Last reviewed
Medications for alcohol use disorder: naltrexone, acamprosate and more
The FDA-approved medications for alcohol use disorder, how they work, who they suit, and why so few people are offered them.
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner and founder of Wellthy Psychiatry & Wellness
✓ Medically reviewed by Earl Johns, MSN, PMHNP-BC
Photos are illustrative and don’t show actual patients.
Medications for alcohol use disorder are effective and safe for most people, and most insurance plans cover them. Yet only a small share of people who could benefit are ever offered one.
Naltrexone
Naltrexone reduces cravings and makes drinking less rewarding, which can cut down heavy drinking days. It comes as a daily pill or a monthly injection (Vivitrol). You can’t take it with opioid medications, and it isn’t right for some people with significant liver disease.
Acamprosate
Acamprosate helps people who have already stopped drinking stay stopped, by easing the restlessness, anxiety and poor sleep of early recovery. It’s taken three times a day, and the dose is adjusted for kidney function.
Disulfiram
Disulfiram (Antabuse) causes flushing, nausea and a racing heart if you drink. It only works when taken every day, so it suits people who are highly motivated and have someone supporting them.
Other options
Clinicians sometimes prescribe medications such as topiramate or gabapentin off label when the FDA-approved options aren’t a fit. The right choice depends on your goals, other medications and health history.
Your goal can be cutting back or stopping
Some people want to quit completely. Others want to drink less. Medication can help with either goal, and it works best alongside therapy or peer support.
A gentle next step
Wellthy Psychiatry offers judgment-free, LGBTQ+ affirming care by telehealth across California. A free 15-minute phone consult is an easy way to see if we’re a good fit.
This article is for general education and isn’t medical advice. If you’re in crisis, call or text 988, the Suicide & Crisis Lifeline, or call 911.
About the author
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner · UCSF-trained · Founder of Wellthy Psychiatry & Wellness
Earl provides LGBTQ+ and neurodivergent-affirming psychiatric care, blending medication management, therapy and whole-person approaches. His background includes inpatient psychiatry and community mental health at Glenn County Behavioral Health and Equity Health, a federally qualified health center. He sees clients in San Francisco and by telehealth across California.
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