Medications can be an important part of treatment for people with alcohol use disorder. This article reviews the three Food and Drug Administration approved alcohol use disorder medications, how each one works, who may be a candidate, common side effects and safety issues, and how medication fits with counseling and other supports. This is general education and not individualized medical advice. Medication and placement decisions need assessment by a qualified clinician.
What are alcohol use disorder medications?
The medication options most commonly used in outpatient care for alcohol use disorder are naltrexone, acamprosate, and disulfiram. These drugs are nonaddictive and have different ways of reducing drinking or helping a person maintain abstinence. All three are recognized in national treatment guidance and by federal agencies as available pharmacologic options for adults with alcohol use disorder. NIAAA and SAMHSA provide clinician and patient guides to these medications.
How each medication works
- Naltrexone, an opioid receptor antagonist, reduces alcohol reward and craving, and can lower the risk of heavy drinking. It is available as a daily tablet or a monthly extended-release injection. NIAAA overview, VIVITROL prescribing information.
- Acamprosate helps normalize brain systems that have been altered by long-term drinking and can reduce protracted withdrawal symptoms such as anxiety and insomnia, making it easier to stay abstinent. It is given as an oral tablet taken twice or three times daily. SAMHSA brief guide, Campral prescribing information.
- Disulfiram works as a behavioral deterrent: it blocks aldehyde dehydrogenase so that drinking alcohol produces unpleasant effects such as flushing, nausea and headache. Disulfiram is usually given as a daily tablet when the person is committed to avoiding alcohol. Antabuse label (disulfiram), SAMHSA guide.
How clinicians choose among medications
The choice of medication depends on the persons goals, medical history, current substances used, kidney and liver function, pregnancy or breastfeeding status, and ability to follow a regimen. Medication is most effective when combined with counseling or behavioral treatments and ongoing medical follow-up. National resources and treatment guidelines stress shared decision making with a clinician when selecting medications. NIAAA treatment navigator, SAMHSA brief guide.
Key clinical considerations
- Goal: If the primary goal is abstinence, acamprosate or disulfiram may be preferred; for reducing cravings and heavy drinking, naltrexone is commonly used. NIAAA.
- Opioid use: Naltrexone is an opioid blocker and should not be started in patients currently dependent on opioids unless they have completed opioid detoxification and a clinician confirms it is safe. Also, naltrexone will block opioid pain medicines. VIVITROL label.
- Liver disease: Naltrexone and disulfiram require careful liver monitoring. Acamprosate is not metabolized by the liver but requires dose adjustment for reduced kidney function; renal function should be checked before prescribing. SAMHSA, Campral label.
- Pregnancy and breastfeeding: Data are limited. Disulfiram is generally avoided in pregnancy. Decisions about naltrexone or acamprosate during pregnancy should be made with specialists, weighing maternal and fetal risks. NIH/NCBI review, SAMHSA guide.
- Adolescents: Safety and effectiveness are less well established in people under 18, so specialist input is recommended. Naltrexone label, NIAAA.
Safety, monitoring, and high-risk situations
Before starting any medication, clinicians typically check medical history, liver function tests and kidney function as appropriate, and review other medications to avoid harmful interactions. For people with recent heavy use, active withdrawal can be life threatening and needs assessment and treatment before starting relapse-prevention medications. Benzodiazepines are the standard medical treatment for moderate to severe alcohol withdrawal and inpatient or closely monitored medical care may be required. NIAAA on withdrawal, ASAM guideline.
If someone is having seizures, confusion, very fast heartbeat, trouble breathing, or other medical emergencies, call 911 now. For suicide risk or a mental health crisis, call or text 988 for the 988 Suicide & Crisis Lifeline. For urgent medical questions about alcohol withdrawal or overdose, seek emergency care immediately.
Comparison table: naltrexone, acamprosate, disulfiram
| Medication | Form | Main clinical effect | Usual starting condition | Major monitoring or cautions |
|---|---|---|---|---|
| Naltrexone | Oral tablet daily or monthly injection (extended release) | Reduces craving and alcoholrelated reward, lowers risk of heavy drinking | Often started when not actively intoxicated; patient should not be opioid dependent | Check liver tests, avoid if using opioids, may interfere with opioid pain meds. FDA |
| Acamprosate | Oral tablets, usually twice or three times daily | Reduces protracted withdrawal symptoms, supports maintenance of abstinence | Intended for patients who are abstinent at treatment start | Adjust dose for kidney impairment; not metabolized by liver. FDA |
| Disulfiram | Oral tablet daily | Produces an aversive reaction with alcohol to deter drinking | Used when patient is motivated to avoid alcohol and understands risks | Can cause severe reactions with alcohol, monitor liver tests, avoid in pregnancy unless benefits outweigh risks. DailyMed |
Common questions patients and families ask
How long will I take the medication?
Duration varies. Some people use medication for a few months after stopping heavy drinking, others use it for a year or longer based on ongoing risk and shared clinical decision making. Treatment duration should be individualized and reviewed regularly with your clinician. SAMHSA brief guide.
Can I use medication if I am still drinking?
Some medications may be started while the person still drinks lightly, but others, such as acamprosate, are intended for use after the person is abstinent. Naltrexone is often used to reduce heavy drinking even if complete abstinence is not yet achieved, but starting any medication should follow a clinician assessment. NIAAA, SAMHSA.
Can medications be combined with counseling?
Yes. Medications work best when combined with behavioral therapies, counseling, and mutual-support groups. Medication is one tool in a broader treatment plan. NIAAA treatment navigator.
Sources and further reading
- NIAAA, Treatment for Alcohol Problems: Finding and Getting Help
- NIAAA Alcohol Treatment Navigator, Ten Questions for Alcohol Treatment Programs
- SAMHSA and NIAAA, Medication for the Treatment of Alcohol Use Disorder: A Brief Guide
- FDA VIVITROL prescribing information (naltrexone extended-release)
- FDA Campral prescribing information (acamprosate)
- DailyMed Antabuse label (disulfiram)
- Meta-analysis and systematic reviews of disulfiram and other pharmacotherapies (PMC)
Next steps if you or a family member needs help
If you or a loved one is considering medication for alcohol use disorder, the next step is a confidential assessment by a qualified clinician to determine the best treatment plan. If you are in New Jersey and want information about outpatient detox or addiction treatment options, see our treatments page, locations, or contact admissions for confidential help: treatments, locations, contact us. The admissions team can help arrange an assessment and explain clinical criteria, availability and next steps.
Remember, this article is educational and not a substitute for medical care. If you are in immediate danger, call 911. If you or someone is having thoughts of suicide or in a mental health crisis, call or text 988 for the 988 Suicide & Crisis Lifeline. Medication decisions should be made with a clinician after medical evaluation and discussion of risks and benefits.
