Pharmacological Treatment of Patients with Alcohol Use Disorder

Target Audience: Prescribing providers in primary care, psychiatry, and addiction-treatment settings

Target Population: Individuals with alcohol use disorder (AUD)

Background and Objective: This evidence-based guideline provides recommendations regarding AUD pharmacologic treatments; several are FDA-approved for treating AUD (naltrexone, acamprosate, disulfiram [Antabuse]). The guidelines focus on helping individuals reduce or stop their use of alcohol (not on treating withdrawal).

Key Points

The guidelines are categorized by whether benefits of treatment outweigh harms and by the level of evidence.

• Recommendations (benefits clearly outweigh harms)

  • Evaluate patients for comorbid substance use and psychiatric disorders, and elicit patients' treatment goals and preferences during the assessment.

  • Offer naltrexone or acamprosate to patients with moderate-to-severe AUD (ms-AUD) who have a goal of abstinence or reducing alcohol consumption.

  • Offer naltrexone to patients with ms-AUD and co-occurring opioid use disorder who wish to abstain from opioids.

  • Avoid acamprosate if there is severe renal impairment.

  • Avoid naltrexone if there is acute hepatitis, hepatic failure, or ongoing opioid use.

  • Avoid benzodiazepines and antidepressants unless treating alcohol withdrawal or a comorbid disorder.

  • Avoid pharmacological treatments in pregnant or breast-feeding women.

• Suggestions (benefits outweigh harms, but the balance is less clear)

  • Topiramate or gabapentin can be offered to ms-AUD patients who have a goal of abstinence or reducing alcohol use.

  • Disulfiram can be offered to ms-AUD patients who wish to achieve abstinence.