An Overview of Medications That Can Help

Medication can support alcohol recovery, but it must be used with realism and restraint. No medication cures alcohol use disorder (AUD), and none replaces behavioural change, psychological support or social connection.

However, for some people, medication reduces the symptoms that keep pulling them back to alcohol, making recovery more achievable. Before commencing any medications, it requires clinician assessment, consideration of interactions and contraindications (including liver disease and opioids) and individual biology, as well as other health factors. Seek medical advice.

This section explains:

• which medications are commonly used
• what they are actually doing in the brain and body
• who they may help
• and where their limits are

A core principle to hold in mind

Alcohol use disorder is not only behavioural. It is:

• neurobiological
• psychological
• hormonal
• social

Medication addresses biology. Recovery requires behavioural and psychological change as well. Medication works best when it:

• lowers baseline distress
• reduces relapse pressure
• buys time for new coping strategies to develop

There are a number of specific AUD medications including:

• Disulfiram
• Acamprosate
• Naltrexone
• Nalmefene

This list is not exhaustive and can vary from country to country and across local and regional health boards. There are other medications including antidepressants and other types of medications that may be helpful in recovery. Some of them are also discussed in this chapter.

Always seek medical advice before starting any medication. Medications affect people differently and finding the right combination to suit your individual biology and psychology are the key, along with behavioural and psychological change. Also, these medications are available by prescription only.

DISULFIRAM (ANTABUSE)

What it does, who it’s for and where it fits

Disulfiram is a medication designed to support complete abstinence from alcohol. It does not reduce cravings. It does not make alcohol less appealing. It works by making drinking physically unpleasant and potentially dangerous. Disulfiram is best understood as a behavioural enforcement tool. It is most useful for people who are already committed to stopping and want a strong external safeguard.

What this medication does in the brain and body

Disulfiram blocks the enzyme responsible for breaking down alcohol. When alcohol is consumed while Disulfiram is in the body, toxic by-products build up quickly, causing a severe physical reaction.

This can include:

• flushing
• nausea and vomiting
• headache
• palpitations
• breathlessness
• anxiety and panic

The reaction is not psychological. It is physiological. This creates a clear and immediate consequence that discourages drinking.

What this medication is designed to help with

Disulfiram is designed to:

• prevent impulsive or “just one” drinking
• support firm abstinence decisions
• provide external accountability
• reduce relapse during high-risk periods

It is most effective when someone has already decided not to drink.

What this medication does not do

Disulfiram does not:

• reduce cravings
• treat anxiety or mood problems
• address underlying drivers of drinking
• make recovery easier emotionally

It enforces behaviour. It does not build coping skills.

Who this medication is usually suitable for

Disulfiram is usually suitable for people who:

• want complete abstinence
• understand and accept the risks
• have strong motivation to stop
• benefit from firm external boundaries
• have support and monitoring in place

Who this medication is not suitable for

Disulfiram is not suitable for people who:

• want to cut down rather than stop
• are ambivalent about abstinence
• may drink impulsively despite consequences
• have significant heart or liver conditions
• may struggle with adherence or supervision

How this medication is taken

Disulfiram is taken daily. Its effects last beyond the day of dosing, meaning alcohol must be avoided even after stopping the medication. Consistency and supervision significantly increase effectiveness.

Common side effects and early adjustment

Common side effects include:

• drowsiness
• headache
• metallic taste
• fatigue

Most are mild and settle with time. Severe reactions occur only if alcohol is consumed.

Psychological and emotional effects to be aware of

Some people experience:

• increased anxiety around drinking situations
• a sense of restriction or pressure
• relief from not having to “decide”

Disulfiram works best when the decision to stop has already been made.

Using this medication alongside recovery work

Disulfiram should always be combined with:

• behavioural support
• structure and routine
• relapse prevention planning

Without this, people often stop taking it.

When this medication may not be enough

If cravings remain intense or emotional distress is high, additional psychological or pharmacological support is usually needed. Disulfiram is not a standalone recovery plan.

Safety notes and medical guidance

Disulfiram should only be used under medical supervision. Alcohol must be strictly avoided.

A realistic summary

Disulfiram enforces abstinence through consequences. For the right person, at the correct time, it can be highly effective.

