Which Medications Work Best To Help Me Stop Drinking?

When we find ourselves in a tricky situation, it’s natural to wish for a magic pill to make it go away. And alcohol misuse is, certainly, a tricky situation (to say the least). It can feel nearly impossible to stop drinking once the habit takes hold, and you might find yourself wondering, “If only there were a pill to stop drinking!” 

If you’re facing this problem, first of all, know that you’re not alone. And if you’re wondering how to stop alcohol cravings or if there’s a medication to stop drinking, you’re in luck — there are several! Let’s explore the pros and cons of each to help you decide if one is right for you, based on your needs and goals around alcohol.

AUD: The Basics

First things first: what exactly are we dealing with? Alcohol use disorder (AUD) is a progressive mental health condition marked by an inability to stop excessive drinking. According to the National Institute on Alcohol Abuse and Alcoholism
(NIAAA), in the U.S. as many as 29.5 million people ages 12 and older are struggling with AUD. That’s more than 10% of everyone in this age group!

While it might puzzle a nondrinker who has never dealt with alcoholism (“Why can’t they just stop?”), there’s brain chemistry behind the condition and its often devastating effects. For an in-depth look at AUD, check out our blog “What Is Alcohol Use Disorder?” For now, here’s the gist of it:

• Alcohol changes our brain chemistry. Alcohol boosts the reward neurochemical dopamine — the driving force of good and bad habits alike. This dopamine release is what makes us crave alcohol.
• Misuse can turn into dependence. Over time, the brain adjusts to the new normal and shifts its natural neurochemical production accordingly. The result? We become dependent on booze to function at baseline. There’s not much “reward” or joy to speak of at this point — it’s more about how bad we feel if alcohol is suddenly removed, leading to withdrawal.
• Withdrawal and cravings make it difficult to stop. Withdrawal symptoms range from the merely uncomfortable (headaches, shakiness, and irritability) to the downright dangerous (seizures and delirium tremens). On top of that, we have cravings — those irresistible, all-consuming urges that drive us toward booze. 

Needless to say, once we’re at the stage of dependence, getting out of the alcohol trap can seem all but impossible. But rest assured, there’s a way out!

Medication for Alcoholism: Three Paths

This is where medications come in (at least for some of us). There are three main approaches to treating AUD with medications: making alcohol less effective, making it intolerable, or making it less desirable. Let’s explore each one in more detail.

1. “It’s Not Working Anymore”: Medications That Make Booze Lose Its Effects

Why is drinking so habit-forming to begin with? As we know, it’s all about brain chemistry. Let’s face it: without that dopamine rush, fewer people would probably be guzzling down a liquid that doesn’t always taste great on its own (there’s a reason it’s called an “acquired taste”).

Medications that interfere with the rewarding effects associated with drinking take out the pleasure factor, making it easier to stay away from booze. After all, with the main reason to drink out of the picture, what’s the point?

Naltrexone (Vivitrol, Revia)

Naltrexone was originally developed to treat opioid addiction, but has been gaining traction as an effective treatment for AUD. Chemically similar to opioids but without the same euphoric effects, it works by blocking opioid receptors in the brain. Because these receptors are part of the brain’s reward system activated by alcohol, blocking them reduces the pleasure we get from drinking.

Imagine you’re waiting for a fun package (a chocolate wafer cake, a new yoga outfit — whatever tickles your fancy), but your mailbox is so full of junk mail that nothing else can fit. The postal worker ends up taking your package back to the post office and you’re left with a pile of mail that’s neither good nor bad — it’s just taking up space. Well, that’s what naltrexone does to our brain! (For a deep dive, check out “Unlocking the Science: How Long Does Naltrexone Block Alcohol?”)

Pros:

• Naltrexone reduces the pleasure we get from alcohol, making it an effective way to discourage drinking.
• Now available as a monthly injection, we don’t have to worry about taking a daily dose — it’s a done deal.
• There’s some evidence that naltrexone might help with weight loss (which could be a plus for some).

Cons:

• We can still get withdrawal symptoms if we’ve been drinking for a while before starting treatment.
• There are a few side effects, such as nausea, headache, and dizziness.

Nalmefene (Selincro)

A chemical counterpart of naltrexone, nalmefene is an opioid antagonist. Instead of acting as an opioid by binding to opioid receptors, it blocks the receptors completely — breaking the metaphorical mailbox lock and making it impossible to open at all. The result, however, is the same — we don’t get the reward associated with drinking.

Pros: 

• Nalmefene works for those cutting back on alcohol — complete abstinence isn’t necessary (though it may very well be the natural fallout!).
• Take it when you need to, don’t take it if you don’t need to — the decision is up to you.

