PART 2: BREAKING THE CHAIN
Medications Used for Alcohol Abuse Treatment
Written By: Dr. Rodney C. Brunson
Published on March 19, 2025
FDA-Approved Medications
Disulfiram (Antabuse)
Antabuse, the first drug approved by the FDA for alcoholism treatment in the 1950s, is still in use today. This aversive medication remains effective. It was incidentally discovered in the 1930s when workers in the rubber industry, who were exposed to tetraethylthiuram disulfide, became ill after consuming alcohol.
Fifteen years later (1947), researchers in Copenhagen studying compounds for parasitic stomach infections took small doses of disulfiram to assess side effects. When they later consumed alcohol, they became ill. They concluded that disulfiram interacts with alcohol, leading to unpleasant symptoms, and conducted further studies to confirm their findings (Held & Jacobsen, 1948).
From the 1940s to the 1950s, Danish researchers performed additional studies on disulfiram treatment for alcohol dependence, hoping that alcoholism could be treated through aversion conditioning. It proved remarkably effective, but they initially administered high doses (1,000 to 3,000 mg daily) to maximize patient reactions. In the 1950s, the FDA approved disulfiram for alcohol dependence treatment in the U.S.
Dr. Ruth Fox, the founder of ASAM (American Society of Addiction Medicine), was the first American physician to use disulfiram for alcohol dependence in 1949. She lowered the dosing after observing severe side effects. After treating 2,500 patients, she concluded that disulfiram was an effective deterrent. By the late 1950s, disulfiram was primarily used to support abstinence rather than induce aversion, with reduced doses and restrictions for patients with heart disease or cirrhosis.
While it is unclear whether disulfiram directly reduces the urge to drink (as Baclofen does), it disrupts alcohol metabolism, causing an intense reaction when alcohol is consumed. This "disulfiram reaction" creates severe illness, discouraging further drinking. Over time, the patient develops an aversion to alcohol due to the repeated negative experiences.
How Does Disulfiram (Antabuse) Work?
(Note: This is not medical advice. Consult a healthcare provider for guidance.)
Before starting Antabuse, the patient must abstain from alcohol to prevent immediate reactions.
Taken daily, Antabuse only causes a reaction when alcohol is consumed—typically within 10 to 30 minutes after ingestion.
The disulfiram-alcohol reaction varies from moderate to severe and may include:
Sweating, warmth, and flushing of the upper chest and face
Rapid breathing, difficulty breathing, and/or shortness of breath
Chemical-smelling breath, blurred vision, throbbing headache, and thirst
Nausea and vomiting
Chest pain, palpitations, and low blood pressure
Vertigo, syncope (fainting), confusion, and weakness
Disulfiram can remain in body tissues for up to two weeks, meaning any alcohol consumed during this period can trigger symptoms.
For maximum effectiveness, patients must be committed to complete abstinence. Supervision, whether through court-ordered therapy, family support, or behavioral contracts, improves adherence. Incentives, reminders, and structured behavioral training may further help maintain compliance.
Disulfiram is most effective for patients who have completed detoxification or achieved early abstinence. While it may not reduce cravings, it prevents relapse through aversive conditioning.
Disulfiram has been considered safe since the 1950s, with rare fatalities now that dosing is lower. However, it should not be used in patients with heart disease or liver disease. Additional precautions and warnings apply.
(This is only a basic introduction to disulfiram use, precautions, and benefits. Please consult a healthcare provider for detailed medical guidance.)
Acamprosate: Used to Prevent Relapse and Maintain Abstinence
History of Acamprosate
Acamprosate was approved for alcohol dependence treatment in the U.S. in 2004, making it the third FDA-approved drug for alcoholism.
French scientists first developed and tested acamprosate for safety and effectiveness between 1982 and 1988. It was first released in Europe and, twenty years later, received FDA approval in the U.S. under the brand name Campral.
