Controlling Alcohol Cravings With Medication

People who have become alcohol dependent often experience withdrawal symptoms and cravings when they try to stop drinking, and these cravings can pose problems for those trying to quit.

The good news, however, is that there are medications that may help manage these alcohol cravings and assist someone in their recovery from alcohol use disorder (AUD). Here, we review medications that are FDA-approved, those under investigation, as well as alternatives to medication that can also help manage cravings.

Approved Medications for Alcohol Cravings

There are three medications that have been FDA-approved for the treatment of AUD, and two of them may help manage alcohol cravings.

Vivitrol (Naltrexone)

Vivitrol is a once-monthly injection that works by blocking the high in the brain that people experience when they drink alcohol. Naltrexone is also available as a tablet in the generic form. By blocking the pleasure the person receives from alcohol and the reward feedback loop in the brain, naltrexone eventually reduces cravings.

Acamprosate

Acamprosate, previously marketed as Campral in the United States, reduces the physical distress and emotional discomfort people usually experience when they quit drinking. How it works to lessen the craving for alcohol is not completely understood, but researchers believe that it helps restore a chemical imbalance in the brain's reward system that is altered by long-term alcohol abuse.

Acamprosate does not help someone quit drinking. It is prescribed (usually three time-released pills a day) for those who have already stopped drinking alcohol. Because the side effects are mild and well-tolerated, it is usually prescribed for up to 12 months following alcohol abstinence.

Antabuse (Disulfiram)

Antabuse, the brand name for disulfiram, does not target cravings. It works by causing a severe adverse reaction when someone taking the medication consumes alcohol, which includes:

• Flushing
• Nausea
• Vomiting
• Headaches
• Palpitations

Because reactions can be severe, it might be saved for use in high-risk patients, or when you are going into a high-risk situation such as a party where there will be alcohol.

Medications Under Investigation

In addition to FDA-approved medications , there are also those which are prescribed off-label to treat AUD, those being studied for this use, and others that have been approved to treat alcohol dependence outside of the United States.

• Topamax (Topiramate): Topamax is an anti-epileptic medication that has shown promise in trials similar to naltrexone. Physicians may prescribe it off-label for alcohol dependence.
• Neurontin (Gabapentin): Neurontin is also an anti-epileptic drug approved to treat seizures and postherpetic neuralgia, a type of pain associated with shingles. Some research has shown it may be effective in helping to reduce cravings.
• Zofran (Ondansetron): Zofran is indicated for nausea and vomiting in people being treated for cancer. In some older research, it was associated with reduced cravings in young adults with early AUD when combined with cognitive behavioral therapy (CBT).
• Selincro (Nalmefene): Selincro has been approved for use in Australia and Europe to help reduce drinking. Some have noted controversy around this approval. It can be taken on an as-needed basis, as in before a high-risk situation, and has been associated with a reduction in heavy drinking days. However, some research on its efficacy has been mixed.
• Baclofen: Baclofen, a muscle relaxant, is available in branded forms Ozobax, Lioresal, Gablofen and available as a pill, injectable, and an oral solution in the United States. It has been approved to treat AUD in France. The results on how well it treats AUD have been mixed.
• Selective serotonin reuptake inhibitors (SSRIs): The American Psychiatric Association (APA) doesn't recommend antidepressants for AUD unless there is another disorder present they would treat. In one small double-blind, placebo controlled study from 2019, a group of 10 people with alcohol dependency who received citalopram had less cue-induced craving for alcohol.

Alternatives to Medications

In addition, there is more than just medication that may help with alcohol cravings. The following could be used with or without medication.

Cognitive Behavioral Therapy (CBT)

CBT is a form of psychotherapy, or talk therapy, used in the treatment of substance use disorders, including AUD. CBT works to help someone reframe their thoughts and change their actions. It can be useful in addressing cravings as it can help someone come up with coping mechanisms for when they occur.

Support Groups

According to the National Institute on Alcohol Abuse and Alcoholism, participating in a mutual-help group like Alcoholics Anonymous (AA) or another 12-step program can provide even more support when combined with other treatment. In addition, being around a new community that encourages sobriety may be helpful to diminish external cues for alcohol cravings.

A small survey and small study found less self-reported cravings in AA members who had said they'd had a “spiritual awakening” (no cravings the week before) and in a small group who prayed (in the moment after viewing craving inducing-images). At the same time, a review from 2017 points to AA’s benefits primarily coming from therapeutic factors that mirror those found in other treatment—those that are social, cognitive, and affective. As the review points out, however, this needs further study.