Treatment Options for Alcohol Use Disorder: What Works

Alcohol use disorder is usually treated with three kinds of help, often combined: medication (naltrexone, acamprosate, disulfiram, and nalmefene in the UK and Europe), talking therapy such as CBT or motivational interviewing, and mutual-support groups like AA or SMART Recovery, and most people start as outpatients through a GP or primary care doctor. If you drink heavily every day, the first step is a medically supervised plan for stopping, not quitting overnight on your own.

Very few people who could use treatment get it. In the United States, only 7.9% of people with alcohol use disorder in 2023 (about 2.3 million) got any treatment for it, according to NIAAA.

That's a shame, because it helps. A 2023 JAMA meta-analysis of 118 trials and 20,976 people found that for every 11 people treated with acamprosate, one more avoided a return to any drinking than with placebo; the number was 18 for oral naltrexone, and 11 for naltrexone in preventing a return to heavy drinking. A 2020 Cochrane review of 27 studies found that structured 12-step programs led to higher rates of continuous abstinence at 12 months than other therapies. None of these is a cure on its own, but they add up when combined.

What are the main treatment options?

NIAAA groups the evidence-based options into three families, and the NHS uses much the same structure:

Type	What it is	Who delivers it
Medication	Pills (or a monthly injection) that ease cravings, blunt the pull of alcohol or make drinking unpleasant	A GP, primary care doctor or psychiatrist
Talking therapy	CBT, motivational interviewing, brief interventions, couples or family therapy	Therapists, addiction services, some GPs
Mutual support	Free peer groups such as AA, SMART Recovery, LifeRing, Women for Sobriety	Volunteers and peers, in person or online
Supervised withdrawal	A plan to stop safely if your body has come to depend on alcohol	A doctor, at home with check-ins or in a clinic

The evidence favours combining them. The 2023 JAMA review supports naltrexone and acamprosate as first-line medicines "in conjunction with psychosocial interventions", which is a careful way of saying pills work best alongside some kind of talking support. If one approach doesn't suit you, try another: switching medicines, therapists or groups is normal.

Not sure whether your drinking counts as a disorder? Our AUDIT-C self-check is a quick place to start, and a doctor can do a fuller assessment.

Do you need detox before treatment?

Only if your body has come to depend on alcohol, and that question matters. People who drink heavily every day can develop withdrawal when they stop: shaking, sweating, anxiety, nausea and, in severe cases, seizures or delirium tremens (confusion, hallucinations, fever). Withdrawal can be dangerous, which is why heavy daily drinkers should not quit cold turkey without medical guidance.

Supervised withdrawal (often called detox) is a short, medically guided process, and the NHS notes it can often be done at home with medication and regular check-ins, or in a clinic or hospital for people at higher risk. A doctor may prescribe short-term withdrawal medication (often a benzodiazepine) to keep it safe. The work of staying stopped comes after. Our guides to alcohol withdrawal symptoms and when to get medical help for withdrawal cover the warning signs in detail. A seizure, confusion or hallucinations mean emergency help now.

If you drink less than that, or not every day, you can usually start with a GP appointment and skip this step entirely.

Which medications treat alcohol use disorder?

Three medicines are approved in the United States, and a fourth, nalmefene, is used in the UK and Europe. They work in different ways, so they suit different goals:

Medicine	How it works	Best fit	Things to tell your doctor
Naltrexone	Blocks some of the "reward" from alcohol, which can ease cravings	Stopping or cutting down	Opioid painkillers or opioid treatment; liver problems
Acamprosate	Helps settle the brain after drinking stops	Staying stopped once you have stopped	Kidney problems
Disulfiram	Makes drinking cause flushing, nausea and a racing heart	Complete abstinence with a firm deterrent	Heart problems; any alcohol in food or products
Nalmefene (UK/EU)	Taken on days you might drink, to drink less	Cutting down	Opioid use

Side effects are real but usually manageable. In the 2023 JAMA meta-analysis, acamprosate made diarrhoea about 1.6 times as likely as placebo, and naltrexone made nausea about 1.7 times as likely. Your doctor picks the medicine and the dose; never start, stop or combine these on your own.

