Alcohol use disorder (AUD) is a growing health issue in the United States; it’s estimated that more than 6% of adults are affected. While recovery isn’t easy, there are a wide array of treatment options that can help—and they go beyond 12-step programs and in-patient rehab. There are currently three prescription medications for alcohol use disorders approved by the Food and Drug Administration (FDA), along with other drugs that some doctors use off-label for drinking problems.
Here’s what you need to know about the drugs that can help you stop drinking and where you can go for help.
3 FDA-approved medications for alcohol use disorder
The FDA has approved the following medications to help with alcohol use disorder.
1. Campral (acamprosate)
Acamprosate can help some people with AUD stop drinking by reducing cravings and decreasing the psychological reward from alcohol. It is typically taken in tablet form three times per day.
2. Vivitrol (naltrexone)
Similar to acamprosate, naltrexone eliminates the pleasure people with AUD experience from alcohol, thus reducing the urge to drink. It’s available as a daily pill, a monthly injection, and through a medication implant.
3. Antabuse (disulfiram)
Disulfiram is a tablet you take once per day after you’ve stopped drinking for at least 12 hours. It blocks the metabolism of alcohol and ultimately makes you very sick if you drink while on the medication.
Which medication can help you stop drinking?
Of the FDA-approved medications listed above, the drug that will work best for you will depend on a variety of factors, including whether or not you’ve stopped drinking already, your health history, and your budget.
Disulfiram is the oldest approved medication for AUD in the United States. However, it has fallen out of favor with some doctors because of how severely it punishes someone if they slip-up and have a drink, which is very common during recovery.
“It’s kind of like reaching into the cookie jar, and the cookie jar breaks your arm—you’re unlikely to reach in again,” says Harshal Kirane, MD, director of addiction services at Staten Island University Hospital. “[However], disulfiram is not always the best option for patients because any alcohol that gets absorbed and enters the bloodstream, whether through drinking, using alcohol in cooking or even hand sanitizer, can produce an adverse reaction.”
Acamprosate and naltrexone have been shown to have similar efficacy, says Robert Brown, MD, hepatologist and director of the Center for Liver Disease and Transplantation at NewYork-Presbyterian/Weill Cornell Medical Center, but there are some differences to be aware of: “The advantage of naltrexone is that it’s [taken] once daily, which helps improve patient compliance, and there’s data [to show] that it works even if a person is still drinking when they start the medication,” he says. “But I tend to prescribe more acamprosate than naltrexone because if a patient also has a problem with opioids, they can’t take naltrexone.”
Cost may also be a factor in your decision. American Family Physician found that a one month’s supply of generic acamprosate costs $55, slightly higher than generic naltrexone, which costs $45 for a month’s worth of pills.
Off-label drugs to reduce drinking
Doctors may also prescribe other medications for “off-label” use to help patients stop drinking. This means that the FDA has not deemed the drug to be safe or effective for alcohol use disorder, but the healthcare provider has decided it’s “medically appropriate” for their patient.
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“These medications fall broadly into the class of drugs known as mood stabilizers, such as topiramate, Lamictal, and Trileptal,” explains Dr. Kirane. “The evidence that these medicines can be helpful is limited and tends to come from small, unblinded studies. They should definitely be considered if someone’s not finding the other medications to be particularly effective.”
Baclofen, a drug used to treat muscle spasms, may also be a viable treatment for alcohol use disorder. This is especially useful for patients who have advanced liver disease, as baclofen is primarily metabolized in the kidneys, says Brown.
Other alcohol use disorder treatment options
There’s no one-size-fits-all treatment for people who wish to cut back on drinking. Medication, while potentially helpful, might not be a magic bullet for alcohol abuse.
“Counseling, behavioral supports, and medication should all be on the table to find a dynamic form of treatment that not only meets patients’ needs when they enter treatment, but can evolve as they continue to improve and grow,” Dr. Kirane says.
If you’re struggling with a drinking problem, work with your doctor to develop a plan to quit. You can also seek support from Alcoholics Anonymous and the National Helpline for SAMHSA, the Substance Abuse and Mental Health Services Administration.