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Summary: The best medication for alcohol use disorder (AUD) is the medication that helps you achieve long-term, sustainable remission of AUD.

Key Points:

  • Each person develops alcohol use disorder in a manner unique to their personal history and circumstances.
  • The most effective treatment for alcohol use disorder depends on that unique, individual medical, substance use, family, and social/environmental history.
  • The best medication for alcohol use disorder (AUD) depends on factors associated with each individual.

A decision about which medication, if any, to use in treatment and recovery from AUD requires a full evaluation from an addiction treatment professional, and collaboration on a treatment plan that gives you the best chance of meeting your treatment goals.

Medication for Alcohol Use Disorder (MAUD)

In a new article published by the Journal of the American Medical Association (JAMA) in their JAMA Insights series called “Medications for Alcohol Use Disorder” reviews the current state of evidence supporting the most common medications for alcohol use disorder (MAUD) currently available. The information in this publication can help patients and families make an informed decision about the use of medication during treatment and recovery from alcohol use disorder (AUD).

We’ll start our report on this article clarifying exactly what we means by alcohol use disorder (AUD) and medications for alcohol use disorder (MAUD).

First, the authors of offer this succinct definition of alcohol use disorder (AUD):

“A chronic, relapsing medical condition characterized by intense cravings, loss of control, and excessive alcohol use associated with serious social, occupational, and physical consequences.”

In addition, they identify the following negative physical health outcomes associated with chronic, untreated alcohol use disorder:

  • Most common cause of cirrhosis of liver
  • Increased risk of following types of cancer:
    • Mouth
    • Pharynx
    • Larynx
    • Esophagus
    • Breast
    • Colorectum
  • Increased risk of heart disease
  • Increased risk of unintentional injury

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this definition of medications for alcohol use disorder (MAUDs):

“These medications relieve the withdrawal symptoms and psychological cravings caused by chemical imbalances in the body associated with alcohol use disorder (AUD). Medications are evidence-based treatment options. They do not provide a cure for the disorder and are most effective for people who participate in a treatment program.”

SAMHSA provides an in-depth resource on MAUDs in the following publication:

Medication for the Treatment of Alcohol Use Disorder: A Brief Guide

In addition, please read the following article on our blog:

Are There New Ways to Treat Alcohol Addiction?

There are currently sixteen (16) medications available for treatment for people with a clinical diagnosis of alcohol use disorder:

  1. Disulfiram
  2. Acamprosate
  3. Naltrexone
  4. Nalmefene
  5. Topiramate
  6. Gabapentin
  7. Varenicline
  8. Baclofen
  9. Sodium oxybate
  10. Aripiprazole
  11. Ondansetron
  12. Mifepristone
  13. Ibudilast
  14. Suvorexant
  15. Prazosin
  16. Doxazosin

The article we discuss today evaluates the evidence for the four most common – widely considered the four most effective – medications for alcohol use disorder (MAUD) currently available:

  1. Oral Naltrexone/Injectable Naltrexone
  2. Acamprosate
  3. Disulfiram (supervised)
  4. Topiramate

The study authors review four factors associated with each medication:

  • Strength of evidence for abstinence
  • Strength of evidence for reduced drinking
  • Adverse events associated with each medication
  • Goals for treatment associated with each medication

In this article, we’ll share their observations on each medication, and close by discussing how these medications fit into a comprehensive, integrated approach to treatment for alcohol use disorder. First, however, we’ll review the latest facts and figures on the prevalence of AUD and treatment for AUD in the U.S.

Alcohol Use Disorder (AUD) and Treatment for Alcohol Use Disorder

The 2025 National Survey on Drug Use and Health (2025 NSDUH) shows the following prevalence rates for alcohol use disorder (AUD) in the U.S.

Alcohol and Substance Use Disorder by Age Group: Facts and Figures (2025)

People With Alcohol Use Disorder (AUD)

  • Total: 25.7 million (8.9%)
    • 12-17: 710,000 (2.8%)
    • 18-25: 4.7 million (13.1%)
    • 26+: 20.3 million (8.9%)

People in Recovery from Alcohol Use Disorder and/or Substance Use Disorder (AUD/SUD)

  • Total: 22.3 million (8.5%)
    • 12-17: n/a
    • 18-25: 1.8 million (5.1%)
    • 26+: 20.4 million (9.0%)

Received Medication for Alcohol Use Disorder (MAUD)

  • Total: 1.1 million (0.4%)
    • 12-17: 26,000 (0.1%)
    • 18-25: 49,000 (0.1%)
    • 26+: 1.0 million (0.5%)

Received Medication for Alcohol Use Disorder (MAUD) Among People With Alcohol Use Disorder (AUD)

  • Total: 679,000 (2.6%)
    • 12-17: data unavailable
    • 18-25: 21,000 (0.4%)
    • 26+: 643,000 (3.2%)

The data shows that MAUDs – although effective – are dramatically under-utilized. The numbers are overwhelming. They show that nearly 98 percent of people with AUD don’t use MAUDs. That’s one reason we’re writing this article: to help raise awareness about a treatment component that can increase likelihood a person with AUD can achieve remission and long-term, sustainable recovery.

