Understanding Addiction

Guide 04 of 04

Medications for Alcohol Use Disorder

FDA-approved medications reduce cravings, prevent relapse, and support recovery from alcohol use disorder. This guide explains what each option does, how to choose, and what to expect.

3 FDA

Medications approved for alcohol use disorder

5

Total options including off-label treatments with clinical evidence

Best

Outcomes when medication is combined with counseling and peer support

Section 1 of 5

Understanding AUD

Alcohol use disorder is a chronic medical condition, not a moral failing or a lack of willpower.

AUD exists on a spectrum from mild to severe. Heavy drinking over time reshapes the brain's reward system in ways that make stopping without support genuinely difficult, not just a matter of choosing to.

When alcohol is used repeatedly, the brain adapts. Circuits that regulate pleasure, motivation, and stress become dependent on alcohol's effect. When alcohol is removed, the imbalance that results produces withdrawal symptoms, anxiety, insomnia, and strong cravings. These are neurological events driven by brain chemistry, not evidence of weak character.

Alcohol use disorder is diagnosed clinically based on patterns of use, loss of control, continued use despite consequences, and physical dependence. Treatment works best when it addresses both the biological component, through medication when appropriate, and the behavioral component, through counseling and peer support.

Most people who could benefit from medication for AUD never receive it. Understanding what is available is a first step toward better outcomes.

"Medications can make it easier to stick to your goals of cutting down or stopping drinking. They work best with counseling, group-based treatment, or peer support."

ASAM Medications for Alcohol Use Disorder Patient Guide

For drug courts and supervision programs

FDA-approved medications for AUD do not produce a positive result for alcohol or illicit substances on standard drug tests. A person taking naltrexone, acamprosate, disulfiram, topiramate, or gabapentin for AUD treatment will not test positive for those substances. These are prescribed medical treatments, not substances of abuse.

Section 2 of 5

Naltrexone

Naltrexone is the most widely used FDA-approved medication for alcohol use disorder.

Naltrexone blocks the opioid receptors in the brain that are activated when alcohol is consumed. This reduces the euphoric reward that alcohol provides, making it less reinforcing and easier to cut down or stop.

Naltrexone

Brand names: ReVia (oral tablet), Vivitrol (monthly injection)

How It Is Taken Once daily pill, or once monthly intramuscular injection (Vivitrol)

FDA Status FDA-approved for alcohol use disorder; also approved for opioid use disorder

How It Works Blocks opioid receptors; reduces pleasure from drinking and decreases cravings

Best For Flexible goals: reducing drinking or stopping entirely; works for both

Key cautions: Do not take naltrexone if you are using opioid pain medications, buprenorphine, or methadone, as it will cause immediate withdrawal. Also avoid with severe liver disease. Common side effects include nausea and dizziness, particularly when starting, which usually improve within the first few weeks. The monthly injection (Vivitrol) avoids the need for daily adherence and can be an advantage for some people.

What to know

Naltrexone does not make you sick if you drink. It works by reducing the reward alcohol provides, not by creating an aversion. This means it can support a goal of moderation, not just complete abstinence. Most people tolerate it well and do not stop because of side effects.

Section 3 of 5

Acamprosate & Disulfiram

Two additional FDA-approved options, each with a distinct mechanism and best-fit scenario.

Acamprosate calms the overactivated brain that results from chronic alcohol use. Disulfiram works differently: it creates a physical deterrent by making alcohol consumption unpleasant. Neither reduces cravings the same way naltrexone does.

Acamprosate

Brand name: Campral

How It Is Taken Three times daily with meals; often combined with naltrexone

FDA Status FDA-approved for AUD; one of the most commonly prescribed options

How It Works Stabilizes the GABA and glutamate systems disrupted by heavy alcohol use, reducing post-acute withdrawal symptoms and cravings

Best For People who have already stopped drinking and want to remain abstinent; also helps with sleep and lingering withdrawal symptoms

Key caution: Avoid in severe kidney disease. Acamprosate is not effective if the person is still drinking actively. It is most effective after detoxification. Side effects are generally mild; diarrhea is the most common but rarely causes people to stop treatment.