Key points to remember

• Designed for abstinence only
• Creates a physical reaction to alcohol
• Does not reduce cravings
• Requires commitment and supervision
• Works best alongside structured support

NALTREXONE

What it does, who it’s for and where it fits

Naltrexone has grown in popularity in recent years as a treatment for alcohol use disorder. It’s primarily used as a first-line relapse-prevention treatment to support abstinence following withdrawal, but evidence also shows it can reduce return to heavy drinking, and growing numbers of people are using it to help reduce their consumption rather than quit completely. It works by reducing the rewarding effects of drinking, making alcohol less compelling. Naltrexone can be used either to support abstinence or, in certain patients, as part of an approach to drink less — but anyone considering a reduction programme while continuing to drink should seek medical advice before starting.

What this medication does in the brain and body

Alcohol triggers the release of endorphins, activating the brain’s reward system. Naltrexone blocks opioid receptors, reducing dopamine release. This leads to:

• less pleasure from alcohol
• reduced reinforcement
• weaker urges to continue drinking

What this medication is designed to help with

Naltrexone is designed to:

• reduce cravings
• reduce binge drinking
• reduce loss of control
• support abstinence or reduction

What this medication does not do

Naltrexone does not:

• stop drinking automatically
• treat withdrawal
• resolve emotional drivers
• replace behavioural change

Who this medication is usually suitable for

Naltrexone is usually suitable for people who:

• want to stop or significantly reduce
• binge drink or lose control
• are not opioid-dependent
• want craving reduction support

Who this medication is not suitable for

Naltrexone is not suitable for people who:

• use opioid medications
• are opioid-dependent
• have severe or acute liver impairment, acute hepatitis or liver failure
• need detox support

How this medication is taken

Naltrexone is usually taken daily, though some people use targeted dosing under medical guidance. Consistency improves outcomes.

Common side effects and early adjustment

Common side effects include:

• nausea
• headache
• fatigue
• reduced appetite

These usually settle within weeks.

Psychological and emotional effects to be aware of

Some people feel:

• emotionally flatter early on
• disappointed by reduced reward
• relief from reduced obsession

These effects often stabilise with time.

Using this medication alongside recovery work

Naltrexone works best with:

• behavioural strategies
• craving management
• support and structure

When this medication may not be enough

If anxiety, sleep problems or emotional distress persist, additional treatment is often needed.

Safety notes and medical guidance

Naltrexone requires medical assessment, including baseline liver and kidney function tests. Ongoing blood monitoring may be recommended depending on individual health factors.

A realistic summary

Naltrexone reduces alcohol’s reward and helps weaken compulsion.

Key points to remember

• Reduces reward from alcohol
• Can support abstinence or reduction
• Does not treat withdrawal
• Works best with behaviour change

ACAMPROSATE (CAMPRAL)

What it does, who it’s for and where it fits

Acamprosate is a medication designed to help people stay stopped after alcohol cessation. It can support brain stabilisation during early and ongoing abstinence.

What this medication does in the brain and body

Long-term drinking disrupts the balance between calming and stimulating brain chemicals. Acamprosate can help restore this balance, reducing nervous system overactivity.

What this medication is designed to help with

Acamprosate is designed to:

• reduce post-acute cravings
• stabilise mood
• improve sleep
• support long-term abstinence

What this medication does not do

Acamprosate does not:

• stop drinking on its own
• reduce intoxication

It is intended primarily to support abstinence. Continued drinking should prompt a review of whether treatment is providing benefit.

Who this medication is usually suitable for

Acamprosate is usually suitable for people who:

• have stopped drinking
• want to stay abstinent
• experience anxiety or restlessness
• struggle with early recovery stability

Who this medication is not suitable for

Acamprosate is not suitable for people who:

• are still drinking
• want to cut down
• have severe kidney problems

How this medication is taken

Acamprosate is taken daily, consistently. It works gradually rather than immediately.

Common side effects and early adjustment

Common side effects may include:

• diarrhoea
• stomach upset
• fatigue

These usually settle.