Now let’s take a closer look at the evidence supporting the use of the top four MAUDs available today.

How Strong is the Evidence for MAUDs?

We’ll share the evidence for these four medications in the order we present them above: naltrexone, acamprosate, disulfiram, and topiramate.

Naltrexone (oral and injectable)

Naltrexone attaches to structures in the brain and blocks the action of both alcohol and opioids. Use of Naltrexone is associated with decreased alcohol seeking behaviors, decreased binge-type consumption, and decreased total alcohol use for people with AUD.

  • Strength of evidence for abstinence: moderate (oral) / low (injectable)
  • Strength of evidence for reduced drinking: moderate (oral) / low (injectable)
  • Adverse events: may cause nausea or dizziness (oral) / may cause injection site reaction (injectable)
  • Treatment goals: reduced drinking

Acamprosate

Acamprosate attaches to structures in the brain associated with cravings. It can decrease both physical cravings for alcohol and psychological desire for alcohol. It doesn’t help withdrawal symptoms. However, after withdrawal, can decrease likelihood of relapsing to alcohol use.

  • Strength of evidence for abstinence: moderate
  • Strength of evidence for reduced drinking: moderate
  • Adverse events: may cause diarrhea
  • Treatment goals: abstinence

Disulfiram, Supervised

Disulfiram is the first medication approved by the FDA for AUD. First available 75 years ago in 1951, it prevents the body from metabolizing alcohol. Presence of disulfiram in the body when alcohol is ingested can result in severe discomfort, including nausea, vomiting, sweating, elevated heart rate, and flushing on skin. The discomfort is the deterrent. Evidence shows disulfiram can help increase abstinence from alcohol use.

  • Strength of evidence for abstinence: strong
  • Strength of evidence for reduced drinking: n/a
  • Adverse events: characterized by negative reaction to alcohol may cause fatigue, nausea, and in rare cases, liver damage
  • Treatment goals: abstinence

Topiramate

Topiramate affects structures in the brain negatively impacted by alcohol consumption. Early trials in humans show it can help decrease total alcohol consumption, decrease days of heavy drinking, and promote abstinence. This medication is FDA-approved for seizures and migraine headaches, and prescribed off-label for people with alcohol use disorder.

  • Strength of evidence for abstinence: insufficient data
  • Strength of evidence for reduced drinking: moderate
  • Adverse events: cognitive problems, paresthesia (tingling, numbness, pressure, cold, warmth on skin)
  • Treatment goals: reduced drinking

Evidence shows varying strength of evidence for each of these medications. While all can help people with alcohol use disorder, their immediate utility depends on the treatment goals of each patient. We’ll discuss the effect of these medications and their role in AUD treatment below.

If I Want to Quit Drinking, Where Do These Medications Fit In?

In treatment for alcohol use disorder (AUD), medication is most effective when prescribed as one component of a multimodal treatment plan that includes therapy, counseling, lifestyle changes, and family/community/peer support.

If you’ve tried to address your AUD previously, but experienced a relapse, you can talk to your provider about including one of the medications above in your treatment plan. The medication you choose depends on your goals.

If you want something that makes consuming alcohol feel miserable – nausea, vomiting, etc. – then ask your provider about supervised disulfiram. If you want something that prevents alcohol from changing your mood – i.e. prevents the experience of pleasure associated with alcohol – you can ask your provider about naltrexone and/or topiramate.

As you can see, the appropriate medication depends on you, your goals, and your history with alcohol use and treatment for alcohol use disorder. The authors of the study reach this broad conclusion about MAUDs:

“AUD is a highly prevalent and undertreated condition in the US. Naltrexone, acamprosate, and disulfiram are FDA-approved medications that are effective and safe treatments for AUD and may be initiated in inpatient and primary care settings.”

If you think you need professional support for alcohol use disorder, we encourage you to seek a full evaluation from an experience addiction professional. Decades of research shows that the earlier a person who needs treatment for alcohol use disorder gets evidence-based treatment, the better the outcome.