This tool helps you understand which alcohol use disorder (AUD) medications might be most appropriate for your specific situation based on your goals, medical history, and other factors. Remember: medications should always be used under medical supervision as part of a comprehensive treatment plan.
Important This is not medical advice. Always consult with your healthcare provider before starting any medication.
When someone is trying to stop drinking, medications can be a lifeline. But here’s the truth most people don’t talk about: medications for alcohol use disorder don’t just help you quit-they can also increase your risk of relapse if used wrong. It’s not about the drugs failing. It’s about how they’re used, who takes them, and what else is going on in their life.
Three FDA-approved medications are used today: acamprosate, naltrexone, and disulfiram. Each works differently. Each has its own risks. And each can backfire if not matched to the right person.
Acamprosate doesn’t make you sick if you drink. It doesn’t block pleasure. Instead, it tries to fix your brain after years of alcohol damage. After you stop drinking, your brain chemistry goes haywire. Glutamate spikes. GABA crashes. Acamprosate (sold as Campral) steps in to calm that storm. It’s not a quick fix. You need to be sober for at least three to five days before starting it. And if you slip? It won’t stop you from drinking again. It just helps you stay steady if you’re trying to stay clean.
Naltrexone works differently. It blocks the opioid receptors in your brain-the same ones that light up when you eat chocolate, have sex, or drink alcohol. When those receptors are blocked, drinking doesn’t feel as good. Heavy drinking episodes drop. Cravings ease. Oral naltrexone (Revia) is taken daily at 50 mg. The injectable form (Vivitrol) is given once a month. But here’s the catch: naltrexone doesn’t stop you from having one drink. It just makes it less rewarding. If you’re not motivated to change, it won’t magically turn you into a teetotaler.
Disulfiram (Antabuse) is the old-school option. It makes you sick. If you drink while on it, you get a brutal reaction: flushing, vomiting, racing heart, low blood pressure. It’s designed to scare you off alcohol. But here’s the problem: people stop taking it. A study of 1,383 people in the COMBINE trial found nearly 29% quit disulfiram because of side effects like metallic taste, drowsiness, and fear of accidentally drinking. One sip of mouthwash. One bite of sauce with alcohol. One glass of wine at a party. And boom-emergency room.
Not everyone responds the same way. The data shows clear patterns.
And here’s something surprising: combining acamprosate and naltrexone doesn’t give you double the benefit. The landmark COMBINE study found no added advantage over using one alone. But some smaller studies suggest combination therapy might help certain subgroups-especially those with severe withdrawal symptoms. Still, there’s no clear rule. Doctors often pick one and stick with it.
Many people think medication alone is enough. It’s not.
A 2023 study found that 65% of people who stopped taking their AUD medication relapsed within three months. Why? Cost. Side effects. Lack of counseling. And yes-some people just forget. Acamprosate requires three pills a day. Naltrexone? One pill. Vivitrol? One shot a month. But even then, people miss doses. One study showed only 34.7% of patients stayed on their meds beyond 90 days. And the biggest reason? Out-of-pocket cost. Even generics cost $200-$400 a month. That’s more than a lot of people can afford on minimum wage.
Another hidden risk: starting the wrong drug too soon. You can’t start naltrexone if you’re still using opioids. You need a full 7-10 day washout. If you don’t wait, you risk sudden opioid withdrawal-dangerous, even deadly. And if you start disulfiram without fully understanding the reaction? You might not survive your first slip.
Then there’s liver damage. Naltrexone is processed by the liver. If you have cirrhosis? It can build up. Your doctor needs to check your liver enzymes before and during treatment. Acamprosate is cleared by the kidneys. If your creatinine clearance is below 30 mL/min, you need a lower dose. But most primary care doctors don’t know this. SAMHSA reports only 28% of them feel trained to prescribe these drugs.
It’s not just the old three anymore.
Gabapentin, originally for seizures and nerve pain, is showing real promise for AUD. In a 2020 trial, 45% of people with severe withdrawal symptoms stayed sober on gabapentin-compared to 28% on placebo. And it’s safer for the liver. No liver toxicity. No dangerous interactions. For people with alcohol-related liver disease, it’s becoming a go-to option.
Then there’s ketamine. Yes, the party drug. In a 2022 trial, three weekly infusions cut relapse rates by 41%. It’s not approved yet, but the results are too strong to ignore. Microbiome treatments? A 2023 pilot study using lactobacillus and NAC reduced heavy drinking days by 37%. And digital tools? A smartphone app that tracks cravings and sends coping tips reduced relapse risk by 33% when paired with medication.
And the most exciting? Personalized medicine. Researchers can now predict who will respond to acamprosate with 68% accuracy-just by scanning their brain’s white matter with an MRI. Genetic tests are catching on too. People with certain serotonin transporter genes respond 2.3 times better to ondansetron. We’re moving from trial-and-error to precision treatment.
If you or someone you care about is trying to quit drinking, here’s what actually works:
There’s no magic pill. But there are tools that work-if you use them right. And if you’re not getting the support you need? Keep pushing. Ask for help. Because relapse isn’t failure. It’s a sign the treatment needs adjusting-not that you’ve failed.
Yes, you can drink while taking naltrexone or acamprosate-but you shouldn’t. Naltrexone doesn’t prevent drinking, but it reduces the pleasure you get from it. Acamprosate doesn’t react with alcohol at all. But drinking while on either drug defeats the purpose. These medications work best when paired with abstinence. Drinking while on them increases the chance of relapse because your brain doesn’t learn new, healthier patterns.
Disulfiram has a powerful deterrent effect, but it’s risky. If you drink-even a small amount-you can have a life-threatening reaction: vomiting, low blood pressure, heart palpitations. Many people stop taking it because of side effects like drowsiness and a metallic taste. Compliance is low. Studies show nearly 30% of users quit within weeks. It only works if you’re highly motivated and have someone holding you accountable. For most people, safer options exist.
No, gabapentin isn’t FDA-approved for alcohol use disorder-but it’s widely used off-label, especially for people with liver disease or severe withdrawal symptoms. A 2023 study showed it reduced cirrhosis decompensation by 53% in people with alcohol-related liver damage. It’s safer than naltrexone for those with liver problems and doesn’t cause dangerous reactions like disulfiram. Many addiction specialists now consider it a first-line option for certain patients.
Most trials show benefits lasting 6 to 12 months. But alcohol use disorder is often a chronic condition. The National Institute on Alcohol Abuse and Alcoholism says some people need medication for years-even for life. Stopping too soon increases relapse risk. If you’ve been sober for 6 months and feel fine, don’t quit meds without talking to your doctor. A slow taper, combined with ongoing therapy, is safer than stopping cold.
Cost is the #1 reason people stop taking these drugs. But options exist. Disulfiram costs as little as $20 a month. Generic naltrexone is around $250. Acamprosate is $200-$300. Ask your doctor about patient assistance programs. Some clinics offer free or sliding-scale meds. Pharmacies like Walmart and Costco sell generics for under $10 a month. And in some states, Medicaid covers these drugs with zero copay. Don’t give up-there’s help if you ask.
If you’re on medication for alcohol use disorder and thinking about stopping, pause. Talk to your doctor. If you’re not on medication but want to quit, ask about options. There’s no shame in needing help. And there’s no point in trying to go it alone. The best treatment isn’t just a pill-it’s a plan. And that plan should include support, monitoring, and time.
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