Medications for Alcohol Use Disorder: Naltrexone, Acamprosate, and Disulfiram

Written by Jennifer Kletzli · Medically reviewed by Matthew Parker, MD

Most people never hear that medication is even an option for drinking. Fewer than 2 in 100 adults with alcohol use disorder are prescribed any of these drugs, which is a striking gap for treatments that are safe, covered, and backed by decades of research.¹

For veterans and service members, that gap matters even more, because drinking often sits on top of pain, PTSD, or the stress of transition. Medication will not do the whole job, but it can make the difference between white-knuckling it and actually getting traction.

Is there a pill to help you stop drinking?

Yes, though it is not a single magic pill. Three medications are approved to treat alcohol use disorder, and they work in different ways: naltrexone blunts the reward from drinking, acamprosate settles the brain after you quit, and disulfiram makes alcohol physically unpleasant.¹ A doctor helps match one to your goal, whether that is quitting outright or cutting back.

All three are prescription medications, all three are non-addictive, and all three do their best work when paired with counseling, a support group, or a treatment program.² Think of the medication as lowering the difficulty, not removing the work.

How does naltrexone work for alcohol cravings?

Naltrexone blocks the brain’s opioid receptors, the same ones that make a drink feel rewarding. With that reward turned down, cravings ease and heavy-drinking days tend to drop.¹ It comes as a daily pill or as Vivitrol, a once-a-month injection for people who would rather not manage a pill every day.⁵

One of its advantages is that you do not have to be sober to start. It can be taken while you are still drinking, which makes it a good fit for someone trying to cut down.¹

Important safety note: Naltrexone blocks opioid pain medication and can trigger sudden withdrawal in anyone who is opioid-dependent. You generally need to be opioid-free for about 7 to 10 days before starting it, so tell your provider about every medication you take.⁵

What is the difference between acamprosate and naltrexone?

They solve two different problems. Naltrexone targets the craving and reward while you are still drinking or trying to cut back. Acamprosate, sold as Campral, is for after you have already stopped: it calms the lingering restlessness, anxiety, and poor sleep that follow quitting, which helps you stay abstinent.²

The practical tiebreakers are your health and your habits. Acamprosate is cleared by the kidneys rather than the liver, so it is often the safer pick for someone with liver disease or someone taking opioids, though it needs adjusting if kidney function is reduced.⁴ It is also taken three times a day, so pill routine matters. Both are considered front-line options.²

How does disulfiram work, and who is it for?

Disulfiram, known as Antabuse, takes a different approach. It blocks the enzyme that breaks alcohol down, so if you drink, a byproduct builds up and causes a rough reaction: flushing, nausea, a pounding heart, and headache.³ The reaction is the point. It gives you a strong reason not to drink in a moment of temptation.

That makes it best for people who are highly motivated to stay completely sober, especially with someone to help them stay consistent. You cannot start it until you have been alcohol-free for at least 12 hours, and you have to avoid hidden alcohol in things like mouthwash, some sauces, and certain cold remedies.³

What is the Sinclair Method?

The Sinclair Method is a specific way of using naltrexone: instead of taking it every day to stay sober, you take it about an hour before you drink. Over time, drinking stops being rewarding, and for many people the desire fades on its own.⁷

It is a real, evidence-supported approach that a lot of people search for by name, and it appeals to those who want to reduce drinking rather than quit cold. It should be done with a doctor guiding the plan, not improvised.⁷

Are these medications safe and non-addictive?

Yes. Naltrexone, acamprosate, and disulfiram are not addictive and do not create dependence.² They are ordinary prescription medications that a provider monitors, each with its own cautions, which is why the full medication list you take matters so much at the first appointment.

The bigger risk, honestly, is not taking them when they could help. These drugs are badly underused, and part of the reason is simply that people do not know to ask.¹

Do you still need counseling if you take medication?

In almost all cases, yes, and the two work better together. Medication lowers the physical pull of alcohol, while counseling, peer support, or a program helps with the habits, triggers, and reasons behind the drinking.¹

For anyone whose drinking is tangled up with trauma or pain, that combination matters more, because the medication alone does not address what the alcohol was numbing. Our overview of the levels of care shows where medication fits alongside outpatient and more intensive support.

Does the VA or TRICARE cover medication for alcohol use disorder?

Both do. The VA provides alcohol use disorder medications, including naltrexone and acamprosate, as part of substance use treatment for eligible veterans.⁶ TRICARE covers medically necessary substance use treatment, including medication, for service members and families.

You do not need to enter a rehab program to get a prescription. A primary care provider or a VA clinician can start most people, and our guide to how TRICARE covers alcohol rehab walks through the wider benefit if you need more than medication. You can also check what your plan covers before you book.

Questions people ask

Recoverion is an independent educational resource, not a treatment provider, insurer, or government agency. This article is general information, not medical advice, and medication decisions should be made with a licensed clinician who knows your full history. Confirm coverage with the VA or your TRICARE plan before you act.