Emerging Treatments for Alcohol Use Disorder
It's never been a better time to seek care.
For decades, the treatment landscape for Alcohol Use Disorder (AUD) was largely limited to dated behavioral interventions, mutual support groups, and three FDA-approved medications—naltrexone, acamprosate, and disulfiram (Antabuse). While these treatments help many, they don’t work for everyone. As our understanding of addiction evolves, so too do our approaches to treating it.
Exciting new research is paving the way for alternative pharmacological treatments, some of which we are already using off-label in clinical practice. These medications, along with new treatment paradigms like moderation-based approaches and medication-assisted harm reduction, are expanding treatment options for both physicians and patients. Here are some of the most promising new medications for AUD:
Topiramate
Originally an anti-epileptic medication, topiramate shows significant promise in reducing alcohol cravings and increasing abstinence rates. It works by adjusting the brain’s GABA and glutamate systems, which play key roles in alcohol dependence. While side effects like cognitive dulling and decreased appetite can be a challenge for some patients, topiramate provides a valuable alternative when other medications fail. (Most of my patients do not complain about losing weight on topiramate…)
Baclofen
A GABA-B agonist, baclofen is particularly helpful for individuals with AUD who also have liver disease, as it is metabolized by the kidneys rather than the liver. Some studies suggest it can reduce alcohol cravings and promote abstinence. Baclofen is already widely used for AUD in France, though it has yet to receive FDA approval in the U.S. (The French are always more avant-garde than us.)
For patients struggling with alcohol who already have liver damage and haven’t had much luck with acamprosate (the FDA approved AUD medication that is also broken down by the kidneys), baclofen can be a great choice.
Gabapentin
Gabapentin, commonly prescribed for neuropathic pain and seizures, treats AUD by reducing withdrawal symptoms, cravings, and heavy drinking. It is especially useful for patients with co-occurring anxiety, insomnia, or pain: symptoms that commonly occur when folks reduce or stop their alcohol intake. Given its relatively mild side effect profile, gabapentin is increasingly being used off-label in AUD treatment. Because gabapentin is a controlled substance in some states and can be sedating, it’s important to council patients not to combine this medication with alcohol.
Ondansetron
Ondansetron, a serotonin 5-HT3 antagonist typically used to treat nausea, has shown potential in reducing alcohol consumption, particularly in individuals with early-onset AUD. Research suggests that ondansetron may be especially effective for those with certain genetic predispositions to alcohol overuse that are related to serotonin signaling.
Ketamine-Assisted Therapy
Ketamine, a dissociative anesthetic with rapid-acting antidepressant effects, is now being explored as a treatment for AUD. Studies suggest that ketamine, when combined with psychotherapy, can help reduce cravings and prevent relapse by disrupting maladaptive drinking-related memories. While still in its early stages, ketamine-assisted therapy is quickly gaining attention as a novel approach to addiction treatment.
GLP-1 Receptor Agonists
I’m most excited about this one. Originally developed for diabetes and now widely prescribed for weight loss, GLP-1 receptor agonists like semaglutide and liraglutide are being investigated as we speak for their effects on alcohol consumption. Preclinical studies suggest that these medications may reduce alcohol cravings by acting on brain reward pathways.
Two ongoing NIH-funded studies are currently examining the impact of GLP-1 medications on AUD:
A Massachusetts General Hospital study evaluating semaglutide’s effects on alcohol consumption and craving.
A University of North Carolina study exploring how GLP-1 drugs influence alcohol-related brain activity.
If these studies confirm positive outcomes, GLP-1 receptor agonists will represent a groundbreaking new pharmacological approach to treating AUD. The high cost of these drugs is still a big barrier. But they could be game changing when it comes to treating the complex disease of addiction.
Moderation and Medication-Assisted Harm Reduction
Historically, AUD treatment has been dominated by abstinence-based models. But not all patients are ready or willing to stop drinking entirely. Do we turn all these folks away and tell them to come back when they are ready to do things our (abstinent) way? Sadly, many providers and payors do just that. But thoughtful approaches to addiction care recognize that reducing alcohol consumption—even if not eliminating it completely—can still lead to meaningful health benefits.
Moderation-Based Treatment
Programs like Moderation Management and the Sinclair Method (which uses targeted naltrexone dosing) offer structured ways to reduce drinking without requiring total abstinence. This approach can be particularly appealing to patients who are resistant to traditional treatment or who do not meet criteria for severe AUD.
Medication-Assisted Harm Reduction
Rather than focusing solely on sobriety, medication-assisted harm reduction uses pharmacological tools to help patients drink less and reduce alcohol-related harm. This includes prescribing medications like naltrexone, baclofen, or topiramate to individuals who continue to drink but want to regain control over their consumption. Moderation management and medication-assisted harm reduction embrace a nuanced, flexible approach to addiction treatment- an approach that considers the complexity of the disorder, with varying presentations requiring tailored support. These support methods also embrace a vital addiction treatment concept: giving folks some care, with some amount of risk, is always better than giving folks no care.
The Future of AUD Treatment
With a growing range of pharmacological options and a shift toward more individualized, patient-centered care, the field of addiction medicine is evolving rapidly. We are moving beyond the outdated one-size-fits-all approach and embracing treatments that meet patients where they are.
With more medications and more effective treatment options, it’s never been a more exciting time to be a provider working in addiction medicine. More importantly, it’s never been a better time to seek help if you or a loved one is struggling with alcohol. With new meds and treatments on the horizon, recovery is more achievable than ever.
-Lauren
Interesting, I hadn’t heard of this. How revolutionary!
Thanks for sharing, Lauren!