Medications That Help You Stop Drinking: What the Options Are
Quick answer: Three medications — naltrexone, acamprosate, and disulfiram — are FDA-approved to help people stop or reduce drinking. Naltrexone in particular has strong evidence and is significantly underused. Medication doesn't replace the work, but it can make the work considerably easier.
Medication for alcohol use disorder is one of the most effective and least used tools available. Studies consistently show that certain medications significantly reduce cravings, decrease relapse rates, and improve long-term sobriety outcomes.
The underuse isn't because the medications don't work. It's largely because of stigma, limited awareness, and a cultural belief that quitting should be accomplished through willpower alone. None of those are good reasons to skip a tool that could genuinely help.
This is a plain-language guide to the main options, how they work, and who they're most appropriate for.
Naltrexone
Naltrexone is one of the most evidence-backed medications for alcohol use disorder. It works by blocking opioid receptors in the brain — the same receptors that alcohol stimulates to produce the "reward" feeling. When those receptors are blocked, alcohol produces far less pleasure than usual.
The practical effect: the pull toward drinking diminishes because the brain doesn't get the expected reward. Cravings decrease, and slips are less likely to turn into full relapses because the reinforcing experience is blunted.
Two forms:
- Daily oral pill (50mg): taken every day
- Monthly injectable (Vivitrol): given as a shot once a month, eliminating the need to remember daily pills
The monthly injection is particularly useful for people who struggle with medication adherence — when the shot is already in, there's no "should I take it today?" decision.
Who it's best for: People motivated to stop or significantly reduce drinking; also used in the "Sinclair Method," where people take it before every drinking episode to progressively reduce alcohol's reward over time.
Key consideration: Naltrexone requires that you not be physically dependent on opioids — it can trigger withdrawal in anyone taking opioid-based pain medications or using opioids recreationally.
Acamprosate (Campral)
Acamprosate works differently from naltrexone. Rather than blocking the reward of drinking, it helps stabilize the brain chemistry imbalance that develops after prolonged heavy drinking — reducing the anxiety, restlessness, and discomfort of early sobriety that drives many people back to drinking.
It doesn't affect the "high" from alcohol. Its main benefit is in making the absence of alcohol feel more tolerable, particularly in the first few months.
Dosing: Usually three times a day, which can be a challenge for adherence. It works best when started after detox is complete.
Who it's best for: People who've recently stopped drinking and are struggling with persistent anxiety, insomnia, and general dysphoria that doesn't improve quickly on its own.
Disulfiram (Antabuse)
Disulfiram is an older medication that works through a deterrence mechanism rather than reducing cravings. If you drink alcohol while taking it, you experience highly unpleasant physical reactions: flushing, nausea, vomiting, rapid heart rate.
It doesn't make drinking impossible — but it makes the consequences immediate and severe.
Who it's best for: People who are highly motivated to stop but want a hard chemical barrier against impulsive drinking. It's most effective when someone else supervises the daily dose (a partner, a family member, a pharmacist), because the deterrence only works if you keep taking it.
Key consideration: Disulfiram requires strict avoidance of all alcohol, including in food, mouthwash, and certain medications. There are also significant drug interactions to be aware of — a conversation with a doctor is essential.
Topiramate and Gabapentin
These are used off-label (not FDA-approved specifically for alcohol use disorder but with growing evidence):
Topiramate reduces cravings and alcohol consumption. Some research suggests it's comparable to naltrexone in effectiveness, with the added benefit that it doesn't require abstinence before starting. Side effects, including cognitive effects, are the main limiting factor.
Gabapentin can help with insomnia, anxiety, and cravings, particularly in early sobriety. It's sometimes used as a short-term bridge through withdrawal-related discomfort.
Both should be discussed with a doctor rather than treated as self-help options.
How to Access Medication
The main barrier isn't the medications themselves — it's getting them prescribed. Options:
- Your primary care doctor can prescribe all of these. Many won't bring it up unless you do. Bring it up.
- Addiction medicine specialists or psychiatrists often have more experience with the nuances of these medications.
- Telehealth services (several in the US specialize specifically in alcohol use disorder) can prescribe naltrexone and acamprosate remotely, making the access question much simpler.
You don't need to be at a crisis point to ask for these medications. Anyone who wants support for stopping or reducing drinking can ask.
Medication and Other Support
Medication works best as part of a broader approach. Combining it with therapy — particularly cognitive behavioral therapy — produces better outcomes than either alone. Tracking your progress, building trigger awareness, and having social accountability all work alongside medication rather than being replaced by it.
Therapy for Stopping Drinking covers the therapy options that pair well with medication.
Frequently Asked Questions
Is medication for alcohol use disorder a sign of weakness?
No. It's a sign of using available tools intelligently. Medication for alcohol use disorder has comparable or better evidence than medication for many other conditions we treat without hesitation. The stigma around it isn't medically justified.
Can I take naltrexone if I haven't quit yet?
Yes. The Sinclair Method specifically involves taking naltrexone before drinking to progressively reduce the reward and break the habit. It's an approach where you don't have to be completely abstinent before starting medication.
How long do people take these medications?
It varies. Some people use naltrexone for a few months through the highest-risk period. Others continue longer. There's no set timeline — it's a conversation with your doctor based on your situation and goals.
Are there side effects?
All medications have potential side effects. Naltrexone can cause nausea, especially initially; taking it with food helps. Acamprosate can cause diarrhea. Disulfiram requires strict compliance. Your doctor can help you weigh the side effect profile against the benefit.