Acamprosate targets neurotransmitter imbalances in the brain, particularly glutamate and GABA, which become dysregulated with prolonged alcohol use. These imbalances contribute to alcohol withdrawal symptoms such as insomnia, anxiety, and restlessness. Acamprosate helps prevent these symptoms, making it easier to maintain sobriety.
Studies show that acamprosate:
Reduces drinking days
Increases abstinence rates
Delays relapse
Why Acamprosate is Effective for AUD
Safe & Non-Addictive: Acamprosate does not cause dependence or abuse.
Liver-Friendly: Since it is not metabolized by the liver, it is safe for patients with liver disease (common in alcoholics).
Compatible with Other Treatments: Acamprosate does not interact with benzodiazepines (often used in alcohol detox) or opioid medications for pain management.
Continued Use After Relapse: If a patient relapses, acamprosate can still be continued during detox with benzodiazepines.
How Acamprosate is Used
Start 5 days after the last drink for best results.
Full effectiveness is reached after 5 to 8 days of consistent use.
Kidney function should be tested before starting. Avoid use in patients with:
Renal impairment (Creatinine clearance < 30%)
Pregnancy (unless medically necessary)
Elderly patients (65+) (use with caution)
Dosing & Side Effects
Standard dosage: 666 mg three times daily (333 mg tablets).
Take with meals and do not crush or split the tablets.
Treatment should continue until the patient achieves stable recovery and abstinence is maintained.
Side Effects & Considerations
Persistent diarrhea (dose may need to be lowered).
Suicidal ideation (discontinue if this occurs).
Acamprosate helps prevent relapse by reducing alcohol cravings and supporting long-term abstinence.
Final Thoughts
Both Disulfiram (Antabuse) and Acamprosate (Campral) are proven treatments for alcohol dependence, but they serve different purposes:
Disulfiram creates negative reinforcement by inducing illness when alcohol is consumed.
Acamprosate helps maintain abstinence by reducing cravings and withdrawal symptoms.
Each patient’s needs differ, so a healthcare provider should determine the most suitable medication based on their history and recovery goals.
FDA APPROVED - NALTREXONE (REVIA IN PILL FORM ) and VIVITROL(A LONG ACTING NALTREXONE IN A MONTHLY INJECTABLE FORM)
“The Sinclair Method”. John David Sinclair, MD, Journal Article Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Roy Eskarpa, PhD . The Cure For Alcoholism. NIH: national Library of Medicine. Incorporating Alcohol Pharmacotherapies Into Medical Practice.
Naltrexone is FDA approved for the treatment of AUD (alcohol use disorder formerly known as alcoholism ) Discussed above. It has been a medication used for AUD since 1994. It is prescribed to lower the rewarding (the liking) and the craving (the wanting) effects of alcohol caused by the feel good chemical that the brain releases in the blood - Dopamine. Using certain methods of taking it, it is more than 70% effective in extinguishing the uncontrolled use of alcohol ( David Sinclair: The Sinclair Method ).
HISTORY: Naltrexone was first developed to treat SUD (or addiction) involving Opioids (heroin, morphine, and oxycodone. This was in 1984. It was studied in the 1980’s for alcohol addiction where it was shown to decrease alcohol consumption in rats. These studies were followed by human studies and confirmed to be effective along with psychosocial therapy. Scientists showed that it decreased or reduced the consumption of alcohol, the cravings for alcohol, and the relapse rates for alcohol use. Naltrexone was rebranded as REVIA (oral form). The feel good feeling one gets from alcohol is known to result from the bodies production to opioids. Revia (naltrexone) blocks this reaction in the body leading to a far lesser reward from drinking alcohol. It is like eating sweets but not experiencing the sweetness or like riding a bicycle with two flat tires (not a rewarding experiences).