Cons:

• Once again, there are side effects, such as nausea, dizziness, and insomnia. And, most importantly, nalmefene is hard on the liver, which might already be having trouble with alcohol in the picture on a regular basis.
• Flexibility is great, but it comes at a cost. Ever heard of decision fatigue? The brain gets tired of making multiple decisions, so leaving drinking as an open question can backfire.

2. “It’s Making Me Sick”: Medications That Make Alcohol Intolerable

A more drastic way to treat AUD with medications involves making booze highly unpleasant instead of merely neutral. Sure, this one’s not for the faint of heart (and is only right for those committed to leaving alcohol behind for good). Still, many have found that taking a medication that induces alcohol intolerance is actually an effective way to get back in the driver’s seat when it comes to making daily decisions. Took your meds in the morning? You know booze is out of the question tonight — no need for the time-consuming and exhausting mental back-and-forth throughout the day.

Disulfiram (Antabuse)

The story of disulfiram (known by the brand name Antabuse) began — of all places — in a rubber plant. At the turn of the 20th century, it was used in the industrial process of rubber production. A couple of decades later, some workers at a Swedish rubber boot factory (along with their American counterparts) noticed a curious trend: for those exposed to the chemical on a regular basis, “happy hour” wasn’t quite so happy anymore. When mixed with alcohol, disulfiram seemed to induce flushing, nausea, and palpitations — symptoms similar to those of alcohol intolerance.

While the workers at the rubber factory probably found this to be a buzzkill, the properties of disulfiram eventually proved to be useful in treating AUD. As it turned out, it throws a wrench in the metabolism of alcohol, leading to a build-up of a toxic by-product, acetaldehyde. While acetaldehyde is normally converted into harmless acetate by the liver, disulfiram makes it stick around, leading to symptoms that are (to put it mildly) highly unpleasant. (For more information, check out our blog “How Does Disulfiram Work?”.)

Pros:

• Once we know what those “unpleasant effects” of mixing disulfiram with booze are, we’ll never want to repeat the experiment.
• Making a single decision each day puts the power in our hands. Taking it is equivalent to setting a strong intention: “I will not drink today.”

Cons:

• If we do drink, the effects could be dangerous (particularly since mixing alcohol and disulfiram can lower our breathing rate to a dangerous level). It’s important to seek medical help if this happens!
• It’s important to be vigilant about any booze that we come in contact with to avoid triggering a reaction. (Even that wine sauce or liquor-infused chocolate can be a culprit!)

Calcium Carbimide (Temposil)

Similar in action to disulfiram, calcium carbimide also interferes with alcohol metabolism. If we drink on this medication, we’ll experience unpleasant effects that act as a deterrent to drinking.

Pros:

• Temposil acts faster than disulfiram, so the deterrent effects are more immediate.
• These immediate effects make Temposil useful for more short-term treatment scenarios.

Cons:

• The side effects are similar to disulfiram and include potential cardiovascular issues.
• Temposil is less widely used and studied than disulfiram.

3. “I Don’t Want It Anymore”: Medication for Alcohol Cravings

Now, let’s step back a bit. We talked about why alcohol loses its “magic” if we’re taking naltrexone or nalmefene. But think about what happens before we drink, before we take disulfiram to ward off the temptation to pour it in the first place. The answer is, a thought — “I want a drink” — enters our head. That thought is often referred to as an urge or a craving — and many believe that it’s the very root of addiction.

What do cravings feel like? It depends on the person, but when it comes to substance use, cravings are desires for something we wish we didn’t want (now that’s mind-bending, isn’t it?). By eliminating the craving, which is the result of brain chemistry conditioned by habitual alcohol use, we eliminate the “need” we feel to have that drink.

It’s important to understand that cravings are not “true” desires, and that as far as habits are concerned, “wanting” isn’t the same as “liking.” Dopamine makes us feel like we want things we don’t necessarily enjoy — that’s why we can feel the compulsion to keep drinking in spite of the fact that alcohol isn’t providing authentic enjoyment. At a certain point, if we’ve become dependent, even the illusion of pleasure disappears, while the craving only seems to grow stronger.

Medications that target cravings, in turn, help us interrupt the vicious cycle from the get-go. The result? We don’t have to pour that drink, taste it, and find it unsatisfying. We don’t have to safeguard ourselves from having it by taking medications that could send us to the emergency room if we mix them with booze. In fact, alcohol might not even cross our mind at all!

Acamprosate (Campral)

For those who are committed to being booze-free, Campral has been a popular option. One important caveat: it works over time and is meant for those who’ve left alcohol behind and are trying to stay away from it for good.

Pros:

• If taken as prescribed, Campral has helped many get booze off their mind by reducing cravings.
• It’s generally well tolerated, with diarrhea as the most common side effect.

