To achieve stability and long-lasting relief from alcohol use disorder (AUD), most people need treatments that address their mental health and social life. Treatments like psychotherapy and support groups are critical. However, with these approaches alone, many people still struggle to avoid drinking as they may experience cravings and withdrawal symptoms that make it hard to stop. There are medications available that can help with these challenges, making it easier to focus on other forms of treatment. Medication management is an often overlooked strategy for treating AUD.

Part of the reason that more people don’t receive medication for AUD is the stigma of substance use. There’s still a widespread idea that these disorders are a matter of choice or a moral failing. The medical field has shifted to talking about AUD as a mental health condition or a brain disease. In practice, many care providers and recovery communities still use methods that rely on shame and judgment. Taking medication for a substance use disorder is not replacing one addiction with another, and it’s not a “crutch” or a sign of weakness. As long as you’re working with a qualified prescriber, it’s a humane and effective form of treatment.

In this article, we’ll compare and contrast three medications for AUD: naltrexone, disulfiram and acamprosate. 

How each medication works

Each medication for alcohol use disorder works a bit differently to help with specific treatment goals. Some people want to avoid drinking alcohol under any circumstances. Others may only want to reduce their alcohol consumption. These medications can help by reducing cravings and withdrawal symptoms, reducing the effects of alcohol, or creating unpleasant effects when you drink alcohol. 

Here’s a quick snapshot of each medication’s effects:

• Naltrexone reduces the pleasurable effects of alcohol or opioids.
• Disulfiram causes nausea, vomiting, confusion, fast heartbeat, chest pain, and weakness when alcohol is consumed.
• Acamprosate reduces cravings and withdrawal symptoms.

For people who don’t want to drink any alcohol, disulfiram may be the best choice. It’s critical to understand its effects and have the control to maintain abstinence. Disulfiram isn’t the best choice for people who have trouble controlling their impulses or understanding what will happen if they drink while taking their medication. 

For those who only want to reduce their alcohol consumption, or those who are at risk of drinking, naltrexone or acamprosate may be better. Naltrexone is particularly helpful for those who don’t have chronic AUD but are prone to binge drinking. 

Effectiveness and clinical evidence

Of all the medications available for alcohol use disorder, acamprosate and naltrexone have shown the best results in clinical trials. These medications help people limit their drinking. Those who do relapse may have an easier time ending alcohol use again. 

Naltrexone blocks the sedation and euphoria that alcohol often induces, ultimately inhibiting the rewards felt in the brain when drinking.

Acamprosate can help improve sleep and anxiety symptoms, and people also continue to benefit from its effects for up to a year after they stop taking it.

There is moderate evidence that disulfiram is helpful for alcohol use disorder. It’s most effective for people who are motivated and engaged. Otherwise, there’s a risk that people may not take their medication.

Choosing a medication for alcohol use disorder

Aside from treatment goals, there are a few other factors to consider when choosing a medication. Your personal preferences are among the most important. Your ability to understand the medication’s effects and stick to your treatment plan, as well as other behavioral considerations, also play important roles. 

Your provider should consider your history with alcohol use, other medical conditions you have, and medications you’re taking, too. 

Side effects and contraindications

As with any medication, side effects and interactions are possible. Each drug has unique risks that your prescriber should review with you.

Minor side effects may fade as your body adjusts, but serious effects — like worsening depression, suicidal thoughts, or allergic reactions — require immediate attention. Naltrexone and disulfiram should never be taken together. Certain foods, products, or medicines may also interact with AUD medications.

Naltrexone — Never attempt to overpower naltrexone by using opioids, as this can cause severe problems, including death. Ask your provider before taking medications for coughs, pain or diarrhea. Avoid opioids, disulfiram or thioridazine. After stopping naltrexone, you may be more sensitive to opioids.

Acamprosate — Not recommended for members with kidney problems, and is often less suitable for older adults.

Disulfiram — Avoid alcohol in all forms, including sauces, vinegars, mouthwash and rubbing alcohol. Side effects can last for two weeks after discontinuation.

Some minor side effects are normal and may subside after you get used to the medication. Others are more serious and require immediate medical attention. 

Your ReKlame Health provider can help you find the right medication for alcohol use disorder

Reaching out for help with AUD and deciding to seek treatment isn’t easy. You’re taking a big step by learning about your options and looking for support. Healing is a lifelong journey, but you don’t have to take it alone, and it gets easier as you go. Your prescriber can be a valuable partner, providing medication management services and social support.

ReKlame Health is a team of board-certified psychiatric nurse practitioners (PMHNP-BC) who have the credentials, experience and cultural awareness to provide excellent treatment. You’ll also work with a care navigator who can help you find other resources and care to meet your needs.

We commend you for taking this step toward recovery. You can see a ReKlame provider within 48 hours. Here’s how to join.