Naltrexone can work rapidly in the body, (from one to two hours after ingesting the pill but may last around 12 hours.) It is effective for, as mentioned, reducing the craving and enhancing a patients ability to abstain from drinking and by reducing the amount of drinking. Again it showed lowered relapse rates during active use of naltrexone and after having stopped the naltrexone. Further, for people who binge drink, naltrexone lowered the number of drinks consumed per day and also prevented one from falling into a full relapse. Naltrexone can cause liver toxicity and the liver should be looked at closely for liver damage through its use. If liver damage has already occurred naltrexone should probably not be used ( particularly in large doses. There is a warning to be careful or to monitor liver function if prescribed.
How to take it: Naltrexone works better if there are no signs or symptoms of acute withdrawal, the withdrawal symptoms should have subsided. There should be from 3 to 7 days of abstinence. It can be taken if actively drinking or under medical supervision Naltrexone comes in pill form or injectable form. Pill form is taken at least daily where the injection form is taken monthly (vivitrol). Doses can be given as low as 2 mg but the average dose is from 25 to 50 mg daily. It may take two weeks to reach the 50 mg dose which is the average maintenance dose. SIDE EFFECTS are mild with naltrexone mostly causing nausea or sedation. This is related to timing of the dose mostly. There are no worries about abuse of naltrexone.
WHO SHOULD NOT TAKE NALTREXONE. Persons who are taking opioids ( Suboxone, Methadone ) or opioids for pain in general. Those who are undergoing withdrawal from opioids. Hepatitis or liver failure. Those who will have to take opioids in the near future. Not recommended for adolescents. Carefully consider if pregnant.
WHO SHOULD TAKE NALTREXONE? ANYONE WHO WISHES TO STOP DRINKING ALCOHOL AND WHO ARE NOT TAKING OPIOIDS, WHO ARE ACTIVELY UNDERGOING DETOXIFICATION FROM OPIOIDS OR HAVE LIVER FAILURE OR HEPATITIS. USE WITH CAUTION IF PREGNANT
“PATIENTS PRESENT TO ME LOOKNG FOR ANSWERS WITH QUESTIONS ON THE TREATMENT OF ALCOHOLISM /AUD. THEY MAY PRESENT CONVINCED THAT THEY ABSOLUTELY ARE OPPOSED TO EVER DRINKING AGAIN once they stop. THEY WONDER IF IT IS TRUE THAT THIER ALCOHOL DRINKING PROBLEM CAN BE CURED WITH THE HELP OF A DAILY PILL OR A MONTHLY INJECTION. “DOC WILL NALTREXONE (REVIA OR VIVITROL) HELP ME STOP DRINKING TOO MUCH OR HELP MY ADDICTION TO ALCOHOL WITHOUT GETTING HOOKED ON NALTREXONE IT? CAN THIS TREATMENT TRULY BE THE END OF MY ADDICTION? (SEE SINCLAIR METHOD)? HOW LONG CAN I TAKE IT? CAN IT BE TAKEN FOR AS LONG AS I WANT OR NEED IT? “. THE ANSWER TO ALL OF THESE QUESTIONS IS A RESOUNDING YES. NALTREXONE IS AN EXCELLENT CHOICE FOR THOSE WHO WANT TO REDUCE THE AMOUNT OF ALCOHOL INTAKE OR TO EXTINGUISH THEIR USE OF ALCOHOL IF THAT IS THE GOAL. DR. RODNEY CLAY BRUNSON, DO,FASAM OSTEOPATHIC PHYSICIAN AND SURGEON ******** AN OSTEOPATHIC PHYSICIAN IS A DOCTOR OF OSTEOPATHY (D.O.) AND IS ONE OF THE TWO TYPES OF PHYSICIANS LICENSED TO PRACTICE MEDICINE AND SURGERY IN THE WESTERN HEMISPHERE. DO’S ARE FULLY QUALIFIED PHYSICIANS LICENSED TO PRESCRIBE MEDICINE AND PERFORM SURGERY IN ALL 50 STATES
********YOU MAY FIND A DO IN ALL SPECIALITIES INCLUDING ADDICTION MEDICINE “WHAT WOULD YOU SAY IF I TOLD YOU THAT I KNOW A WAY OF TAKING THE FUN OUT OF DRINKING”? IT WOULD BE LIKE EATING ICE CREAM WITHOUT THE SWEETNESS. OR LIKE TAKING THE EXHILARATION OUT OF DOWNHILL SNOW SKIING”.
