Archived: This summary is based on a report that is greater than 3 years old. Findings should not be considered current.
Is This Information Right for Me?
Yes, this information is right for you if:
- Your doctor* said you have alcohol use disorder and need to stop drinking or cut down the amount you drink.
- You have decided to stop or cut down your drinking.
This information may not be helpful to you if:
You are under age 18.† The information in this summary is from research on adults.
What will this summary tell me?
This summary will tell you about:
- What alcohol use disorder is
- Medicines to treat alcohol use disorder
- What research says about how well the medicines work
- Possible side effects of the medicines
- Things to talk about with your doctor
** Alcohol use that interferes with your daily life, affects your relationships with others, or puts you in danger.
†† Needing to drink more alcohol to feel the same effect, not being able to stop alcohol use, and/or having withdrawal symptoms.
* In this summary, the term doctor refers to your health care professional, including your primary care doctor, nurse practitioner, psychiatrist, or physician assistant.
† Although the legal drinking age in the United States is 21, the information in this summary is from research on people 18 years of age and older.
Where does the information come from?
Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on medicines to treat alcohol dependence and alcohol use disorder published between January 1970 and October 2013. The report included 135 studies and was reviewed by health care professionals, researchers, experts, and the public.
Understanding Your Condition
What is alcohol use disorder?
Alcohol use disorder is a medical condition that happens when drinking alcohol causes serious problems. It can be a long-term or lifelong condition and could come back after treatment.
Symptoms of alcohol use disorder include:
- You drink more or for longer than you intended.
- You wanted to stop drinking or cut back but could not.
- You spend a lot of time getting alcohol, drinking it, or recovering from its effects.
- You have a strong craving or urge to drink.
- Your drinking interferes with your daily life and causes problems at home, work, or school.
- You keep drinking even though it has caused problems in your relationships with others.
- Your drinking has caused you to stop doing things you enjoy.
- Your drinking has put you in danger (for example, driving while drunk, having unsafe sex, or taking part in other unsafe activities).
- You keep drinking even though it has caused or worsened your physical or mental health problems.
- You have developed a tolerance to alcohol.
- You have to drink more than you used to in order to feel the effects of alcohol.
- You do not feel the same effects of alcohol from the amount you used to drink.
- You have alcohol withdrawal.
- When you stop drinking, you have symptoms such as nausea, sweating, or shakiness or you feel restless, anxious, or depressed.
- You have to drink to ease or avoid the withdrawal symptoms.
Alcohol use disorder can be mild to severe, depending on the number of symptoms a person has.
- Mild: Two or three symptoms
- Moderate: Four or five symptoms
- Severe: Six or more symptoms
Who is at risk for alcohol use disorder?
The risk of alcohol use disorder may run in some families. A person’s environment may also play a role. Other things, such as having low self-esteem or being impulsive, may raise the risk of alcohol use disorder.
Drinking beyond the limits* listed in the chart below may raise the risk of developing alcohol use disorder.
|For:||Limit drinking to:|
|*From the National Institute on Alcohol Abuse and Alcoholism and the U.S. Preventive Services Task Force.|
|Men aged 65 years or younger||
|Men older than 65 years||
|Women of all ages||
The amount in “one drink” depends on the type of alcohol:
- For beer (5-percent alcohol), one drink is a 12-ounce bottle.
- For wine (12-percent alcohol), one drink is a 5-ounce glass.
- For liquor (80 proof), one drink is 1.5 ounces.
For people who have been diagnosed with alcohol use disorder or who have a condition in which drinking may be harmful, even one drink may be too many.
How common is alcohol use disorder?
- In the United States, 17 million adults aged 18 years or older have alcohol use disorder.
- Alcohol use disorder is more common in men than in women.
- Out of every 100 men, 17 will have alcohol use disorder in their lifetime.
- Out of every 100 women, 8 will have alcohol use disorder in their lifetime.
What harm can alcohol use disorder cause?
- Alcohol misuse is the third leading cause of preventable death in the United States, after tobacco use and being overweight.
- People with alcohol use disorder are three to four times more likely to die early than those without alcohol use disorder.
- People with alcohol use disorder also have a higher risk of:
- High blood pressure
- Liver problems
- Pancreas problems
- Stomach problems
- Nerve problems
- Heart disease
- Sleep problems
- Low bone density
- Depression, anxiety, or other mental problems
- Anemia (a very low number of red blood cells)
Understanding Your Options
How is alcohol use disorder treated?
Treatment for alcohol use disorder may include talk therapy (also called “psychotherapy”), support groups, medicines, or a combination of treatments. Alcohol use disorder can be a long-term condition, like high blood pressure or asthma. You may need treatment over a long period of time.
Medicines are usually used with talk therapy and support groups to treat alcohol use disorder. The medicines are usually taken once people have stopped drinking to help keep them from starting to drink again.
Talk Therapy and Support Groups
- Cognitive behavioral therapy: This type of therapy helps you change your thinking and behaviors that lead to drinking.
