Medications for Alcohol Use Disorder: What Helps With Quitting Drinking?

Alcohol use disorder (AUD) is a complex condition that can have serious physical, emotional and social consequences. If you or someone you love struggles with alcohol misuse, you may already know how difficult it can be to cut back or stop drinking altogether. While counseling and support groups play a significant role in recovery, medications can also be an invaluable tool. In this article, we will explore three of the most commonly prescribed medications for AUD — acamprosate (Campral®), disulfiram (Antabuse®) and naltrexone (Vivitrol). We’ll also discuss how to decide if medication is right for you, and where to turn for additional resources and support.

How Can I Tell If a Medication Is Right for Me?

Deciding whether to include medication in your treatment plan for alcohol use disorder is a personal choice that depends on various factors. While some people benefit greatly from medication-assisted treatment, others may find that therapy, counseling or support groups alone work well. Here are some considerations that can help guide your decision:

• Severity of Alcohol Use: The more severe your drinking patterns and associated withdrawal symptoms, the more likely it is that medication could help stabilize your early recovery.
• Treatment Goals: If you aim for complete abstinence, certain medications might work better than others. If your goal is to reduce your drinking, naltrexone, for instance, may help decrease heavy drinking days.
• Medical History: Your overall health status and any co-occurring conditions (like liver or kidney problems) can influence which medication is appropriate for you. Always share your full medical history with your prescribing clinician.
• Concurrent Mental Health Conditions: If you live with a mental health disorder such as depression or anxiety, your doctor may recommend a specific medication that can support both your mental health and AUD recovery.
• Lifestyle Factors: Practical considerations like daily schedules, ease of use and personal motivation to take a pill or injection can factor into whether a medication will be effective in the long term.
• Willingness To Follow Prescribed Guidelines: Some medications for AUD require strict adherence to instructions. For example, disulfiram requires you to strictly avoid alcohol in any form — even in cooking extracts or mouthwash.

Ultimately, there is no one-size-fits-all approach. Medication for alcohol use disorder works best when coupled with therapy, counseling and social support. A trusted healthcare professional can help you evaluate the risks and benefits and determine if a medication is right for your needs and situation.

Acamprosate (Campral®)

Acamprosate, known by its brand name Campral®, is one of the three primary FDA-approved medications for treating alcohol dependence. It is often used after you have completely stopped drinking and gone through the acute withdrawal phase.

How Does Acamprosate Work?

Acamprosate works by helping restore the normal balance of neurotransmitters in the brain. Chronic drinking can alter levels of gamma-aminobutyric acid (GABA) and glutamate — chemicals that help regulate mood, reward and stress responses. When alcohol use is stopped or drastically reduced, these neurotransmitters can become imbalanced, leading to withdrawal symptoms such as anxiety, insomnia, restlessness and cravings.

Acamprosate is believed to modulate these neurotransmitters back toward a normal equilibrium, making it easier for people to maintain abstinence. Unlike disulfiram, acamprosate does not cause unpleasant reactions if alcohol is consumed. Instead, it reduces some of the psychological distress and urges to drink that often accompany early sobriety.

Who Can Be Prescribed Acamprosate?

Acamprosate is generally prescribed for individuals who have already stopped drinking or who are planning to stop in the near future. It is typically recommended for those who:

• Have achieved sobriety but struggle with post-acute withdrawal symptoms and cravings.
• Prefer a medication that does not induce adverse physical reactions upon relapsing (like disulfiram does).
• Have no significant kidney problems (acamprosate is processed through the kidneys).

If you have severe kidney impairment, your doctor may advise against using acamprosate. People with moderate impairment may still be able to use it under close supervision, sometimes with a modified dose.

Considerations When Taking Acamprosate

• Dosing: Acamprosate is usually taken three times a day. Adherence to the dosing schedule is crucial for effectiveness.
• Side Effects: The most commonly reported side effects include diarrhea, nausea, gas and headaches. These symptoms often subside over time.
• Safety Profile: Acamprosate does not carry a significant risk of dependence, and it generally does not interact adversely with other medications you might be taking for mental health conditions.
• Duration of Use: Many people stay on acamprosate for several months to a year. Work closely with your healthcare team to determine when and how to discontinue it.

Disulfiram (Antabuse®)

Disulfiram, sold under the brand name Antabuse®, is one of the oldest medications approved for alcohol use disorder. Unlike acamprosate, which helps regulate neurotransmitters to reduce cravings, disulfiram deters you from drinking by causing an intensely unpleasant reaction when alcohol is consumed.

How Does Disulfiram Work?

Disulfiram interferes with the way your body metabolizes alcohol. When you drink alcohol, it is first converted into acetaldehyde — a toxic substance that typically breaks down further into a harmless chemical called acetate. Disulfiram blocks the enzyme responsible for converting acetaldehyde into acetate. As a result, acetaldehyde builds up in your bloodstream if you drink alcohol while taking disulfiram. This causes symptoms such as:

• Flushing
• Nausea and vomiting
• Headache
• Rapid heartbeat
• Low blood pressure
• Dizziness

These effects can last from 30 minutes to several hours and are designed to create a strong psychological and physical deterrent to consuming alcohol.

Who Can Be Prescribed Disulfiram?

Disulfiram is typically best suited for individuals who are highly motivated to quit drinking and willing to avoid alcohol entirely — even trace amounts. Disulfiram can be effective for those who:

• Want a medication that has an immediate and tangible deterrent effect.
• Have strong external support systems to help them adhere to an abstinence-based approach.
• Do not have certain comorbid health conditions that disqualify its use (such as severe heart disease or psychosis).

