Medication for AUD: what to expect and how meds help
If alcohol has started running your life, medication can be a real game changer. Drugs for Alcohol Use Disorder (AUD) don’t “fix” everything, but they lower cravings, cut down heavy drinking, and make therapy or support groups more effective. Here’s a clear, no-nonsense look at the meds commonly used, how they work, and practical tips for using them safely.
Which medications work and how they differ
Naltrexone — blocks the brain’s reward from alcohol, so drinks feel less satisfying. Comes as a daily pill or a monthly injection (Vivitrol). Avoid if you need opioid painkillers: naltrexone stops opioids from working and can cause withdrawal in people on opioids.
Acamprosate — helps reduce intense cravings, especially after you stop drinking. It’s usually taken three times a day and is a good choice when the liver is damaged by alcohol, because it’s mostly cleared by the kidneys. Kidney checks may be needed.
Disulfiram — causes a strong, unpleasant reaction (flushing, nausea, fast heartbeat) if you drink while taking it. That deterrent can help people who want a hard stop. It’s best for motivated patients who can avoid hidden alcohol sources (mouthwash, some foods, medications).
Off-label options — drugs like topiramate, gabapentin, and baclofen are sometimes used when approved meds aren’t suitable. They can help with cravings or mood but have side effects and require careful dosing and monitoring.
Practical tips to make medication work
Pick the right goal first: do you want total abstinence or fewer heavy-drinking days? That shapes which drug fits you best. Be honest with your prescriber about other meds, pain treatment, liver or kidney problems, and pregnancy plans.
Combine meds with counseling. Medication plus therapy or mutual-help groups gives the best results. Meds help the brain calm down; therapy teaches coping skills and builds support.
Watch for side effects and interactions. Nausea, sleepiness, dizziness or mood shifts can happen. If you’re on opioids, don’t take naltrexone. If you choose disulfiram, avoid all alcohol products and read labels carefully.
Stick with follow-up. Regular check-ins let your clinician adjust doses, test liver/kidney function, and address new problems fast. If a drug doesn’t help after a few weeks, switching or combining treatments is common and reasonable.
If you’re pregnant, trying to get pregnant, or have serious liver disease, talk to a specialist before starting any AUD medication. Getting help from an addiction doctor, psychiatrist, or clinic that treats AUD improves your odds of success.
Medication isn’t a moral fix—it’s a tool. Used with clear goals, a support plan, and medical follow-up, it can change how you feel about drinking and give you back control over your life.