Psychological and emotional effects to be aware of

Acamprosate is used primarily to support abstinence and reduce the risk of relapse after withdrawal. Some people may notice:

• calmer baseline mood
• reduced agitation
• fewer emotional swings

However, as recovery progresses, these may not all be directed attributed to acamprosate alone. but part of the person’s overall recovery plan.

Using this medication alongside recovery work

Acamprosate works best with:

• routine
• therapy
• recovery structure

When this medication may not be enough

Persistent cravings or relapse risk may require additional interventions.

Safety notes and medical guidance

Medical review is required before starting.

A realistic summary

Acamprosate supports brain healing during abstinence.

Key points to remember

• Supports staying stopped
• Gradual stabilising effect
• Best for post-detox recovery
• Continued drinking should prompt a review of whether treatment is providing benefit.

NALMEFENE

What it does, who it’s for and where it fits

Nalmefene is a medication designed to support cutting down, and not, generally, for abstinence. Nalmefene is for people with alcohol dependence who have a high drinking risk level, do not have any concerning physical withdrawal symptoms and may not require immediate detoxification. It should be used with ongoing psychosocial support. It is used as part of a harm-reduction approach for people who want to drink less.

What this medication does in the brain and body

Nalmefene modulates opioid receptors involved in alcohol reward. This reduces reinforcement and weakens the urge to continue drinking.

What this medication is designed to help with

Nalmefene is designed to:

• reduce binge drinking
• reduce total intake
• reduce loss of control
• increase drink-free days

What this medication does not do

Nalmefene does not:

• treat withdrawal
• enforce abstinence
• remove habits or triggers

Who this medication is usually suitable for

Nalmefene is usually suitable for people who:

• want to cut down
• binge drink
• are not physically withdrawing
• do not require detox

Who this medication is not suitable for

Nalmefene is not suitable for people who:

• experience withdrawal
• want full abstinence
• use opioid medication

How this medication is taken

Nalmefene is taken as needed, on days when drinking is expected.

Common side effects and early adjustment

Common side effects include:

• nausea
• dizziness
• sleep disturbance

These often reduce with time.

Psychological and emotional effects to be aware of

Some people experience frustration when alcohol feels less rewarding. This can prompt reflection or resistance.

Using this medication alongside recovery work

Nalmefene works best with:

• planning
• tracking
• behaviour change

When this medication may not be enough

If reduced drinking still causes harm, abstinence may be safer.

Safety notes and medical guidance

Medical assessment is required before use. Drinking should normally be recorded and still be at a high-risk level after an initial assessment before medication is started.

A realistic summary

Nalmefene supports harm reduction, not recovery on its own.

Key points to remember

• Designed for cutting down
• Taken as needed
• For a specific group of people with alcohol dependence who want to reduce drinking, do not have physical withdrawal symptoms and not in need of medical detoxification.
• Works best with structure

NON-SPECIFIC AUD MEDICATIONS

Medications that support recovery indirectly

These medications do not treat AUD itself but may reduce relapse-driving symptoms.

N.B. The term “Off-label” used with some of the medications discussed here, means a medication that is being used for a purpose other than the one it was originally licensed or officially approved for.

Antidepressants and Alcohol Recovery

Antidepressants may be appropriate for a co-occurring mental health condition, but they are not medications for treating AUD itself or preventing alcohol relapse. Depression and anxiety are extremely common in people with alcohol problems. They may be:

• pre-existing
• alcohol-induced
• withdrawal-related
• or a mixture of all three

Antidepressants do not treat alcohol use disorder, but they can be helpful when mood symptoms are a major relapse driver.

Important clinical reality

Heavy drinking can:

• blunt antidepressant effectiveness
• worsen side effects
• make response unpredictable

Antidepressants often work better after drinking has reduced or stopped.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Examples: sertraline, fluoxetine, citalopram Role: Depression and generalised anxiety. SSRIs are commonly prescribed and generally well tolerated. They may help when:

• low mood is persistent
• anxiety is present outside drinking episodes

They do not reliably reduce drinking on their own and may worsen outcomes if prescribed without addressing alcohol use.

Serotonin–Noradrenaline Reuptake Inhibitors (SNRIs)

Examples: venlafaxine, duloxetine Role: Depression with anxiety or chronic stress. SNRIs may be useful where:

• anxiety is prominent
• physical stress symptoms are present

They can sometimes increase anxiety early on and require careful monitoring.

