Yes, there are FDA-approved medications specifically designed to help you stop or reduce drinking. Three medications currently have approval for treating alcohol use disorder: naltrexone, acamprosate, and disulfiram. Each works differently, and the best choice depends on whether your goal is to quit entirely or cut back, along with your overall health.
These medications aren’t a cure on their own, but they meaningfully improve your odds. In one large clinical trial, people taking naltrexone with basic medical support were abstinent 81% of the time, compared with 75% for those on a placebo. That gap may sound modest, but over months and years it translates to significantly fewer relapses and heavy drinking episodes.
Naltrexone: Reducing Cravings and the Urge to Drink
Naltrexone is the most widely prescribed medication for alcohol use disorder and works by blocking the brain’s opioid receptors. When you drink, your brain normally releases natural opioids that create a pleasurable buzz. Naltrexone intercepts that signal, so alcohol feels less rewarding. Over time, this weakens the connection your brain has built between drinking and feeling good, which reduces cravings.
The standard oral dose is 50 mg once daily. Most doctors start you at half that dose for the first few days to minimize side effects like nausea or headache, then move up to the full amount. Studies consistently show naltrexone reduces the number of heavy drinking days and delays relapse in people who are trying to stay sober.
If remembering a daily pill is a challenge, or if you’ve tried the oral version without success, there’s also a monthly injection called Vivitrol. It delivers 380 mg of naltrexone into muscle tissue once every four weeks, administered at a clinic. This removes the daily decision of whether to take your medication, which can be especially helpful early in recovery when motivation fluctuates.
One important limitation: naltrexone cannot be used if you’re currently taking opioid painkillers or are physically dependent on opioids. It blocks the same receptors those drugs act on, so it would trigger immediate withdrawal. Your doctor will typically confirm you’re opioid-free before prescribing it. People with significant liver problems should also use it cautiously, as it can occasionally stress the liver.
Acamprosate: Easing the Brain After You Quit
Acamprosate takes a completely different approach. Rather than making alcohol less rewarding, it helps your brain chemistry stabilize after you’ve already stopped drinking. Heavy, long-term alcohol use disrupts the balance between excitatory and calming signals in the brain. When you suddenly quit, your brain can become overactive, producing anxiety, restlessness, insomnia, and a general sense of unease that makes relapse tempting. Acamprosate calms that overactivity by modulating glutamate and GABA pathways.
The evidence for maintaining total abstinence is encouraging. In clinical trials, twice as many patients taking acamprosate stayed completely sober for a full year compared with those on a placebo (27% versus 13%). It’s taken as a tablet three times a day, which is more demanding than naltrexone’s once-daily schedule, but for people whose primary struggle is the discomfort of early sobriety, it can make a real difference.
Acamprosate is processed through the kidneys rather than the liver, making it a good option for people with liver damage from years of drinking. However, it’s not suitable for those with severe kidney impairment. People with moderate kidney problems can take it at a reduced dose.
Disulfiram: The Deterrent Approach
Disulfiram was the first medication approved for alcohol use disorder and has been available for over 40 years. It works through aversion rather than brain chemistry modification. Disulfiram blocks an enzyme called acetaldehyde dehydrogenase, which your body uses to break down a toxic byproduct of alcohol. If you drink while taking disulfiram, that byproduct builds up rapidly, causing facial flushing, nausea, vomiting, sweating, and a racing heart. The reaction typically hits within hours and can be severe enough to cause dangerous drops in blood pressure or heart rhythm problems.
The idea is that knowing how miserable drinking will make you serves as a powerful deterrent. This works best for people who are already motivated to quit and want an extra layer of accountability. It’s less effective for someone who might simply stop taking the pill in order to drink. For that reason, some treatment programs have a family member or counselor supervise daily dosing.
Disulfiram carries more safety concerns than the other two options. It’s not appropriate for people with severe heart disease, psychosis, or advanced liver disease. Rare cases of serious liver toxicity have been reported. It’s also avoided during pregnancy.
Off-Label Medications
When the three approved medications don’t produce enough improvement, doctors sometimes turn to off-label options. Topiramate, a drug originally developed for seizures, has shown enough benefit in clinical trials that some guidelines now list it alongside the approved medications as an initial option, particularly for people whose goal is to drink less rather than stop completely.
Gabapentin is considered a second-line choice. Clinical trials at various doses have produced mixed results, though a meta-analysis found it did reduce heavy drinking days. One concern with gabapentin is that it carries some addictive potential of its own, so it’s typically reserved for people who haven’t responded to other treatments.
How Medication Fits With Counseling
Medication works best as part of a broader plan, but the relationship between pills and therapy is more nuanced than “do both.” The large COMBINE study, one of the most rigorous trials on this question, found that naltrexone paired with basic medical management (brief check-ins with a prescriber) was effective on its own. Adding intensive behavioral therapy on top of that didn’t produce additional improvement. However, structured counseling alone, without any medication or regular medical visits, performed worse than medication with basic support.
The practical takeaway: you don’t necessarily need intensive therapy to benefit from medication, but you do need some form of ongoing support. Regular check-ins with whoever prescribes your medication, a therapist, a support group, or some combination give you the structure to stay on track, adjust your treatment if needed, and work through the situations that trigger drinking.
How Long You’ll Take Medication
There’s no fixed course like a round of antibiotics. Most guidelines recommend staying on medication for at least several months, and many people benefit from a year or longer. The first three to six months of sobriety carry the highest relapse risk, so stopping medication too early can undermine the progress you’ve made. Your prescriber will help you decide when and whether to taper based on how stable your recovery feels, whether cravings have diminished, and what other support you have in place.
Starting any of these medications requires a conversation with a doctor or other prescriber, but it doesn’t have to be a specialist. Primary care physicians can prescribe all three approved medications and manage treatment through routine office visits. If your drinking has been heavy and recent, your doctor may also want to address withdrawal safety before starting long-term medication, since stopping alcohol abruptly after sustained heavy use can be medically dangerous on its own.