If you've been told that treating Alcohol Use Disorder means willpower alone, that's outdated information. Three medications are approved by the FDA specifically for Alcohol Use Disorder, and research shows they meaningfully help people cut back or stop drinking. Yet fewer than 2% of adults with Alcohol Use Disorder in the U.S. ever receive one. This article walks through how each medication works, who they're generally a good fit for, and what your provider will consider when helping you choose.
The Three FDA-Approved Medications
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, there are currently three FDA-approved medications for Alcohol Use Disorder: naltrexone, acamprosate, and disulfiram. All three are non-addictive, and each targets the problem differently — some reduce the urge to drink, one helps steady brain chemistry after you've already stopped, and one creates a strong deterrent if you do drink.
NIAAA's clinical guidance for providers notes that all three medications "are nonaddictive, and they may be used alone or combined with behavioral treatments or mutual-support groups," giving patients and clinicians real flexibility in building a treatment plan.
Naltrexone: Pill or Monthly Injection
Naltrexone works by blocking opioid receptors in the brain that are involved in the rewarding, pleasurable effects of drinking. For many people, this takes the edge off cravings and makes heavy drinking episodes feel less reinforcing — some describe it as alcohol simply feeling less appealing. It comes in two forms: a daily oral tablet, or Vivitrol, an extended-release injection given once a month by a healthcare provider. Because it doesn't require someone to already be abstinent, naltrexone can often be started while a person is still drinking, which makes it a practical option for people focused on cutting back rather than stopping immediately.
One important safety consideration: naltrexone blocks opioid receptors, so it isn't appropriate for people currently taking opioid pain medication or receiving opioid agonist treatment (such as buprenorphine or methadone). Starting naltrexone — especially the injectable form — without being opioid-free first can trigger a sudden and severe withdrawal reaction. This is something your provider will always screen for carefully before prescribing.
The FDA prescribing information for Vivitrol (naltrexone extended-release injectable suspension) lists contraindications including patients "receiving opioid analgesics," those with "current physiologic opioid dependence," and anyone in "acute opioid withdrawal." Patients generally need to be opioid-free for a minimum of 7 to 10 days before starting, since precipitated withdrawal "can be severe enough to require hospitalization."
Acamprosate: Helping the Brain Rebalance
Acamprosate (brand name Campral) works differently. Rather than blocking a reward pathway, it's thought to act on the brain's glutamate and GABA systems — the same chemical messengers that get thrown off balance by long-term heavy drinking. In practice, it's used to help people maintain abstinence once they've already stopped drinking, easing some of the lingering discomfort (like anxiety, restlessness, and insomnia) that can follow early sobriety and make relapse more likely. It's typically taken as two tablets, three times a day, and is usually started shortly after someone has stopped drinking rather than while they're still actively using alcohol.
SAMHSA's clinical guide describes acamprosate's role in "counterbalancing" the glutamate-GABA imbalance created by chronic alcohol exposure, and notes it is generally taken as delayed-release tablets three times daily as part of a maintenance-of-abstinence strategy.
Disulfiram: A Deterrent Approach
Disulfiram (Antabuse) takes a more direct approach. It blocks an enzyme involved in metabolizing alcohol, so if someone drinks while taking it, they experience an unpleasant reaction — flushing, nausea, a racing heartbeat, and general discomfort. The idea is straightforward: knowing that drinking will make you feel sick acts as a strong deterrent. Because of how it works, disulfiram requires a real commitment to abstinence and should never be started until someone has already stopped drinking (generally for at least 12 hours), and it isn't the right fit for everyone — it works best for people who are highly motivated to stay abstinent and want that extra layer of accountability.
NIAAA's provider guidance is direct on timing: "Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours," underscoring why this medication is generally reserved for patients who have already achieved some initial abstinence and understand the reaction it's designed to produce.
How Your Provider Helps You Choose
There isn't a single "best" medication for Alcohol Use Disorder — the right one depends on you. Your provider will typically consider:
Your goal: Are you hoping to cut back on drinking, or stop entirely? Naltrexone is often a good fit for reduction goals since it can start while you're still drinking; acamprosate is built around supporting abstinence you've already achieved.
Other health conditions and medications: Naltrexone isn't compatible with opioid pain medication or opioid-based addiction treatment. Acamprosate requires dose adjustment for kidney problems. Disulfiram interacts with certain medications and requires stable liver function and a clear understanding of the risks of drinking on it.
Your preferences: Some people prefer the "set it and forget it" convenience of a once-monthly Vivitrol injection over remembering a daily pill. Others prefer full control over a daily oral medication.
Medication Plus Counseling
None of these medications are meant to work in isolation. NIAAA and SAMHSA both emphasize that medication is most effective when it's paired with counseling or behavioral support — whether that's structured therapy, brief regular check-ins with a provider, or mutual-support groups. Medication addresses the biological piece (cravings, brain chemistry, deterrence), while counseling helps build the coping skills, routines, and support system that make lasting change possible. You don't need to choose one or the other; combining them is standard, evidence-based care.
SAMHSA's guide notes that "most patients benefit from a combination of these approaches," and that even brief, "weekly or biweekly" 15-to-20-minute counseling sessions combined with medication form "an effective treatment" for many people — it doesn't require intensive therapy to make a real difference.
Why These Medications Are Underused
Despite being safe, effective, and available for decades, medications for Alcohol Use Disorder remain strikingly underused. NIH-funded research analyzing national survey data found that only about 1.6% of U.S. adults with Alcohol Use Disorder reported using an FDA-approved medication for it — out of an estimated 14.1 million adults with the condition. Many people simply don't know these options exist, and others may feel embarrassed to bring it up. Neither needs to be the case. Asking about medication for drinking is no different from asking about medication for blood pressure or diabetes — it's a normal, judgment-free part of taking care of your health.
Your Acorn TeleMAT provider will review your drinking history, overall health, current medications, and goals to talk through which medication (if any) makes sense for you — and whether counseling or other support should be part of the plan too. There's no one "right" way to want to change your relationship with alcohol.
This article is for general educational purposes and isn't a substitute for individualized medical advice. Talk with your provider about which medication, if any, is appropriate for your specific health history and goals.