Mirtazapine

Class: Noradrenergic and specific serotonergic antidepressant Role: Depression with insomnia, poor appetite or weight loss. Mirtazapine is sometimes useful in early recovery where:

• sleep is severely disrupted
• appetite is poor

Sedation can be helpful or problematic, depending on the individual.

Tricyclic antidepressants

Role: Rarely first line. These are generally avoided due to:

• side-effect burden
• toxicity in overdose

ANXIETY-FOCUSED MEDICATIONS

Beta blockers (e.g. propranolol)

Class: Adrenergic blockers Role: Physical anxiety control. Beta blockers can reduce:

• racing heart
• tremor
• adrenaline surges

Beta blockers such as propranolol may sometimes be prescribed to help manage the physical symptoms of anxiety, including a racing heart, shaking or sweating, where clinically appropriate. They do not treat alcohol use disorder itself or the underlying psychological causes of anxiety, but may be helpful after detox for some people who continue to experience troublesome physical symptoms of anxiety.

Gabapentin

Class: Calcium channel modulator Role: Early recovery stabilisation. Gabapentin has been studied for alcohol-related outcomes and is used in some people, but it is not routinely recommended for AUD treatment in many countries. Any off-label use should be specialist-led. In the USA and some other countries, gabapentin is often chosen when other abstinence medications are less effective or not tolerated.

When used, it should be:

• time-limited
• monitored
• used as a stabiliser, not a long-term solution

Specialist And Emerging Options

Topiramate

Class: Anticonvulsant Role: Reducing drinking and cravings. Topiramate has some evidence for reducing alcohol consumption, even without abstinence, but the evidence is not conclusive. However, it is used in some instances in some countries. Many people often discontinue due to:

• cognitive slowing
• fatigue
• emotional flattening

It can be effective but often poorly tolerated. Again, seek appropriate medical advice before commencing any medical treatment.

Baclofen

Class: GABA-B agonist Role: Craving reduction in selected cases. Becoming more commonly used in parts of Europe and the USA.

Baclofen may be considered as a second-line, specialist-led treatment after successful withdrawal where first-line treatments such as acamprosate or naltrexone have not worked or are unsuitable. Its use for AUD remains off-label . Risks include sedation and withdrawal if stopped abruptly. Use is specialist-led but its use for AUD treatment is on the rise.

Varenicline

Class: Partial nicotinic receptor agonist Role: Reduced alcohol reward (off-label). Originally for smoking cessation. Evidence suggests benefit in people who both smoke and drink. Not licensed for AUD.

Ondansetron (low dose)

Class: 5-HT3 antagonist Role: Early-onset AUD subgroup. Shows benefit in people with early-onset AUD, likely reflecting genetic differences in serotonin systems. Highly specialised use.

Hormone Replacement Therapy (HRT)

Hormonal changes during perimenopause and menopause can significantly affect alcohol use. Common symptoms include:

• sleep disruption
• anxiety spikes
• mood instability
• increased stress sensitivity

Alcohol may feel like fast relief, but it often:

• worsens sleep
• increases anxiety rebound
• aggravates hot flushes

The role of HRT

HRT can:

• stabilise oestrogen levels
• improve sleep
• reduce anxiety and low mood
• may indirectly reduce alcohol cravings

For some women, treating troublesome menopausal symptoms such as poor sleep, anxiety and hot flushes may remove factors that contribute to drinking. HRT is not a treatment for AUD itself, but it may:

• help remove key triggers
• make recovery significantly easier

Assessment should be GP or specialist-led and individualised.
(SEE APPENDIX G: WOMAN AND AUD for further reading)

Heartburn, Acid Reflux and Stomach Medications

Alcohol can irritate the stomach and worsen acid reflux, heartburn, indigestion and nausea, particularly after periods of heavier drinking. These symptoms often improve when alcohol is reduced or stopped, but sometimes additional treatment is helpful. Proton pump inhibitors (PPIs) such as omeprazole and lansoprazole reduce the amount of acid produced by the stomach and are commonly used to treat acid reflux and related conditions. They do not treat alcohol use disorder itself, but they may help you feel physically better while cutting down, stopping or in early recovery. Speak to a pharmacist or doctor about whether they are appropriate for you, particularly if symptoms are persistent or severe.

