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CAPTAPsychiatry · Brian Still, MD
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Medication for alcohol use

Several medications make it easier to cut back or stop drinking, yet most people with a drinking problem are never offered one. They work best alongside a plan you actually agree with.

Signs it may be time to get help

  • Drinking more or longer than you meant to, or finding it hard to cut back
  • Cravings, or drinking to settle anxiety, sleep or stress
  • Drinking that is affecting your health, work or relationships
  • You have quit before and want help staying quit

How I evaluate it

We go through your drinking pattern, your goal (cutting back or stopping, both are reasonable starting points), past attempts, withdrawal history, other medications and your mood and sleep. I order liver and kidney tests at a local lab when a medication needs them.

Treatment options

  • A medication chosen for your goal, health and other prescriptions
  • Treatment of the anxiety, depression or insomnia that often keeps drinking going
  • Relapse-prevention planning, and referral to counseling or mutual-support groups if you want them
  • Referral to a higher level of care when that is safer

Medications for alcohol use

None of these are controlled substances, and none are habit-forming.

Naltrexone
A daily pill that reduces cravings and the reward from drinking, so heavy-drinking days become less likely. It works whether your goal is to cut back or to stop. It can’t be taken with opioid pain medicines, and I check liver tests. A monthly injectable form is given in person; I can coordinate that with a local clinic.
Acamprosate
Helps you stay alcohol-free once you have stopped, by easing the restlessness, poor sleep and cravings of early recovery. It is taken three times a day, is safe for the liver, and the dose is adjusted for kidney function.
Topiramate
Not FDA-approved for alcohol use, but good evidence shows it reduces heavy drinking. It is started slowly to limit side effects such as tingling or word-finding trouble.
Disulfiram
Causes an unpleasant reaction if you drink. It helps some people who are committed to not drinking at all, often with someone supporting them in taking it.

What telehealth can and can’t do

Stopping alcohol suddenly can cause dangerous withdrawal. If you drink heavily every day, or have had seizures or severe withdrawal before, you may need medically supervised withdrawal first. I don’t prescribe benzodiazepines or other controlled substances by telehealth, so I’ll help you arrange that with a local program or detox.

This page is general information, not medical advice. Your plan is made together at your visit.