It’s important to note that disulfiram is not used to manage withdrawal symptoms. In fact, it should never be started until someone has fully detoxed from alcohol (at least 12 hours to 24 hours since last drink) to avoid adverse reactions.

Considerations When Taking Disulfiram

• Strict Avoidance of Alcohol: Even small amounts of alcohol, such as those found in some mouthwashes, cough syrups or cooking extracts, can trigger a disulfiram reaction. You must carefully read labels and avoid products that contain alcohol.
• Monitoring: Some people find it beneficial to take disulfiram under supervision — for example, having a family member or health professional hand them the pill daily to ensure adherence.
• Duration: Disulfiram may be used for as long as it is helpful in supporting sobriety. Some individuals continue it for months or even years, while others only need it for a shorter period.
• Side Effects: Beyond the alcohol-disulfiram reaction, some people report drowsiness, headache and a metallic or garlic-like taste in the mouth.
• Importance of Motivation: Disulfiram is most effective when individuals have a strong commitment to abstinence and a supportive environment to help them maintain that commitment.

Naltrexone (Vivitrol)

Naltrexone, approved by the FDA for treating both alcohol and opioid dependence, comes in two forms for alcohol use disorder: an oral tablet (brand name ReVia®) and an extended-release injectable (brand name Vivitrol®). It is widely used to reduce alcohol cravings and is effective in helping people decrease the amount of alcohol they consume.

How Does Naltrexone Work?

Naltrexone works by blocking opioid receptors in the brain associated with the rewarding effects of drinking. When you consume alcohol, the body releases endorphins that bind to these receptors, contributing to the feeling of euphoria. By blocking these receptors, naltrexone makes drinking less pleasurable, which can help reduce cravings and the urge to drink.

An important note is that naltrexone is not the same as an opioid; it merely binds to the same receptors. It also does not deter drinking with a negative reaction (as disulfiram does). Instead, it cuts back on the reward or “buzz” associated with alcohol use.

Who Can Be Prescribed Naltrexone?

Naltrexone can be prescribed to a wide range of individuals, including those who are still drinking but want to reduce consumption, as well as those who have already quit drinking but are trying to prevent relapse. Healthcare providers often recommend naltrexone for people who:

• Want to reduce heavy drinking rather than strictly focusing on total abstinence (though it can also support abstinence).
• Have no opioid dependence and are not on opioid medications for pain management. (Taking naltrexone when you have opioids in your system can precipitate withdrawal.)
• Do not have acute hepatitis or severe liver impairment.

If you have any type of liver disease, you should discuss this thoroughly with your doctor before starting naltrexone, as high doses of naltrexone can potentially affect liver function.

Considerations When Taking Naltrexone

• Formulations: Oral naltrexone is generally taken once a day, while the extended-release injection (Vivitrol) is given once a month by a healthcare professional.
• Side Effects: Common side effects can include nausea, headaches, dizziness, fatigue and, for the injectable form, pain at the injection site.
• Adherence: Some people prefer the monthly injection because it removes the need to remember a daily pill, and it provides consistent medication levels. Others may find it more convenient or less expensive to take daily oral doses.
• Alcohol Use: Unlike disulfiram, naltrexone does not cause a severe reaction if you drink. It simply reduces the reward you feel. However, you should be aware that continued heavy drinking can still pose serious health risks.
• Combined Therapy: For many people, the greatest success comes when naltrexone is paired with psychosocial support, counseling or participation in a recovery program.

Other Helpful Resources

Medications can be an essential component of your alcohol use disorder treatment, but they typically work best as part of a holistic plan. If you’re considering medication or have already started on one of these options, keep in mind the following additional resources:

• Counseling and Therapy: Cognitive behavioral therapy (CBT), motivational interviewing and other forms of counseling can help address the underlying causes of alcohol misuse.
• Peer Support Groups: Programs like Alcoholics Anonymous (AA), SMART Recovery and other support groups provide a sense of community, accountability and shared experience that can bolster long-term recovery.
• Inpatient and Outpatient Rehabilitation Programs: Comprehensive programs like those offered by The Recovery Village provide structured treatment, ranging from medical detox to aftercare planning. These programs often integrate medication management, therapy, and group support for a personalized plan.
• Family and Social Support: Involving loved ones in your recovery journey can increase accountability and motivation. Family therapy may also help heal relationships strained by alcohol misuse.
• Teletherapy and Online Resources: If attending in-person sessions is not feasible, many online platforms offer counseling and therapy. These virtual resources can be more flexible and accessible when you have a busy schedule or limited transportation.

The path to recovery can sometimes feel overwhelming, but you do not have to walk it alone. Medications like acamprosate, disulfiram and naltrexone can offer valuable support in reducing cravings, improving abstinence rates, and, in the case of disulfiram, providing a firm deterrent to relapse. Deciding on the best option depends on your personal goals, medical background and comfort with each medication’s unique approach. Speak with a healthcare professional to explore which medication might align with your lifestyle and recovery needs.

Above all, remember that no single medication or strategy is a “magic bullet.” Successful treatment for alcohol use disorder often involves multiple approaches — combining medication, therapy and a strong support network. If you’re ready to take the next step, connect with a medical provider or treatment center like The Recovery Village to discuss a comprehensive plan tailored to you.