Disulfiram is a special case. A 2014 meta-analysis of 22 trials found it worked in open-label trials (where people knew they were taking it, which is the point of a deterrent) and showed no effect in blinded ones. In practice it tends to help most when someone else, a partner or a pharmacist, supervises the daily dose.

Naltrexone or acamprosate: which is better?

Neither wins outright. A 2014 JAMA review of 122 trials found no significant difference between them when they were compared directly, so the choice usually comes down to your goal and your health:

Start with your goal. Acamprosate is designed to help you stay off alcohol after you've stopped, and the NHS describes courses of up to six months. Naltrexone helped prevent a return to heavy drinking in the 2023 review, so it's often chosen when cutting down is the aim or when you're worried about slipping.

Then your body. Naltrexone can't be used with opioid medicines, and doctors may check your liver first. Acamprosate is cleared by the kidneys, so kidney function affects whether and how it's prescribed. Routine matters too: acamprosate is usually taken several times a day, while naltrexone is once a day (or, in some countries, a monthly injection).

Medicines are underused partly because people don't know to ask. Saying "Is naltrexone or acamprosate right for me?" in an appointment is completely reasonable.

Which talking therapies help?

Talking therapy builds the skills medication can't: spotting triggers, handling cravings, and coping with the stress you used to drink through.

• Cognitive behavioural therapy (CBT) teaches practical skills for high-risk situations and unhelpful thoughts. It's usually a set course of sessions.
• Motivational interviewing (and the structured version, motivational enhancement therapy) helps when you're of two minds about changing. It doesn't push; it helps you hear your own reasons.
• Brief intervention is a short, structured conversation with a GP or nurse. A 2018 Cochrane review of 69 studies found people who got one drank about 20 g less alcohol a week a year later than those who didn't. That's about 2.5 UK units, or roughly 1.4 US standard drinks, a modest change that suits people whose drinking is risky but not yet severe.
• Couples and family therapy can help when drinking has strained a relationship. Families have their own options too, covered in our guide on how to help someone who drinks too much.

Ask your doctor what's available locally or online.

AA, SMART Recovery or another group?

Mutual-support groups are free, run by peers, and meet in person and online. The main difference is philosophy:

• Alcoholics Anonymous (AA) follows the 12 steps, with a spiritual (not necessarily religious) framing, sponsors and regular meetings. The 2020 Cochrane review found structured 12-step programs made people about 21% more likely to stay continuously abstinent at 12 months than therapies such as CBT (risk ratio 1.21).
• SMART Recovery uses CBT-style tools: weighing pros and cons, handling urges, problem solving. Its research base is smaller. A 2017 systematic review found 12 studies, only three of them on effectiveness.
• LifeRing and Women for Sobriety are secular alternatives with smaller networks.

Which works best? Probably whichever you'll keep going to. A 2026 study following 1,152 adults found the 12-step-alternative groups worked about as well as 12-step groups, and that involvement (regular attendance, a home group, helping out) predicted abstinence much more strongly than which group people chose. Try two or three meetings of more than one kind before you decide.

Outpatient, residential or something in between?

Most people never need rehab. Care comes in levels, and the right one depends on your withdrawal risk, your health, your home situation and what you've tried before:

Outpatient care (appointments with a GP, therapist or clinic while you live at home) is where most treatment happens. Intensive outpatient or day programmes add several sessions a week for people who need more structure. Residential or inpatient care, living at a treatment centre for a few weeks, is usually kept for severe dependence, complex health needs, or when outpatient care hasn't been enough.

NIAAA's free Alcohol Treatment Navigator explains these levels and lists questions to ask any provider. Be wary of any programme that promises a success rate or a cure.