Disulfiram

Brand name: Antabuse

How It Is Taken Once daily; observed or supervised dosing improves effectiveness

FDA Status FDA-approved for AUD; used only when the goal is complete abstinence

How It Works Blocks the enzyme that breaks down alcohol, causing a highly unpleasant reaction (flushing, nausea, rapid heartbeat, difficulty breathing) if any alcohol is consumed

Best For People strongly motivated to stop drinking entirely who benefit from a physical deterrent and daily accountability

Key cautions: Avoid alcohol in all forms, including cough syrups, mouthwashes, and some foods prepared with wine or vinegar. Do not take with certain antibiotics (such as metronidazole). Avoid if you have significant heart, liver, or other organ disease, as the reaction can be dangerous. Having a trusted person help you take it daily is associated with better outcomes. Rare but serious: liver failure.

Section 4 of 5

Topiramate & Gabapentin

Two off-label options with strong clinical evidence, particularly when first-line medications have not worked.

Topiramate and gabapentin are not FDA-approved specifically for AUD, but both have meaningful clinical evidence and are endorsed by ASAM as reasonable treatment options. Off-label does not mean experimental.

Topiramate

Brand names: Topamax, Trokendi XR

How It Is Taken Twice daily; dose must be increased slowly over several weeks

FDA Status Off-label for AUD; also approved for seizures and migraine prevention

How It Works Acts on glutamate and GABA systems to reduce the brain's reward response to alcohol; reduces cravings and drinking frequency

Best For People who have not responded to naltrexone or acamprosate; also supports goals of reduction, not only abstinence

Key cautions: Can cause cognitive side effects including word-finding difficulty and mental slowing, particularly at higher doses. Must be tapered slowly before stopping, as abrupt discontinuation can cause seizures. Avoid in pregnancy, severe kidney disease, or glaucoma. Not recommended if you already have memory or cognitive concerns.

Gabapentin

Brand name: Neurontin

How It Is Taken Three times daily; dose is adjusted based on response and tolerability

FDA Status Off-label for AUD; also approved for nerve pain and seizures

How It Works Calms overactive brain signaling; particularly effective at reducing anxiety, insomnia, and pain that often drive continued alcohol use

Best For People with co-occurring anxiety, sleep problems, or chronic pain alongside AUD; also helpful for managing post-acute withdrawal discomfort

Key cautions: Drowsiness is the most common side effect, especially at higher doses. Must be tapered slowly before stopping to avoid withdrawal symptoms. Use with caution in kidney disease, as dosing adjustments are needed. Avoid in pregnancy. Gabapentin has abuse potential in some populations, so monitoring is appropriate.

Section 5 of 5

Questions & Resources

Common questions about starting medication for alcohol use disorder.

Q

Will the medication make me sick if I drink?

Only disulfiram (Antabuse) is designed to create an unpleasant physical reaction if you drink. Naltrexone, acamprosate, topiramate, and gabapentin work by changing brain chemistry to reduce the reward alcohol provides or calm overactive signaling. They do not prevent you from drinking and do not create a disulfiram-like reaction.

Q

How long do I have to take the medication?

ASAM recommends taking medication for at least three months to evaluate whether it is helping. After that, continue as long as it is beneficial. Some people take medication for a year or more. Duration should be determined by your clinical response and goals, not by a fixed program timeline. Naltrexone, acamprosate, and disulfiram can be stopped at any time without withdrawal. Topiramate and gabapentin must be tapered gradually.

Q

Do I have to be completely abstinent before starting?

It depends on the medication. Naltrexone can be started while someone is still drinking, since the goal may be reduction rather than immediate abstinence. Acamprosate works best after detoxification. Disulfiram should not be started unless the person has been alcohol-free for at least 12 hours, and ideally longer. Your prescriber will guide timing based on your situation.

Q

Will these medications show up on a drug test?

No. Naltrexone, acamprosate, disulfiram, topiramate, and gabapentin are not detected by standard urine or breath alcohol tests used in drug courts, probation monitoring, or treatment programs. They are legal prescribed medications, not controlled substances (with the exception of gabapentin, which is scheduled in some states). Inform your supervision officer or treatment coordinator about your prescription.

Find support and treatment

SAMHSA National Helpline

Free, confidential treatment referrals for alcohol and drug use disorders. Available 24/7 in English and Spanish.

1-800-662-4357

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Start with Guide 01

New to this series? Guide 01 explains the biology of addiction and why treatment works.

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Clinical Reference