MEDICATIONS REQUIRING PARTICULAR CAUTION

Benzodiazepines (outside detox)

Benzodiazepines such as chlordiazepoxide (Librium), diazepam and lorazepam have an important role in the medical management of alcohol withdrawal. They calm an overactive nervous system and can help control symptoms such as anxiety, agitation and tremor while reducing the risk of serious withdrawal complications, including seizures.

Their role usually changes once detox is complete. Benzodiazepines are not a treatment for alcohol use disorder itself (aside from detox), and they do not reduce the underlying drive to drink or address the psychological and behavioural factors involved in alcohol dependence.

Regular or prolonged use also carries significant risks. The body can develop tolerance, meaning that larger doses may be needed to achieve the same effect, and physical dependence can develop. Stopping suddenly after regular use can then cause a separate benzodiazepine withdrawal syndrome, which can itself be serious.

There is another important concern for people who may return to drinking: benzodiazepines and alcohol are both central nervous system depressants. Taking them together can substantially increase sedation, impaired judgement and coordination and, at higher doses, the risk of respiratory depression, overdose and death.

This does not mean benzodiazepines should never be prescribed to someone with a history of AUD. There may be legitimate clinical reasons for their use. However, ongoing prescribing generally requires careful assessment of the benefits, risks, duration of treatment and the person’s individual circumstances.

Antipsychotics

Antipsychotic medications are not routinely used to treat alcohol use disorder and should not be thought of as medications that reduce alcohol dependence in the same way as naltrexone, acamprosate or other AUD-specific treatments.

They may, however, be appropriate when someone has another condition requiring them, such as schizophrenia, bipolar disorder or another disorder involving psychosis or severe mood disturbance. Treating these conditions effectively can be an important part of someone’s overall recovery from alcohol problems.

Antipsychotics may also occasionally be used in specialist medical settings to manage particular complications associated with severe alcohol withdrawal, such as severe agitation or hallucinations. However, they are generally adjuncts rather than substitutes for appropriate alcohol-withdrawal treatment, particularly because some antipsychotics can lower the seizure threshold.

The key distinction is therefore simple: antipsychotics can be extremely important medicines when there is a clear clinical indication, but they are not standard treatments for AUD itself.

A Final Word on Medication: One Ingredient in Recovery

If there is one message to take from this section, it is that medication can be an important part of recovery, but it is rarely the whole answer.

As you have seen so far in the book, there are many options. Some medications help you withdraw from alcohol safely. Some reduce cravings or the rewarding effects of drinking. Others may support abstinence, while some treat problems that can sit alongside alcohol use, such as anxiety, depression or sleep difficulties. What is helpful for one person may be completely different from what helps another.

This reflects one of the central themes of this book: there is no single pathway to recovery.

If we think of recovery more like a recipe. Medication may be one ingredient, but so might CBT, behavioural change, mutual-aid groups such as AA or SMART Recovery, counselling, nutrition, exercise, better sleep, relationships, routine, purpose and simply allowing your brain and body time to recover.

You may need several of these. You may need only a few. And the recipe may change over time.

Something that is extremely valuable during the first few weeks may become less important six months later. Equally, something you dismissed at the beginning may turn out to be exactly what you need further down the road. Recovery is not about choosing the one correct treatment. It is about discovering the combination that works for you.

Medication can reduce suffering, stabilise symptoms and give you enough breathing space to begin making other changes. For some people, it can make an enormous difference. But a tablet in itself, cannot build a new routine, repair relationships, change learned behaviours, create connection or give your life meaning. Those parts of recovery come from what you do alongside it.

Again, the strongest recovery plan is therefore often not one treatment, but a combination of treatments, tools and support working together. Multiple forms of support have a higher chance of success. Take what is useful, remain open to different approaches and build your own recovery recipe over time.

N.B. Most of the medications discussed in this section are prescription-only medicines and require appropriate medical assessment. Never start, stop or change a prescribed medication without discussing it with a suitably qualified healthcare professional.