Yes, there are several medications that can help you stop drinking or significantly cut back. Three drugs are approved by the FDA specifically for alcohol use disorder: naltrexone, acamprosate, and disulfiram. Each works differently, and the best choice depends on whether you’re still drinking, already abstinent, or dealing with other health conditions. Beyond these three, a couple of off-label options have shown strong results in clinical trials.
Naltrexone: Reducing the Urge to Drink
Naltrexone is the most widely prescribed medication for alcohol use disorder, available as a daily pill or a once-monthly injection. It works by blocking the receptors in your brain that produce the pleasurable buzz from alcohol. When those receptors are blocked, drinking simply doesn’t feel as rewarding, which over time weakens the craving cycle. People who take naltrexone often describe it as making alcohol feel “pointless” rather than tempting.
The injectable version, sold as Vivitrol, is a 380 mg dose given once every four weeks by a healthcare provider. Once injected, it stays active in your body for the full month and can’t be removed, which eliminates the daily decision of whether to take a pill. This makes it a strong option if you’re concerned about sticking with a daily medication. In meta-analyses, injectable naltrexone was associated with about five fewer drinking days per month compared to placebo.
Naltrexone does come with an important restriction: you cannot take it if you’re currently using opioid medications or drugs like heroin, because it will trigger immediate withdrawal. Liver function tests are recommended before starting and periodically during treatment, though significant liver problems occur in only about 1% of patients. The oral version was FDA-approved in 1994, and the injectable form followed in 2006.
Acamprosate: Easing the Discomfort of Sobriety
Acamprosate tackles a different problem. When you drink heavily for a long time, your brain chemistry shifts to compensate for alcohol’s constant presence. Once you stop, the brain becomes overexcited, producing the anxiety, restlessness, and general unease that make early sobriety so difficult. Acamprosate calms this overactivity by lowering levels of a stimulating brain chemical called glutamate.
Brain imaging in recently abstinent patients shows that acamprosate treatment reduces glutamate levels in the frontal lobe, while people on placebo actually see glutamate increase. This matters because elevated glutamate is what drives much of the discomfort, irritability, and sleep disruption that push people back toward drinking in the first weeks and months of sobriety.
Acamprosate works best for people who have already stopped drinking and want help staying stopped. It’s taken as a pill three times per day, which can be a drawback compared to naltrexone’s simpler dosing. The main medical restriction is severe kidney impairment, since the drug is cleared through the kidneys rather than the liver, actually making it a reasonable option for people with liver damage from heavy drinking.
Disulfiram: The Deterrent Approach
Disulfiram, sold as Antabuse, is the oldest medication in this category, available for over 40 years before naltrexone came along. It doesn’t reduce cravings at all. Instead, it makes drinking physically miserable. The drug blocks an enzyme your body needs to fully process alcohol. If you drink while taking disulfiram, a toxic byproduct called acetaldehyde builds up in your blood, causing flushing, nausea, vomiting, headache, and a rapid heartbeat.
This “if you drink, you’ll feel terrible” approach works well for people who are motivated to stay sober and want a concrete reason not to pick up a drink in a moment of weakness. You need to have been alcohol-free for at least 12 hours before starting it. The clinical evidence for disulfiram is more limited than for the other two medications, and it requires monitoring for liver problems. People taking it are advised to carry an identification card explaining the drug interaction, since even alcohol in cough syrup or cooking sauces can trigger a reaction.
Off-Label Options With Strong Evidence
Two medications originally developed for seizures have shown consistent results in alcohol use disorder trials, though the FDA hasn’t formally approved them for this use.
Topiramate has some of the most impressive numbers of any medication studied for alcohol use disorder. In a large meta-analysis published in JAMA, only 53.8% of people taking topiramate returned to any drinking, compared to 72.2% on placebo. It also reduced the percentage of drinking days by about eight days per month more than placebo. Topiramate appears to dampen the brain’s reward response to alcohol while also reducing anxiety that can trigger relapse.
Gabapentin has been studied at several dose levels. A trial of 150 patients found that doses of 1,800 mg per day significantly improved both complete abstinence and the rate of avoiding heavy drinking, with a clear dose-response pattern: higher doses worked better. A pilot study using 3,600 mg per day found significant reductions in heavy drinking days and increases in days of complete abstinence. Gabapentin is particularly useful for people who also experience anxiety or sleep problems in early sobriety, since it can help with both.
How Medication Fits Into Treatment
Medication for alcohol use disorder works best as one part of a broader plan. People who combine medication with some form of behavioral support, whether that’s individual counseling, group therapy, or a structured program, tend to see better outcomes across multiple measures. Research on medication-assisted treatment shows significant reductions in emergency department visits and hospitalizations compared to treatment without medication.
One common misconception is that you need to hit “rock bottom” or be completely abstinent before medication can help. Naltrexone and topiramate have both been studied in people who are actively drinking, not just those who have already quit. If you’re still drinking and want to stop or cut back, that’s a valid starting point for medication.
Choosing the Right Medication
Your current situation narrows the options quickly. If you’re still drinking and want to reduce your consumption, naltrexone or topiramate is typically the starting point. If you’ve already stopped and want to stay sober, acamprosate is designed for exactly that phase. If you want a hard-line deterrent and are confident you can commit to the regimen, disulfiram provides a strong external barrier.
Health conditions matter too. Active opioid use rules out naltrexone entirely. Severe kidney disease rules out acamprosate. Liver failure or acute hepatitis rules out naltrexone and requires caution with disulfiram. For people with significant liver damage but healthy kidneys, acamprosate is often the safest choice.
Generic versions of all three FDA-approved medications are available, which keeps costs relatively low. Oral naltrexone and disulfiram each cost a few dollars per day at generic pricing. Acamprosate runs slightly higher because of the three-times-daily dosing. The monthly Vivitrol injection is considerably more expensive, though most insurance plans cover it given its FDA approval status. Many state Medicaid programs and substance use treatment programs also cover these medications at little or no cost to the patient.
These medications are prescribed by primary care doctors, psychiatrists, and addiction medicine specialists. You don’t need to enter a residential treatment program to get a prescription. A straightforward conversation with your doctor about your drinking is enough to get started.