Medication-Assisted Treatment (MAT), which involves medication and behavioral therapy, for alcohol use disorder (AUD) is effective.
Off-label medications include topiramate and ondansetron.  Your doctor can help you choose the right medication for you.
Which medication is most effective for treating alcohol use disorder?
Research indicates that naltrexone and acamprosate may be the most effective medications for treating AUD, based on the volume of evidence related to their effectiveness as well as treatment compliance.
How Does MAT for Alcohol Use Disorder Work?
Despite the proven effectiveness of MAT, less than 4% of people with alcohol use disorder get medications to help them abstain from use. This is a shame because, nowadays, there are several very effective medications to help reduce the cravings for alcohol in patients trying to abstain.
The more you know about how these therapies work, the more likely you will ask your doctor for help.
Each medication approved for AUD treatment works differently, but in general, they do one or multiple of the following:
- Reduce cravings
- Lower relapse risks
- Reduce protracted withdrawal symptoms that may contribute to relapse
- Make drinking alcohol unpleasant or less rewarding
These medications can help you focus on your recovery and manage your condition while receiving therapy and other treatment interventions.
Therapies Used in MAT
In a MAT program, you will also take advantage of evidence-based addiction therapies such as these:
- Group counseling
- Individual counseling, such as cognitive behavioral therapy (CBT)
- Family therapy
Medications support but don’t replace the work of therapy. However, medications can help ease cravings and help you physically be more comfortable while you receive counseling and behavioral therapy that supports long-term recovery.
AUD is a chronic condition, and many people relapse while in therapy. Your relapse is a temporary setback, not proof that your medications don’t work or can’t be helpful in the future. A relapse doesn’t mean treatment has failed—it simply means that you may need a higher level of care or a different treatment plan.
Who Is a Candidate for MAT?
Anyone with alcohol use disorder may be a good candidate for MAT. However, the people who have the most success are people who are really ready to make a change and are highly committed to decreasing and/or discontinuing alcohol use.
In addition, certain medical conditions may preclude you from using certain medications for AUD, or may make one medication preferable to another. Talk to your doctor before starting a medication for AUD about which would be right for you.
Remember, using medication to help treat alcohol dependence isn’t substituting one addiction for another. [5, 6] It is an evidence-based method to reduce overall harm to your health and keep you on the road to recovery.
MAT Pharmaceutical Options Explained
The U.S. Food and Drug Administration recognizes three medications (four formulations) for the treatment of alcoholism. Your doctor will help you decide which is right for you.
These are the four options:
- Acamprosate (Campral): This medication can ease cravings for alcohol and makes it easier to stick to sobriety.
- Disulfiram (Antabuse): This medication causes unpleasant side effects like flushing and heart palpitations when you drink alcohol. This makes the prospect of drinking less appealing.
- Oral naltrexone (Revia): This medication eases cravings for alcohol, blocks the rewarding effects of drinking and helps you stay sober.
- “Extended-release” naltrexone (Vivitrol): This medication is delivered via a shot, ensuring that it stays in your body for a month at a time. You won’t have the option to skip doses once it is in your body, which some people find helpful to ensure they don’t miss doses and are able to stick to the treatment plan.
Some off-label medications may include topiramate, which can help reduce the rewarding effects of alcohol and lasting withdrawal, ondansetron, which can reduce drinking and also mental health symptoms like depression and anxiety, as well as gabapentin and antidepressants. Antidepressants aren’t as helpful for people with AUD without mood disorders; however, they can help reduce drinking in those with depression. 
No single medication is right for everyone—individualized care is essential. Your doctor can help you discover the best for you and your alcohol use disorder.
How Effective are MAT Options for AUD?
Naltrexone and acamprosate are typically considered best practice for medications used to treat alcohol use disorder, whereas disulfiram is typically considered a “second-line medication” due to its inconsistency and problems with treatment compliance. 
|Medication||What It Does||Evidence Rating|
|Naltrexone (Revia)||Reduces cravings and blocks the rewarding effects of alcohol||A|
|Disulfiram (Antabuse)||Causes unpleasant effects when the person drinks while taking it||B|
|Acamprosate (Campral)||May reduce protracted withdrawal symptoms||A|
|Topiramate (Topamax) (off-label)||Decreases the rewarding effects of alcohol and reduces withdrawal symptoms||B|
MAT for Alcohol Use Disorder FAQs
Yes: acamprosate, disulfiram, and naltrexone (in both pill and injectable form) are all used to treat alcohol use disorder. They are FDA-approved to help treat AUD. They can be obtained by a prescription from any licensed medical professional.
Yes. MAT can lessen cravings for alcohol and ease withdrawal symptoms, helping people to maintain abstinence.
Success rates for MAT are high. People are much more likely to maintain treatment compliance with MAT than with other treatment approaches alone. The combination of both medications and behavioral therapy together tend to have the best long-term success rates for abstaining from alcohol.
It depends on how you define “cure.” Some people consider AUD a lifelong condition that can be “in remission” but never “cured.” Other people who have been abstinent for a long time without any concern for relapse would consider themselves cured. Regardless of how you prefer to identify, medications can help you maintain long-term abstinence. Be aware, however, that some people who discontinue medication may have cravings return and increase their risk of relapse. Some people prefer to stay on medication indefinitely to prevent relapse.
By Peter Manza, PhD
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More
- Medications for Alcohol Use Disorder. American Family Physician. https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html. March 2016. Accessed June 2022.
- Medications to Treat Alcohol Use Disorder: Targeting the Dark Side. American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.21030286. May 2021. Accessed June 2022.
- Alcohol Use Disorder (AUD) Treatment. U.S. National Library of Medicine. https://medlineplus.gov/alcoholusedisorderaudtreatment.html. September 2017. Accessed June 2022.
- Medicines to Treat Alcohol Use Disorder. Agency for Healthcare Research and Quality. https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/consumer. February 2016. Accessed June 2022.
- Medications for the Treatment of Alcohol Use Disorder. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. https://www.healthquality.va.gov/guidelines/MH/sud/MedicationsForTheTreatmentOfAlcoholUseDisorderBrochure92816.pdf. September 2016. Accessed June 2022.
- Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. National Institute on Alcohol Abuse and Alcoholism. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4907.pdf. 2015. Accessed June 2022.