Cons:

• We have to be on top of our game with this one, as Campral must be taken three times a day with meals.

Topiramate (Topamax)

Topiramate, in turn, targets cravings by decreasing the dopamine release associated with alcohol use. The result? Just like the first category of drugs, Topamax makes booze lose its appeal. However, because the effect is indirect (we’re talking about the reward system as opposed to opioid receptors), it affects our desire for alcohol and — like Campral — lives in the realm of cravings. 

Pros:

• Topamax could also help with weight loss — a perk for some.
• Like nalmefene, Topamax doesn’t call for complete abstinence. Instead, we might take it to reduce the number of drinking days if we’re trying to cut back.

Cons:

• Potential side effects of Topamax include tingling sensations, taste alterations, and cognitive dysfunction.
• We need to be on the lookout for mood changes and signs of depression — careful monitoring is key.

Gabapentin (Neurontin)

Gabapentin is beneficial for managing withdrawal symptoms and reducing alcohol cravings. Developed as an antiseizure medication, it helps stabilize the brain’s electrical activity and has been shown to be effective in treating alcohol dependence.

Pros:

• With its antiseizure and antianxiety properties, gabapentin is also useful for relieving withdrawal symptoms.
• It’s generally well tolerated and isn’t hard on the liver.

Cons:

• Gabapentin comes with some side effects, such as drowsiness and dizziness.
• Its effects vary from person to person, so while it works wonders for some, it’s not for everyone.

So, Which Medications Work Best To Help Me Stop Drinking?

Now that we’re familiar with the meds out there that can help us stop drinking or reduce our cravings, what do we do with this information? Here are some questions to consider as you decide if any one of these treatments might be the right course for you.

Do You Want To Quit or Cut Back?

First and foremost, the answer depends on your goals. Those who want to quit completely and are committed to staying booze-free will have different needs from those who simply want alcohol to be less prominent in their lives.

• For those committed to staying away from alcohol for good, disulfiram or Campral might be the best option. 
• On the other hand, for those wishing to cut back (or put alcohol in the background of their mind), nalmefene or Topamax could be a good choice.

How Many Decisions Do You Want To Make?

And remember what we said about decision fatigue? Science says we make about 35,000 decisions a day. Needless to say, our brain gets tired from the constant back-and-forth.

When we throw medications for AUD into the mix, the number of daily decisions is a factor to keep in mind. Remember, we’re talking about the decision to take the medication as well as the decision whether or not to drink. 

• Naltrexone is the way to go if you want to make one decision about taking your meds and not have to revisit the matter for the next month. Of course, you could, in theory, still choose to drink — but the decision to abstain might get easier as alcohol loses its appeal.
• On the other hand, nalmefene, Temposil, Campral, Topamax, and gabapentin are taken on a daily basis, with Campral usually requiring three doses to be effective. That said, Campral, Topamax, and gabapentin might make the decision to abstain from drinking a bit easier than nalmefene, since they target cravings themselves.
• Disulfiram and its cousins, in turn, are in a class by themselves. Taking your meds is still a daily decision, but a more definite one than medications that simply reduce the urge to drink or make alcohol less pleasant. In this case, you know what will happen if you do drink — and it’s not pretty. So chances are you won’t have as much of a mental struggle when deciding whether to say yes or no to that margarita with colleagues after work.

What Are Your Overall Health Needs?

Finally, overall health is also an important factor. All medications have side effects, and those that help with AUD recovery are no exception. Plus, some of us may have additional needs that we’re trying to address with medications.

• If liver problems are a concern, it’s best to steer clear of nalmefene and disulfiram.
• If depression is an issue, Topamax might not be the best choice.
• For those currently going through withdrawal, gabapentin can provide much-needed relief.

Alternative Paths

Finally, it’s important to keep in mind that if it turns out medication isn’t the right route for you, there are plenty of ways to stop drinking without it! For a deep dive, check out “How Easy Is It To Quit Drinking in 2024?” For now, here are some tips to start with:

• Therapy. These days, therapy doesn’t just mean talking about what happened back when you were 5 years old (though it can, if that helps!). Approaches such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) target thought distortions and give us tangible skills that help with AUD recovery.
• Technology. Want a personal coach, cutting edge research science, and craving-busting tools in the palm of your hand? Try an app like Reframe!
• Mindfulness-based approaches. Meditation, yoga, and approaches such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) are science-backed ways to regulate mood, reduce anxiety, and coast through cravings. They help us stay in the present and gain control over our thoughts, including urges that drive us toward alcohol.

And remember, no matter which approach you choose, it’s essential to have a support system behind you. If you’re looking for a community of like-minded people who’ve been where you are and are now thriving, the Reframe forum is a great place to start!