Medication-Assisted Treatment for Alcohol Use Disorder
All of the above—disulfiram, naltrexone, and acamprosate—are FDA-approved medications for alcohol use disorder and should be considered as pharmacological aids to maintain abstinence or reduce consumption in dependent patients. 1
FDA-Approved Medications
The three medications listed are all approved by the FDA for treating alcohol use disorder, though they have different mechanisms and indications:
Disulfiram is FDA-approved as an aid in the management of selected chronic alcohol patients who want to remain in a state of enforced sobriety, serving as a deterrent by causing unpleasant reactions when alcohol is consumed 2
Naltrexone (both oral and extended-release injectable formulations) is FDA-approved for alcoholism treatment, with the injectable form specifically approved for increasing the proportion of subjects with no heavy drinking days 1, 3
Acamprosate is FDA-approved for helping to maintain abstinence in alcohol-dependent patients who have already achieved initial sobriety 1
Clinical Context and Selection
All three medications received marketing authorization for long-term treatment of alcohol dependence, with disulfiram, acamprosate, and naltrexone specifically approved for helping to maintain abstinence 1. The choice among these agents depends on specific patient factors:
Key Selection Considerations:
Hepatic function status: Naltrexone and disulfiram are contraindicated in patients with hepatic insufficiency, though the absolute nature of these contraindications is debated 1. In contrast, acamprosate carries no risk of hepatotoxicity and is the preferred agent in patients with alcohol-associated liver disease 4
Timing of initiation: Acamprosate should only be started 3-7 days after the last alcohol consumption, once withdrawal has resolved, as it does not treat withdrawal symptoms 4
Treatment goals: While all three help maintain abstinence, naltrexone has also demonstrated efficacy in reducing heavy drinking days 1
Evidence Base
Multiple studies confirm the efficacy of these medications when combined with psychosocial support. Patients treated with active medication (disulfiram or naltrexone) had significantly more consecutive weeks of abstinence and less craving than those treated with placebo, though the advantage was modest 5. Acamprosate and naltrexone reduce alcohol consumption and increase abstinence rates, with effects that appear modest but clinically meaningful 6, 7.
The correct answer is: All of the above.