Alcohol Use Disorder (AUD) is a chronic condition that affects millions of people worldwide. While therapy, support groups, and behavioral changes are critical components of recovery, medication can play an essential role in managing cravings, reducing alcohol consumption, and maintaining sobriety. Currently, there are three FDA-approved medications specifically for treating AUD: disulfiram, naltrexone, and acamprosate.

Today, we'll discuss how each of these medications work, their benefits, and what you should know if you're considering them as part of your treatment plan.

Disulfiram (Antabuse)

How It Works:

Disulfiram is one of the oldest medications used for AUD, approved by the FDA in 1951. It works by causing an unpleasant reaction when alcohol is consumed. Disulfiram inhibits the enzyme aldehyde dehydrogenase, which breaks down alcohol in the body. When someone taking disulfiram drinks alcohol, a buildup of acetaldehyde occurs, leading to unpleasant symptoms such as nausea, vomiting, headache, and flushing. Disulfiram blocks an enzyme (aldehyde dehydrogenase) in the body that helps break down alcohol. When someone taking disulfiram drinks alcohol, a chemical called acetaldehyde builds up in the body. This causes unpleasant symptoms like nausea, vomiting, headaches, and flushing.

Effectiveness:

The primary benefit of disulfiram is its deterrent effect—it’s meant to discourage individuals from drinking by making alcohol consumption uncomfortable. It doesn’t reduce cravings for alcohol but rather provides a psychological and physical barrier to drinking.

Who It’s For:

Disulfiram works best for people who are very motivated to stay sober and understand the risks of drinking while on the medication. It’s usually given to those who are committed to not drinking at all and who have a strong support system to help them stay on track.

Considerations:

It’s important to note that disulfiram can cause severe reactions if alcohol is consumed, even in small amounts. Products like mouthwash, sauces or even absorbing hand sanitizer through your skin can lead to unpleasant symptoms. Therefore, patients must be vigilant about avoiding alcohol in all forms. It is also not recommended for individuals with certain medical conditions, such as liver disease.

Naltrexone (ReVia, Vivitrol)

How It Works:

Naltrexone is a medication that blocks the effects of opioids in the brain. It also helps reduce the enjoyable feelings that alcohol can cause. When someone drinks alcohol while taking naltrexone, they don’t feel the same "high" or pleasure from drinking, which can help lower their cravings and reduce how much alcohol they drink.

Naltrexone comes in two forms:

• Oral Naltrexone (ReVia): Taken daily as a pill

• Extended-Release Injectable Naltrexone (Vivitrol): Administered once a month via injection.

Effectiveness:

Naltrexone has been shown to reduce the frequency and severity of alcohol consumption. It’s especially beneficial for individuals who want to reduce heavy drinking but may not be ready or able to completely abstain. Studies show that naltrexone can help people reduce their alcohol intake significantly, making it easier to maintain control over their drinking behaviors.

Who It’s For:

Naltrexone is a good option for people who continue to experience strong cravings for alcohol and are working toward either reducing or stopping their alcohol use. It’s also effective for individuals who are looking for harm-reduction approaches, as it doesn’t require complete abstinence to work.

Considerations:

Naltrexone should not be used by individuals who are currently using opioids, as it can trigger withdrawal symptoms. Liver function should also be monitored, as naltrexone can elevate liver enzymes in some patients. The injectable form (Vivitrol) offers the benefit of ensuring compliance, as it only needs to be administered once a month.

Acamprosate (Campral)

How It Works:

Acamprosate helps balance chemicals in the brain that control excitement and relaxation, called neurotransmitters, specifically glutamate and gamma-aminobutyric acid (GABA). Long-term alcohol use can mess up this balance, causing anxiety, restlessness, and discomfort, especially during withdrawal and early recovery. Acamprosate helps restore this balance when you stop drinking and reduces the emotional and physical discomfort that can make someone want to drink again.

Unlike disulfiram and naltrexone, acamprosate does not affect the pleasurable effects of alcohol or act as a deterrent. Instead, it helps reduce the post-acute withdrawal symptoms that can persist for weeks or months after stopping drinking.

Effectiveness:

Acamprosate is most effective for individuals who have already stopped drinking and want to maintain sobriety. It’s particularly useful for reducing the risk of drinking again by making it easier to cope with the emotional and physical stress that often comes with early recovery. Studies suggest that acamprosate increases the likelihood of maintaining abstinence, especially when combined with counseling and behavioral therapy.

Who It’s For:

Acamprosate is best suited for individuals who are committed to abstinence and are struggling with post-acute withdrawal symptoms. It’s typically prescribed to people who have already detoxed from alcohol and are in the early stages of recovery.

Considerations:

Acamprosate is taken in pill form three times a day, which can be a challenge for some individuals to adhere to. It’s generally well-tolerated, with few side effects, but it’s not recommended for people with severe kidney impairment.

Choosing the Right Medication

The decision to use medication as part of your treatment for AUD is personal and should be made in consultation with a healthcare provider. Each of these medications has its strengths and is suited to different stages and goals of recovery:

• Disulfiram is ideal for those committed to abstinence and who need something to stop them from drinking.

• Naltrexone is beneficial for individuals looking to reduce heavy drinking or manage cravings without stopping drinking completely.

• Acamprosate is best for those who have already quit drinking and need support in managing withdrawal-related symptoms and preventing drinking again.

Combining medication with therapy, support groups, and lifestyle changes is often the most effective way to achieve long-term recovery from alcohol use disorder.

Final Thoughts

Medication can be a powerful tool in the journey toward recovery from Alcohol Use Disorder. If you’re considering medication as part of your treatment plan, consult an addiction expert, like me, who can help determine which option is best suited for your unique situation. Whether your goal is to reduce drinking or achieve complete sobriety, these FDA-approved medications offer different pathways to help you regain control over your life.

If you have questions or are interested in exploring treatment options for AUD, feel free to reach out for a consultation. Taking that first step toward understanding your options is the key to long-lasting recovery.