- Motivational enhancement therapy: This type of talk therapy uses your internal strengths to encourage and motivate change.
- 12-step programs (such as Alcoholics Anonymous®): These programs use support groups and sponsors to help you go through the process to stop drinking.
- Other support groups: There are many support groups to help people stop drinking (for example, SMART Recovery®, LifeRing Secular Recovery, Secular Organizations for Sobriety, and Women for Sobriety).
Medicines To Treat Alcohol Use Disorder
Your doctor may suggest a medicine to help treat your alcohol use disorder. Medicines are usually used together with talk therapy and support groups.
- Acamprosate (Campral®): This medicine was approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence*. It helps rebalance chemicals in the brain that may be changed by drinking too much.
- Disulfiram (Antabuse®): This medicine was approved by the FDA to treat alcohol dependence*. If you drink alcohol, this medicine causes unpleasant effects, such as nausea, vomiting, headache, flushing (reddening of the face, neck, or chest), sweating, and chest pain. These effects can last for an hour or longer.
- Naltrexone (Revia®, Vivitrol®): This medicine was approved by the FDA to treat alcohol dependence*. It works by decreasing the craving for alcohol.
- Topiramate (Topamax®, Trokendi XR®, Qudexy XR®): This medicine was approved by the FDA to treat seizures and prevent migraine headaches. Some doctors also use it to treat alcohol use disorder. It helps rebalance chemicals in the brain and helps correct the electrical activity of brain cells.
* Alcohol abuse and alcohol dependence were once considered separate disorders. They have now been combined into one disorder – alcohol use disorder.
The chart below gives more information about each medicine. It also tells what researchers have found about how well the medicines work to treat alcohol dependence and alcohol use disorder.
|Medicine (Brand Name)||How It Is Taken||How It Affects Drinking||Other Information|
|* Signs of liver problems can include feeling tired and weak, nausea, vomiting, yellowed skin or eyes (jaundice), and dark-colored urine.|
|Acamprosate (Campral®)||Two pills taken three times a day||This medicine helps some people stop drinking or drink less often.||People who have had severe kidney problems should not take this medicine. People who have had mild or moderate kidney problems should talk with their doctor about taking this medicine.|
|Disulfiram (Antabuse®)||One pill taken once a day||There is not enough research to know for sure if this medicine works to treat alcohol use disorder.||
|Naltrexone (Revia®, Vivitrol®)||One pill taken once a day||This medicine helps some people stop drinking or drink less often.||
|Shot given once a month||This medicine appears to help some people drink less often, but more research is needed to know for sure.|
|Topiramate (Topamax®, Trokendi XR®, Qudexy XR®)||One pill taken once or twice a day||This medicine helps some people drink less often.||This medicine was made to treat seizures and prevent migraine headaches, but some doctors also now use it to treat alcohol use disorder.|
What are possible side effects of medicines to treat alcohol use disorder?
The FDA lists the following possible side effects for medicines to treat alcohol dependence and alcohol use disorder.
|Medicine (Brand Name)||Possible Side Effects|
|* Usually in the arms, hands, feet, or legs.
† Not being able to get or keep an erection.
** This reaction may be severe and could cause scarring. People with a severe reaction may need surgery, but this is rare.
|Naltrexone (Revia®, Vivitrol®)||Both the pill and shot forms can cause:
The shot form can also cause:
|Topiramate (Topamax®, Trokendi XR®, Qudexy XR®)||
Making a Decision
What should I think about when deciding?
There are several things to think about when deciding which treatment is right for you. You may want to talk with your primary care doctor, nurse practitioner, psychiatrist, or physician assistant about:
- Your history of drinking and trying to stop
- If medicine might help treat your alcohol use disorder
- The possible benefits and side effects of the medicine
- Other treatments, such as talk therapy and support groups, that might also help
- The cost of treatment
- The importance of following your treatment plan
- Things your family and friends can do to support you
Questions to ask your doctor:
- Do you think a medicine might help me? If so, which medicine might work best for me?
- Do I need to stop drinking before taking the medicine?
- What side effects should I watch for?
- How long will I need to take the medicine before I know if it is helping?
- If the medicine helps, how long will I need to keep taking it?
- How often will I need checkups?
- What if I tried to stop drinking before and it did not work?
- Would it help for me to talk with a therapist or a counselor?
- What support groups can I go to for help?
To Order Print Copies
To order one or more color copies of this summary, call the AHRQ Publications Clearinghouse at 1-800-358-9295 or place your order online on the AHRQ Publications Clearinghouse Web page. When ordering, indicate the publication number of this summary.
Publication number: 14(16)-EHC029-A
The information in this summary comes from Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC. Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings. Comparative Effectiveness Review No. 134. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 14-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2014.
Additional information came from MedlinePlus.gov, a service of the National Library of Medicine and the National Institutes of Health.
This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Amelia Williamson Smith, M.S., Thomas Kosten, M.D., and Michael Fordis, M.D. People with alcohol use disorder reviewed this summary.