Alcohol use disorder is a chronic condition best treated with a combination of medication and psychosocial therapies. Main medication strategies include aversive agents (disulfiram), drugs that reduce craving or the rewarding effects of alcohol (naltrexone, acamprosate), and several off-label options. Cognitive deficits from long-term heavy drinking respond better to rehabilitation than to drugs. Integrated care that screens and treats co-occurring psychiatric conditions and offers aftercare provides the best outcomes.
Drinking, risk, and when to seek treatment
Many people drink to celebrate or relax. When alcohol stays within recommended limits, it may be a low-risk activity. Repeatedly drinking more than those limits can damage physical and mental health, relationships, and safety - and is a sign to consider treatment for alcohol use disorder (AUD).
AUD is typically chronic: people often need ongoing care, not a one-time fix. Effective programs combine medication with behavioral therapies, aftercare, and relapse-prevention planning.
Core principles of treatment
Medications do not replace counseling. Instead, they work best as part of a comprehensive plan that includes cognitive-behavioral therapy, motivational interviewing, and support groups. Good treatment centers offer intake assessment, coordinated medical and psychiatric care, and a clear aftercare pathway.
Medication categories and current options
Aversive agents: increasing sensitivity to alcohol
Disulfiram is the classic aversive drug. It blocks aldehyde dehydrogenase and causes unpleasant reactions (flushing, nausea, rapid heartbeat) if a person drinks. This deterrent effect can help some patients, but disulfiram requires motivation, supervision, and monitoring for liver side effects.
Drugs that reduce craving or the rewarding effects of alcohol
Naltrexone, an opioid receptor antagonist, can reduce the pleasurable effects of drinking and lower the risk of relapse. It is available as an oral tablet and a long-acting injectable formulation. Acamprosate works on glutamatergic and GABAergic systems and may support abstinence by reducing protracted withdrawal symptoms and cravings.
There are additional medications used off-label - such as topiramate, gabapentin, and baclofen - that show benefit in some studies. Choice depends on a patient's medical history, goals (abstinence versus reduced drinking), and tolerance of side effects.
Cognitive and neurocognitive treatments
Long-term heavy drinking can impair memory, attention, and problem-solving. Pharmacologic approaches to reverse these deficits have had limited success. Rehabilitation relies largely on cognitive rehabilitation strategies and supported re-entry into structured daily activities.
Treating co-occurring psychiatric disorders
Many people with AUD have anxiety, depression, or other psychiatric conditions. Treating these disorders with evidence-based medications and therapy improves overall outcomes. Integrated care - where addiction and mental health services are coordinated - produces better results than treating each condition separately.
Choosing a treatment program
Look for programs that screen for medical and psychiatric comorbidity, explain medication options and risks, coordinate with counselors, and outline aftercare (relapse prevention, follow-up visits, peer support). Treatment is individualized: what works for one person may not work for another.
Bottom line
Medications can reduce craving, deter drinking, and support recovery, but they work best when paired with behavioral treatment and ongoing support. If you or someone you care about struggles with alcohol, seek an assessment from a licensed addiction professional to review combined medication and psychosocial options.