Medications for Alcohol Dependence: What Works and Who Should Try Them

Trying to cut back or stop drinking? Medications can help reduce cravings, prevent relapse, and make early recovery easier. They don’t fix everything, but paired with counseling and support, they can make a big difference. Here’s a plain-language guide to the main meds doctors use and what to watch for.

How the main drugs work

Naltrexone: This one blocks the brain’s “reward” from alcohol so drinking feels less rewarding. It comes as a daily pill or a monthly injection (long-acting). It’s a good fit if cravings and heavy drinking are your main problem. Don’t start if you’re using opioids or need opioid pain relief—naltrexone blocks those drugs. Your doctor will usually check liver enzymes first.

Acamprosate: Best used after you’ve stopped drinking. It helps calm the brain’s overactivity that fuels craving and restlessness in early abstinence. It’s taken as a daily pill and is often chosen when liver issues make naltrexone risky. It’s not for people who can’t take multiple pills a day or have severe kidney problems.

Disulfiram (Antabuse): This one punishes drinking. If you drink while on disulfiram you get a strong, unpleasant reaction—flushing, nausea, fast heartbeat. It works through motivation: it’s for people who truly want a strong deterrent and have support to keep them taking it. Doctors watch for liver problems and make sure you understand the risks before starting.

Topiramate, baclofen, gabapentin (off-label): These meds aren’t specifically approved for alcohol dependence in every country, but some studies and clinicians use them to reduce drinking or ease withdrawal symptoms. They can help some people, but side effects vary—topiramate can affect thinking and memory, baclofen causes drowsiness, and gabapentin can be sedating. Talk to your prescriber about pros and cons.

Choosing the right option & safety tips

Which med fits you depends on your drinking pattern, health, other drugs you take, and how motivated you are. A few practical tips: get medical clearance (liver and kidney checks may be needed), don’t start naltrexone until you’re off opioids, and don’t rely on medication alone—combine it with counseling, mutual-help groups, or therapy.

Keep an eye on side effects and report them. If you’re pregnant or planning pregnancy, talk to your doctor—some meds aren’t recommended. If you slip and drink while on disulfiram or naltrexone, contact your provider right away for advice.

Want help deciding? Ask a clinician who treats addiction. They can match the drug to your goals and monitor safety. Medication isn’t a quick fix, but used correctly it raises your odds of staying sober and feeling better day to day.