Medications to help stop drinking alcohol

People with alcohol use disorder (AUD) cannot stop or manage their use of alcohol even if it negatively affects their health, social life, or responsibilities — like work or school.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 29.5 million people over the age of 12 years lived with AUD in 2021. The NIAAA notes that fewer than 5% of these people received any treatment.

AUD can lead to severe physical and mental health consequences without treatment. While the journey to recovery can be challenging, many people can and do recover from AUD.

Treatment options for AUD include therapy and medications. The following three medications have approval from the Food and Drug Administration (FDA) to manage AUD:

Naltrexone

How it works

Naltrexone is an opioid receptor antagonist. It works by blocking the pleasurable effects of alcohol and reducing the desire to drink. 

Naltrexone may be the most effective medication for reducing heavy drinking. However, it may not be the right option if your goal is complete abstinence from alcohol. 

How to take it

Naltrexone is available as a generic medication in the United States. There are two ways to take naltrexone:

• Oral tablet: The initial dose is one 50 milligram (mg) pill daily, which may increase to 100 mg once daily after 1 week, depending on how you respond to the medication.
• Monthly extended-release injection: A healthcare professional can administer a 380 mg injection into your muscle every 4 weeks, and the dose will last for the full month. In the United States, the naltrexone injection is sold under the name Vivitrol.

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Possible side effects

You may experience the following side effects when taking naltrexone:

• nausea
• diarrhea
• stomach cramps
• sleep problems
• dizziness 
• headache 

Acamprosate

How it works

Experts aren’t exactly clear on how acamprosate works to treat AUD. Evidence suggests the medication likely affects the glutamate system — a network in your brain that transmits signals between nerve cells. In turn, this can reduce alcohol cravings. 

According to a 2023 review, acamprosate may reduce unpleasant alcohol withdrawal symptoms, making it easier to take the first steps toward sobriety.

How to take it

A typical dose of acamprosate is two 333 mg acamprosate oral tablets three times a day. People who weigh under 132 pounds (60 kg) may instead take one 333 mg tablet four times daily. 

A consistent dosing schedule ensures the medication remains effective throughout recovery. However, it can be easy to forget a dose.

In the United States, a generic version of acamprosate is available. The older brand-name version called Campral has been discontinued.

Possible side effects

Side effects of acamprosate are generally mild. Diarrhea is the most common side effect.

Other possible effects include:

• headaches
• dizziness
• nausea 
• vomiting 
• upset stomach

Disulfiram

How it works

Your body breaks alcohol down into different substances, including acetaldehyde. It then turns acetaldehyde into acetate.

Disulfiram is an acetaldehyde dehydrogenase inhibitor. It blocks the conversion of acetaldehyde into acetate. 

If you consume alcohol after taking this medication, acetaldehyde will build up in the body, which causes highly unpleasant effects, including: 

• nausea
• vomiting
• fast heartbeat
• headaches 

The undesirable effects may cause you to avoid drinking alcohol.

Disulfiram is not a first-line treatment option for AUD, but it may help if acamprosate and naltrexone are unsuccessful.

How to take it

Disulfiram is available as a generic in the United States. You can take a 250 mg or 500 mg oral tablet of disulfiram once per day. It will produce adverse effects if you drink alcohol within 12 hours of taking it. 

Possible side effects

The most common side effects of taking disulfiram include:

• sleepiness
• metallic taste in the mouth
• headaches

While rare, severe side effects are also possible, including neurological and liver damage. 

In addition, disulfiram is specifically designed to cause the side effects listed in the “How it works” section above when taken with alcohol. It can cause these effects up to 2 weeks after taking your last pill.

Emerging medications for AUD

Research on AUD treatment is ongoing. 

Some medications that have the potential to help treat AUD include:

• nalmefene (Opvee): This prevents the pleasurable effects of alcohol
• baclofen: This may reduce alcohol withdrawal symptoms
• topiramate: This may help reduce alcohol consumption
• varenicline: This reduces cravings for nicotine and possibly alcohol as well
• gabapentin: This may reduce alcohol cravings and withdrawal symptoms like sleep problems in the months after stopping drinking

Other treatments for alcohol use disorder

While medication can be an effective tool for treating AUD, you may benefit most from a combination of treatments.

The NIAAA recommends behavioral treatments or “talk therapy” for AUD. These approaches can help you: 

• set realistic goals
• learn to avoid or manage triggers
• build a strong support system
• develop the skills you need to stop drinking alcohol

Behavioral treatments may include: 

• Cognitive behavioral therapy (CBT): CBT teaches you to change the thought processes that trigger alcohol use. 
• Couples or family counseling: This can help rebuild important relationships in your life that may have been weakened as a result of the AUD. Additionally, getting support from the people close to you can increase your chances of quitting drinking for good. 
• 12-step facilitation therapy: This is a program led by a skilled counselor that involves a structured process with ongoing participation goals. 

How to seek help for alcohol dependence

If you or a loved one is living with alcohol dependence, know that help is available. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a confidential helpline that can connect you with local resources and support. You can reach SAMHSA’s National Helpline at 1-800-662-HELP (4357) or visit this website. 

You might also consider reaching out to a healthcare professional, mental health professional, or support group. They can help guide you in your journey to recovery.

The NIAA also offers simple instructions on how to find quality treatment for AUD.

Summary

Three medications — naltrexone, acamprosate, and disulfiram — have FDA approval to treat AUD.

Medications can be helpful tools in the journey to recovery, especially when you combine them with other treatment approaches like individual or group therapy.

A healthcare professional or the SAMHSA helpline can help determine the most suitable treatment plan for you. Remember, help is available, and recovery is possible. The first step is reaching out. 

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