A 2 minute assessment to get a personalized mental health or alcohol recovery plan.
See a direct comparison of the AUD medications disulfiram, acamprosate and naltrexone. Learn what they do, how they work and who can benefit the most from each type of medication.
What You’ll Learn:
- Which medications are currently approved for alcohol use treatment.
- How naltrexone works to reduce drinking:
- What naltrexone does
- The mechanisms that make it work
- Who would benefit the most from using naltrexone
- How acamprosate reduces relapse risk after reaching sobriety:
- What acamprosate does
- The mechanisms that make it work
- Who would benefit the most from using acamprosate
- How disulfiram works to reduce alcohol use:
- What disulfiram does
- The mechanisms that make it work
- Who would benefit the most from using disulfiram
- Direct side-by-side comparison of naltrexone, disulfiram and acamprosate
There are a lot of products out there that claim to reduce alcohol consumption, but only three medications have received FDA-approval for that purpose. Those medications are naltrexone, disulfiram and acamprosate.
All three medications have the same goal - to help a person drink less alcohol. But how they go about doing it is drastically different, which is a big factor in deciding which medication is the best option for your situation.
QUICK COMPARISON
If you’re is still drinking and want to reduce cravings → naltrexone
If you’re abstinent but struggling → acamprosate
If you need a strict deterrent to stop drinking → disulfiram
Naltrexone
Of the three traditional alcohol use medications, prescription naltrexone is the most widely used because it is backed by many clinical studies that have shown it can significantly reduce alcohol consumption. While it does have an immediate effect, naltrexone works over time to re-establish associations, thought patterns and behaviors that are connected to drinking.
What It Does:
Reduces alcohol cravings by preventing the pleasurable effects of consuming alcohol and eventually restructuring the related reward pathways that drive the motivation to drink.
How It Works:
Naltrexone blocks opioid reward pathways so that dopamine isn’t released when alcohol is consumed. To be more specific, it blocks the mu-opioid receptor. When there’s no pleasurable effect from drinking, the positive association isn’t there. This reduces cravings and the motivation to drink again or to continue drinking once you start.
Who It’s Best For:
Anyone who wants to curb cravings in order to reduce their alcohol consumption or quit drinking entirely.
- Binge drinkers or “reward-driven” drinkers
- People who want to reduce drinking or full abstinence
- Individuals with strong alcohol cravings
- People who experience significant pleasure when drinking
Acamprosate
Once a person stops drinking, often the goal then shifts to maintaining abstinence. Acamprosate is a more targeted medication that’s used to counter the neurological changes from chronic drinking that can cause prolonged withdrawal symptoms like insomnia and anxiety. By stabilizing mood and sleep, acamprosate provides support in recovery.
What It Does:
Lessens the discomfort that’s associated with alcohol withdrawal symptoms to help reduce the risk of relapse.
How It Works:
Chronic alcohol consumption causes neurological changes and imbalances that can lead to problems after you stop drinking. One of the major changes is that it increases glutamate (excitatory signaling) and decreases GABA (inhibitory signaling). This imbalance leads to anxiety, insomnia and cravings when a person stops drinking. Acamprosate modulates glutamate activity and supports normal GABA function, which calms the hyperactive brain state and reduces post-acute withdrawal symptoms.
Who It’s Best For:
People who have already reached sobriety will get the biggest benefit from acamprosate.
- Patients who have already completed detox
- Individuals with persistent anxiety, insomnia or dysphoria after quitting
- Patients with liver disease (acamprosate doesn’t impact the liver)
- Those seeking long-term relapse prevention
Disulfiram
While the other AUD medications have an effect on neurotransmitters, disulfiram works in a very different way to encourage people to drink less. Instead of simply taking away the pleasant buzz of alcohol, disulfiram makes it an extremely unpleasant experience.
What It Does:
Causes very aversive reactions to alcohol to dissuade users from drinking again.
How It Works:
If you’ve ever had a bad hangover, then you have an idea of what to expect with disulfiram. Acetaldehyde is a toxic byproduct of alcohol. A group of enzymes called aldehyde dehydrogenase oxidizes acetaldehyde into acetate that is then eliminated from the body. Disulfiram works by inhibiting aldehyde dehydrogenase so that acetaldehyde builds up instead of being converted into acetate. The accumulation of acetaldehyde causes intense adverse reactions that include flushing, nausea and a headache.
Who It’s Best For:
People who need a physical deterrent to stop drinking.
- Highly motivated individuals committed to abstinence
- Patients with strong external accountability
- Situations where relapse carries high consequences
Naltrexone vs Disulfiram vs Acamprosate Comparison
Get the Support You Need to Take Control of Your Drinking
Every day Choose Your Horizon helps people take control of their drinking, whether that means drinking less, avoiding heavy consumption or stopping completely. We provide patients with a telehealth platform where they can get a prescription for naltrexone or GLP-1 medications, consult with clinicians, connect with therapists and find support that makes lasting change possible.
Start the process by taking our Alcohol Use Assessment. In a matter of minutes you’ll receive your Audit-C score, expert analysis of your drinking behaviors and recommendations for developing healthier habits.
Key Takeaways
- The three medications that are currently approved for alcohol use treatment don’t work the same and are used for different situations.
- Naltrexone is used to reduce alcohol cravings and the positive association with drinking so that consumption is reduced, particularly heavy drinking.
- Disulfiram is used to create an uncomfortable physical deterrent that causes people to avoid drinking out of fear.
- Acamprosate is used to stabilize the glutamate and GABA systems that are altered by chronic drinking so that withdrawal symptoms are more manageable.
