AUD can be part of your loved one’s treatment plan. The Food and Drug Administration (FDA), which ensures medicines and foods are safe and work well, has approved three medications: disulfiram, acamprosate, and naltrexone. Before prescribing any of them, the healthcare provider and your loved one should decide on an initial goal – likely to either stop drinking or cut back, as it will make a difference in which medicine is prescribed.^[6]

Disulfiram

What is it? The FDA approved the pill disulfiram, also known as Antabuse, in 1949. If a person drinks alcohol while taking disulfiram, they’ll feel sick with nausea, may vomit, have headaches, and experience flushing. The sensations can make people not want to drink.

Who can it help? Because of the nasty effects it has when combined with alcohol, disulfiram works best for people who want to stop drinking.

How is it taken? It is taken as a daily pill. Studies show it works better when someone watches the person take it compared to taking it on their own, as loved ones may skip doses to be able to drink. Its effects can last up to 2 weeks after stopping the medication.

What else to know? The main side effect of disulfiram is feeling very drowsy, which can be moderate to severe. It can also cause hepatitis (liver inflammation) and confusion. Sometimes, it makes people see or hear things that aren’t real, known as psychosis. Because of this, disulfiram might not be suitable for patients who already have a psychotic disorder.

When using disulfiram, loved ones need to avoid anything with alcohol, like cooking wine, vinegar, or mouthwash and cough syrups that have alcohol in them. Disulfiram shouldn’t be taken if alcohol was consumed in the last 48 hours.

Naltrexone

What is it? Approved in 1994, naltrexone blocks the “feel good” effects of drinking and can help reduce the desire to drink.

Who can it help? It may be a good option for people who want to cut back on heavy drinking or stop entirely and don’t have a serious liver condition.

How is it taken? It can be taken as a pill (sold under the brand name Revia) every day or as a monthly injection (sold as Vivitrol). While a monthly shot can be helpful for people staying on track with their medication, it can be expensive. The manufacturer offers co-pay assistance that can reduce the costs if insurance doesn’t cover it.

Apart from taking it daily, Revia can also be taken an hour before drinking alcohol, according to what is known as the Sinclair Method. When used in this way, it blocks the typical “buzz” caused by drinking, which can prevent people from consuming more harmful amounts of alcohol. Some people choose this method to reduce their pattern of alcohol use, whether it’s daily or weekly.

Unlike disulfiram, which makes a person sick if they drink alcohol, naltrexone can be used even if someone keeps drinking alcohol. While it may reduce cravings and the “buzz” from drinking, a person who wants to get intoxicated (e.g., drunk) can still do so on this medication.

What else to know? Naltrexone is also used to treat opioid addiction. So, it is a good choice for people dealing with both alcohol and opioid problems. As a result, naltrexone can’t be used if a person is taking opioids to treat chronic pain because it lessens their effect. For that reason, naltrexone should be stopped 48 to 72 hours (about 2 to 3 days) ahead of surgery.

It’s also recommended that people inform all healthcare providers, including dentists, that they are taking naltrexone. Wearing a bracelet or having a medical card in their wallets noting their use of naltrexone is also recommended. This is so non-opioid pain management can be used in case of an emergency, surgery or for any other medical reason.

Sometimes, the use of naltrexone can lead to suicidal thoughts. It’s important to let the prescriber know right away if a person is feeling depressed or has thoughts of hurting themselves.

Acamprosate

What is it? The FDA approved acamprosate, known by the brand name Campral, in 2004 to help people maintain abstinence.

Who can it help? Acamprosate can help reduce the desire to drink, although it will not help with withdrawal symptoms. It’s meant for patients who want to stay abstinent after not drinking for a while and who don’t have severe kidney problems. Acamprosate works well for people who drink to feel better when they’re upset (called relief drinkers). It’s also helpful for those whose sleep suffers because they want to drink.

How is it taken? The medication comes in pill form and is usually taken three times a day. While this can work well for some, it may be off-putting for others.

What else to know? People who have been sober for 10 to 14 days before starting treatment tend to have better results with acamprosate. Unlike naltrexone, which helps more with cutting down on heavy drinking, acamprosate is better at supporting total abstinence from alcohol. In addition, acamprosate is safe for patients with liver disease. Common side effects include gas, diarrhea, stomach cramps, and itching.^[7]

How well do the medications work?

These medicines are highly effective in treating alcohol use disorder, especially when compared to drugs used for other common health problems. For instance, both naltrexone and acamprosate are better at reducing drinking and helping people stop drinking completely than the usual medicines used to treat high blood pressure. However, while about 70% of people with high blood pressure take medication for it in the United States, fewer than 10% of those with alcohol use disorder get treatment.^[8]

Are there other medications to treat alcohol use disorder?

Only the three medications mentioned above are approved by the FDA for this disorder. However, the American Psychiatric Association (APA) guidelines include two more: gabapentin and topiramate. Another medication, nalmefene, has been approved in Europe for treating alcohol use disorder.^[9]

Gabapentin

Gabapentin is FDA-approved to treat nerve pain in adults and seizures in patients over 3 years old. The APA suggests gabapentin as an option if naltrexone or acamprosate don’t work or if a person can’t tolerate them.

It is not clear how good gabapentin is to treat alcohol use disorders because the evidence is mixed. Some analyses do suggest that gabapentin may be effective, especially in reducing heavy drinking and for people who have experienced more alcohol withdrawal symptoms.^[10] The medication must be taken 3 times a day.

Topiramate

Topiramate is used for seizures, preventing migraines, weight loss, and managing weight long-term. Taken twice a day, it reduces the urge to drink and has been shown to help people stop drinking and cut down on heavy drinking.

Topiramate might be considered as an option to reduce heavy drinking, especially for people with migraines, obesity, or certain eating disorders, since it helps with weight loss and curbs appetite, too.

Nalmefene

Nalmefene is approved in Europe for alcohol use disorder but not in the United States for this purpose. In the Unites States, this medication has been permitted for overdose reversal but not as a medication for alcohol use disorder. Unlike naltrexone, nalmefene doesn’t cause liver problems.^[11] However, it should not be used by anyone using opioids or with severe kidney or liver disease.^[12] People usually take it as needed, not on a schedule.

Monitoring progress

Just like other chronic conditions, people with an alcohol problem usually need ongoing care. Their treatment plan may need to be adjusted at times as well.

Changes may be considered if your loved one is unable to follow the treatment plan. Additionally, prescribers will want to know if they have been able to stay away from drinking or cut back, and if so, for how long. They may ask if your loved one still has cravings to drink. Is their health and social life better or worse? Depending upon the answers to these questions, changes may be made to the plan. The provider may also be able to address co-occurring medical disorders, as well as psychiatric and other substance use issues.^[13]

How can you support your loved one's recovery?

If your loved one has an alcohol use disorder, talk to them about medications. They can make a positive difference in their recovery journey. As with any medication or treatment program, it’s important to talk to a healthcare provider to see which of the medications will best suit your loved one.

Taking care of someone with alcohol problems can be stressful. It’s essential for you to also take care of yourself. You can find ways to do this in this article. Here are some important things to consider:

• Remember, your loved one is responsible for managing their alcohol use disorder, but you can offer encouragement and support.
• Changing habits that have existed for a long time is challenging, takes time, and requires lots of effort. Recovery can include relapses. Getting better from this disorder isn’t easy or fast.
• Notice and praise any effort or improvements your loved one makes, even small ones. Encouraging them can really help.
• Medicines may be most effective when used with therapy or counseling. Encourage your loved ones to consider a complete treatment plan including medications—they can make a big difference for many people.^[14]