From the Guidelines
The most effective treatment for alcohol use disorder is acamprosate, as it has been shown to be better at maintaining alcohol abstinence than placebo, according to the most recent and highest quality study 1.
Treatment Options
The recommended treatments for alcohol use disorder include a combination of medications, psychosocial interventions, and support groups.
- FDA-approved medications include:
- Acamprosate (666mg three times daily), which helps maintain abstinence by normalizing brain chemistry
- Naltrexone (50mg daily oral or 380mg monthly injection), which reduces cravings by blocking opioid receptors
- Disulfiram (250-500mg daily), which causes unpleasant reactions when alcohol is consumed
- Psychosocial treatments like cognitive-behavioral therapy (typically 12-16 weekly sessions), motivational enhancement therapy (usually 4 sessions over 12 weeks), and contingency management are effective when combined with medications
- Mutual support groups such as Alcoholics Anonymous provide ongoing community support
Individualized Treatment
Treatment should be individualized based on severity, comorbidities, and patient preferences.
- A comprehensive approach addressing both the physical dependence and psychological aspects of addiction yields the best outcomes
- Many patients benefit from starting with medically supervised detoxification using benzodiazepines like chlordiazepoxide or lorazepam to manage withdrawal symptoms before beginning long-term treatment
Evidence-Based Recommendations
According to the WHO recommendations 1, acamprosate, disulfiram, or naltrexone should be offered as part of treatment to reduce relapse in alcohol dependent patients.
- The decision to use acamprosate, disulfiram, or naltrexone should be made taking into consideration patient preferences, motivation, and availability
- Brief motivational interventions should be routinely used in the medical management of alcohol use disorders 1
- In patients with ALD, persistent alcohol intake is associated with disease progression; therefore, the most effective recommendation for these individuals is total alcohol abstinence 1
From the FDA Drug Label
Treatment of Alcoholism A dose of 50 mg once daily is recommended for most patients The placebo-controlled studies that demonstrated the efficacy of naltrexone hydrochloride as an adjunctive treatment of alcoholism used a dose regimen of naltrexone hydrochloride 50 mg once daily for up to 12 weeks.
The recommended treatment for alcohol use disorder is naltrexone hydrochloride 50 mg once daily for up to 12 weeks, as an adjunct to social and psychotherapeutic methods. Key factors associated with a good outcome include:
- Type, intensity, and duration of treatment
- Appropriate management of comorbid conditions
- Use of community-based support groups
- Good medication compliance 2
From the Research
Recommended Treatments for Alcohol Use Disorder
The following are recommended treatments for alcohol use disorder:
- Medications such as naltrexone, gabapentin, and acamprosate to reduce heavy-drinking days and prevent return-to-use 3, 4, 5
- Behavioral interventions, such as counseling and therapy, to support patients in maintaining abstinence 3, 6
- Combination of pharmacotherapy and behavioral interventions for optimal treatment outcomes 3, 5
Medications for Alcohol Use Disorder
Some medications that have shown promise in treating alcohol use disorder include:
- Naltrexone: reduces the risk of relapse to heavy drinking and frequency of drinking 3, 4, 5
- Acamprosate: reduces drinking frequency and prevents return-to-use 3, 4, 5
- Gabapentin: reduces heavy-drinking days 3, 4
- Topiramate: decreases heavy-drinking days 3, 4
- Varenicline: may be beneficial in reducing heavy alcohol use 3, 4, 7
Barriers to Treatment Seeking
Despite the availability of effective treatments, many individuals with alcohol use disorder do not seek treatment due to various barriers, including: