What are the treatment options and pharmacotherapy for Alcohol Use Disorder (AUD)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: March 28, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Treatment for alcohol use disorder (AUD) should involve a combination of medications, psychosocial interventions, and support systems, with first-line pharmacotherapy options including naltrexone, acamprosate, and disulfiram, as well as cognitive-behavioral therapy (CBT) or other evidence-based therapies, as supported by the most recent and highest quality study 1. The goal of treatment is to reduce alcohol consumption, prevent liver disease progression, and improve quality of life.

  • Medications such as naltrexone (50mg daily oral or 380mg monthly injectable), acamprosate (666mg three times daily), and disulfiram (250-500mg daily) can help reduce alcohol cravings and maintain abstinence.
  • For patients with liver disease, topiramate (starting at 25mg daily, titrating up to 300mg daily) or gabapentin (300-600mg three times daily) may be considered as off-label alternatives, but their tolerance profile should be carefully assessed 1.
  • Cognitive-behavioral therapy (CBT) is a first-line behavioral approach for treating AUD and other substance use disorders, and its combination with pharmacotherapy has been shown to be associated with increased benefit compared with usual care and pharmacotherapy alone 1.
  • Treatment should begin with medical detoxification if needed, using benzodiazepines like diazepam or chlordiazepoxide on a tapering schedule to prevent dangerous withdrawal symptoms.
  • The choice of medication depends on patient preferences, comorbidities, and treatment goals (abstinence versus reduction), and treatment duration typically ranges from 3-12 months but may continue longer based on individual response.
  • Regular monitoring for medication adherence, side effects, and drinking behavior is essential for successful outcomes, as emphasized in the 2022 clinical guidelines from the French Association for the Study of the Liver and the French Alcohol Society 1.

From the FDA Drug Label

To reduce the risk of precipitated withdrawal in patients dependent on opioids, or exacerbation of a preexisting subclinical withdrawal syndrome, opioid-dependent patients, including those being treated for alcohol dependence, should be opioid-free (including tramadol) before starting naltrexone hydrochloride treatment 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. Naltrexone hydrochloride should be considered as only one of many factors determining the success of treatment of alcoholism. Factors associated with a good outcome in the clinical trials with naltrexone hydrochloride were the type, intensity, and duration of treatment; appropriate management of comorbid conditions; use of community-based support groups; and good medication compliance

The treatment options and pharmacotherapy for Alcohol Use Disorder (AUD) include the use of naltrexone hydrochloride as an adjunctive treatment. The recommended dose is 50 mg once daily for most patients. It is essential to ensure that patients are opioid-free before starting naltrexone hydrochloride treatment to reduce the risk of precipitated withdrawal. A comprehensive treatment plan that includes management of comorbid conditions, community-based support groups, and good medication compliance is crucial for a successful outcome 2 2. 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

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

What is the cause of recurrent right upper abdominal pain radiating to the back and pharynx, with mildly elevated C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR), and slightly elevated liver enzymes, in a patient with a history of fatty liver, presenting with symptoms occurring once a fortnight, particularly at night, over a 2-year period, and recently started traveling to Southeast Asia?
What is the mechanism by which increased protein intake increases Glomerular Filtration Rate (GFR)?
What is the cause of bilateral lower extremity paresthesia (numbness and tingling)?
What is the differential diagnosis for generalized abdominal pain?
What are the treatment options for hyperandrogenism and hirsutism in a middle-aged female with Polycystic Ovary Syndrome (PCOS)?
Can Irritable Bowel Syndrome (IBS) be transmitted through anal intercourse?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question