Naltrexone and acamprosate are established, licensed treatments for alcohol dependence with randomised evidence behind them, and disulfiram has a place for selected, supervised patients. Yet most people with alcohol use disorder are never offered any of them.
The gap is usually one of habit rather than evidence. Naltrexone suits patients aiming to cut down or stop, but not those taking opioids or with significant liver failure; acamprosate suits abstinence maintenance after withdrawal and needs dose reduction in renal impairment. Either can be started alongside psychosocial support rather than waiting for it.
- Offer naltrexone or acamprosate to patients with alcohol dependence who want to stop or cut down.
- Check liver function before naltrexone and avoid it in anyone taking opioids.
- Adjust acamprosate for renal function.
- Start medication alongside counselling rather than after it.
Why it matters
Interest in GLP-1 drugs should not distract from treatments that already work and go unused.
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