Alcohol Use Disorder (AUD) can be treated in many different ways. Treatment is typically initiated with a detoxification period utilizing benzodiazepines (the most common medications are chlordiazepoxide (Librium) and diazepam (Valium). These medications are chosen because they interact with the same areas of the brain that alcohol does. Benzodiazepines are essential for detox, but should otherwise be avoided for individuals with AUD. It is important to recognize that detox is just the beginning of treatment, since AUD is a chronic disease and not an acute ailment.
Long term treatment is often characterized by counseling, meetings, and anticraving medications. This can take the form of individual counseling, groups (such as intensive outpatient and partial hospitalization programs), and meetings (ex AA and SMART recovery)
The most commonly utilized and most effective anticraving medications are naltrexone and acamprosate.
Naltrexone is available in an oral formulation (Revia) and intramuscular form (Vivitrol)
It has been shown to decrease cravings for alcohol. It can be started during alcohol detox or immediately afterwards. It cannot be taken at the same time as opioids. The interaction between opioids and naltrexone can cause opioid withdrawal symptoms (precipitated withdrawal). Side effects including nausea, headaches. Naltrexone is metabolized through the liver, so liver function tests should be performed before treatment. The oral form is taken once daily, and the intramuscular form is given every 28 days. Naltrexone cannot be taken at the same time as opioid medications (including suboxone).
Acamprosase (Campral) has also been shown to decrease cravings for alcohol. It only exists in the oral formulation. It is taken as 2 pills 3 times daily. Since it is metabolized through the kidneys, blood tests evaluating the kidneys should be performed prior to initiation.
Topiramate is a mood stabilizer that is not FDA approved for alcohol dependence however evidence does support its use as an anticraving medication for AUD.
Several other medications have been used for alcohol cravings off-label including gabapentin and baclofen. Antabuse (disulfiram) is sometimes prescribed as a deterrent to drinking alcohol, but it has no effect on cravings.