Alcohol use disorder (AUD) is a chronic brain condition affecting approximately 28 million Americans. Despite being among the most prevalent and costly conditions in the United States, only about 7% of people with AUD receive any treatment. Effective, evidence-based treatments exist — including medications most people don't know about.
AUD is diagnosed on a spectrum from mild to severe based on the number of diagnostic criteria met. These include: drinking more or longer than intended; persistent desire or failed attempts to cut down; spending significant time obtaining, using, or recovering from alcohol; giving up important activities due to drinking; continued use despite physical or psychological harm; tolerance (needing more for the same effect); and withdrawal symptoms when stopping.
Three FDA-approved medications treat AUD — yet most people receiving treatment never receive medication. Naltrexone (oral daily or Vivitrol monthly injection) reduces cravings and the rewarding effects of alcohol — response rates of 50-60%. Acamprosate (Campral) reduces withdrawal-related distress and anxiety. Disulfiram (Antabuse) causes aversive reaction to alcohol, useful when supervised. Any primary care physician or psychiatrist can prescribe these; a specialist is not required.
Cognitive Behavioral Therapy, Motivational Enhancement Therapy, 12-step facilitation, and SMART Recovery are all evidence-based behavioral approaches. The COMBINE trial found that medication plus behavioral intervention produces the best outcomes. Mutual help groups (AA, SMART Recovery) provide ongoing peer support that improves long-term outcomes.