Alcoholism can and does affect all of us. It has affected my life indirectly and everyone that I know (and in a negative way at that) I do not have or have not had a personal problem with drinking alcohol but many of family members do. They have an abnormal relationship with alcohol. In American families in general may have relatives, aunts and uncles, who may have passed away from alcohol use physical complications. We all have community members, friends, you name it, who could not control alcohol consumption. Many are embarrassed to even talk about their drinking problem, or embarresed to admit to a drinking problem Quite often they receive complaints that they are drinking too much and should stop. “STOP you say? Just stop? Only if it was so easy to “just stop.”Some may say this is a moral failing. AUD is a problem far beyond ones conscious control.
But what if one makes a conscious decision to change voluntarily. Can it be done? Yes it can.
Just by taking one little pill it could be the end of your alcohol addiction. Dr. John David Sinclair found out that it was possible to cure alcoholism. His experimentation with rats using “Naltrexone” proved exactly that. “How to cure society from the ravages of alcohol. He developed a method to cure alcoholism. Dr. Sinclair used rats in his laboratory as his subjects. He wanted to see if they could be taught to stop drinking. He gave the rats several different types of pills before coming across one that did just. Simplifying the process he addicted the rats to alcohol then deprived them of the alcohol for a while. Predictably the rats began to exhibit hyperactive behavior (a symptom of withdrawal). He then gave them alcohol again which calmed them down. However he noticed that the rats would consume far more alcohol in a shorter period of time than ever observed before. This deprivation effect can be observed in humans as well and is known as withdrawal and then binge drinking. We humans are supposedly much smarter than rats so we figured out that if we binge or drink excessively we get hangovers, the shakes, irritable so we drink and if we return to drinking the symptoms will go away. Boy are we smart. Problem is that we didn’t realize that if we repeated this process over and over again pretty soon we develop a habit of needing the alcohol to just feel normal as we felt before beginning to drink in the first place. Well thank you Dr. Sinclair for developing a method to break this chain of events. He surmised that the drive to consume alcohol in the first place can become extinguished leading to very low or no alcohol consumption. By using an anti opioid medication he could block the euphoria of alcohol use, that is Naltrexone. It is a prescribed medication that can be used to STOP or to at least significantly “cut down” on the amount of alcohol consumed.
We know nearly exactly how it works. It works in the brain on special cells in certain areas of the brain.
HOW NALTREXONE CHANGES YOUR MIND ABOUT DRINKING
Alcohol works on the brain to cause one to feel good or euphoric after drinking. Who doesn’t like to feel good? Instead of missing out on all the fun we join in with the use the universal social lubricant, alcohol. It is this fun time or feel good helper that causes us to continue to drink when we should stop (liking food getting full and pushing there plate away). But if the effects of the alcohol, or euphoria, is extinguished, that is we do not get the reward then what is the use of drinking in the first place. Dr. Sinclair found that the fun part of drinking can be extinguished with a pill - Naltrexone If taken before drinking alcohol one doesn’t get the feel good sensations ( dopamine effect ) the reward. The blocking effect or the extinguishing effect of the reward from drinking works. As long as a person takes the pill naltrexone or receives the injection the effect lasts.
Naltrexone is safe and is effective so much that the FDA approved it for the treatment of alcoholism in 1994.
“There is now a cure in the treatment of alcoholism. Alcoholism can now be CURED”.
Doctors can treat this disease successfully right in the office with a very inexpensive medication.
Struggling with alcohol addiction?
Learn about recovery resources at WebMD’s Alcohol Use Disorder Guide
Or consult Dr. Rodney Brunson’s Verified Profile for expert medical insights.