The three main types of FDA‑approved medications for Alcohol Use Disorder (AUD) are naltrexone, acamprosate, and disulfiram. Each works in a different way to support recovery, reduce cravings, and prevent relapse [1].
These medications do not cure AUD on their own but are proven effective when used as part of a comprehensive treatment plan that also includes therapy, peer support, and ongoing monitoring by licensed clinicians.
In the early stages of alcohol abuse, alcohol activates the brain’s reward system by increasing dopamine, GABA, and engaging opioid receptors in regions that control pleasure, habit formation, and motivation.
This creates intense feelings of pleasure that reinforce drinking, reinforcing the brain to associate alcohol with reward. With continued drinking, the brain adapts, and tolerance develops, meaning more alcohol is needed to achieve the same effects [2].
Alcohol cravings can be categorized into psychological and physical. Psychological cravings are driven by mental and emotional triggers and are closely tied to the brain’s reward system, which reinforces the association between alcohol and pleasure or relief. These often emerge in response to stress, boredom, or social situations associated with past drinking experiences [3].
For example, seeing friends drink, visiting a bar, or experiencing anxiety can trigger an intense desire to drink and, without the skills to manage them, can increase the risk of relapse.
Physical cravings come from the body’s physiological dependence on alcohol. Chronic drinking alters the brain’s chemistry and activity in the central nervous system, leading to tolerance and withdrawal symptoms when alcohol is absent.
Physical cravings can sometimes be medically dangerous if untreated. When individuals with AUD first stop drinking, they may experience distressing symptoms such as tremors, sweating, nausea, headaches, and even seizures.
Naltrexone is an opioid antagonist available in short-acting oral medication and long-acting injectable formulations. Both formulations can be used for the treatment of alcohol use disorder, and the long-acting injectable formulation is used for the treatment of opioid use disorder.
Naltrexone binds to the brain’s opioid receptors and blocks the effects that opioids and alcohol cause on the reward system. By blocking opioid receptors in areas of the brain associated with reward, the positive reinforcement that comes from alcohol use is reduced. Drinking won’t make you sick, but it will make it less enjoyable.
Individuals must first have a trial of oral naltrexone before starting long-acting injectable naltrexone to ensure they do not have an allergic reaction or intolerable side effects.
Some clinicians may also require a urine toxicology test before starting you on Naltrexone to confirm that opioids are not present in the body, as this can trigger opioid withdrawal [1].
Acamprosate (Campral) targets neurotransmitter function to restore balance to key brain chemicals impacted by alcohol, such as GABA and glutamate. GABA calms the nervous system, and glutamate excites it, and when someone stops drinking, these systems remain out of balance. This can lead to anxiety, insomnia, irritability, and strong cravings.
Acamprosate is ideally combined with counseling, behavioral therapy, and skill-building workshops to maximize long-term recovery success. Unlike other medications that block the pleasurable effects of alcohol, Acamprosate works by supporting this chemical balance after chronic alcohol use. It is typically taken twice daily and can make it easier to manage emotions, triggers, and anxiety during recovery.
Disulfiram does not reduce cravings for alcohol but causes an adverse reaction when it is consumed. These symptoms can include flushing, nausea, vomiting, headache, and a rapid heartbeat. This reaction occurs because disulfiram inhibits aldehyde dehydrogenase, the enzyme responsible for breaking down acetaldehyde, a toxic byproduct of alcohol.
Disulfiram is typically most effective for those who are highly motivated to remain abstinent and are under supervision or have strong accountability measures. By pairing the physical deterrent effects of disulfiram with structured therapy, patients have a dual approach to recovery [4].
| Medication | Mechanism | Main Use | Effect on Cravings |
| Naltrexone | Blocks dopamine in the brain’s reward system | Reduce heavy drinking | Makes alcohol less pleasurable |
| Alcamprosate | Restores neurotransmitter balance | Maintain abstinence | Reduces anxiety, physical and mental discomfort |
| Disulfiram | Causes an adverse reaction | Prevents drinking | Acts as a deterrent when one drinks alcohol |
Medication‑assisted treatment (MAT) for alcohol use disorder (AUD) fits into an overall recovery plan by combining these medications with counseling and behavioral therapies to address both the biological and psychological aspects of addiction.
Research and clinical practice guidelines recommend that treatment plans be individualized, regularly reviewed, and integrated with support services to improve long‑term outcomes and reduce the risk of relapse [5].
In Massachusetts, state laws and policies recognize and support the use of MAT as a part of substance use disorder treatment for alcohol use. Programs aim to ensure that FDA‑approved medications are available and that individuals receive them, along with counseling and other services, in licensed treatment settings [6].
Trinity Wellness Group‘s full-day and half-day treatment programs in Braintree, Massachusetts, offer an ideal structure for those struggling with alcohol use disorder and co-occurring mental health challenges.
Clients receive personalized plans incorporating medication-assisted treatment (MAT) for reducing cravings for alcohol, CBT, DBT coping skills workshops, EMDR for trauma processing, and group sessions that foster peer connections.
Contact us today to find support and begin treatment. Whether you are balancing classes, work, or campus life, care is structured to fit your needs.
[1] National Institute on Alcohol Abuse and Alcoholism. 2021. Medications Development Program.
[2] National Institute on Alcohol Abuse and Alcoholism. 2021. Neuroscience: The Brain in Addiction and Recovery.
[3] Morgenstern, J. et al. (2015). Cognitive regulation of craving in alcohol-dependent and social drinkers. Alcoholism, clinical and experimental research, 39(2), 343–349.
[4] Bradford, T. et al. 2016. Medications for Alcohol Use Disorder. AAFP Foundation.
[5] U.S. Department of Health and Human Services. 2015. REVIEW OF MEDICATION-ASSISTED TREATMENT GUIDELINES AND MEASURES FOR OPIOID AND ALCOHOL USE.
[6] Mass Gov. 2020. Medication-assisted treatment policy.