How do you start with your doctor?

You don't need a referral or a diagnosis to raise it. A plain sentence works: "I'm drinking more than I want to, and I'd like help cutting down" (or "stopping"). A few things make the appointment more useful:

1. Bring numbers. How many drinks on a typical day, how many days a week, and whether you've had morning shakes or sweats. Our standard drink calculator helps you count honestly.
2. Say your goal. Stopping or cutting down both count, and the goal shapes which medicines and groups fit.
3. List your medicines and conditions, especially opioid painkillers, liver or kidney problems, and pregnancy.
4. Ask for a plan, including what to do if you slip. Slips are common; our guide on what to do after a relapse covers getting back on track.

If a GP feels hard to face, the NIAAA Navigator above can point you to other providers, and in the US SAMHSA's National Helpline (1-800-662-4357) is free, confidential and open around the clock.

Find the options to ask about

Pick your goal, your drinking pattern and what kind of help appeals to you. The tool builds a short list of evidence-based options to take to an appointment. It's an educational guide, not a diagnosis or a prescription.

Frequently asked questions

What is the most effective treatment for alcohol use disorder?

There isn't one best option. The strongest results come from combining approaches: a medicine such as naltrexone or acamprosate alongside talking therapy or a support group. The 2023 JAMA review supports both medicines as first-line choices with psychosocial support, and the 2020 Cochrane review found 12-step programs especially helpful for continuous abstinence.

Can you drink while taking naltrexone?

Naltrexone doesn't cause a reaction with alcohol the way disulfiram does, and it's sometimes prescribed to people aiming to cut down, though alcohol still carries its usual risks. It reduces the rewarding effect of drinking, which can make it easier to stop at one or two. It must not be combined with opioid medicines. Ask your prescriber what to expect before you start.

Do I need rehab to quit drinking?

Usually not. Most people are treated as outpatients through a GP, therapist or clinic while living at home. Residential care is generally for severe dependence, complicated health needs, or when outpatient treatment hasn't worked. If you drink heavily every day, the first question is how to stop safely, which a doctor can plan with you.

Can treatment help me cut down instead of quitting?

Yes. Naltrexone, nalmefene (in the UK and Europe), brief interventions and some therapies all support reduced drinking. Abstinence is the safer goal for some people, such as those with liver disease, in pregnancy, or with severe alcohol use disorder, so it's worth talking through which goal fits your health.

How long does treatment last?

It varies. Supervised withdrawal takes days, a course of CBT usually runs for weeks, and medicines are often taken for several months or longer. Support groups have no end date; many people keep going for years. Treat it like managing any long-term health condition: check in, adjust and keep what helps.

The takeaway

Treatment for alcohol use disorder is a combination you can adjust: a medicine if it suits you, some form of talking support, and people who get it. Starting with a GP is ordinary and usually enough to begin. The one thing not to do alone is stop suddenly after heavy daily drinking.

Alongside treatment, some people like a private way to see their progress. Sober Tracker: Go Alcohol Free counts your sober days, adds a star to your Recovery Sky for each one, and puts an urge-surfing timer and breathing exercises one tap away in the Coping Toolkit for cravings between appointments.

Your entries are stored on your device and never sent to us, with no account. It's a habit and wellness tool, not treatment, and it doesn't replace a doctor or a group. It's free to download on the App Store or Google Play.

This article is for education and is not medical advice. If you drink heavily every day, talk to a doctor before stopping, and seek medical help immediately for severe withdrawal symptoms.

Sources

• National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help
• National Institute on Alcohol Abuse and Alcoholism. Alcohol Treatment in the United States
• Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis, JAMA, 2014
• McPheeters M, O'Connor EA, Riley S, et al. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis, JAMA, 2023
• Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder, Cochrane Database of Systematic Reviews, 2020
• Skinner MD, Lahmek P, Pham H, Aubin HJ. Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis, PLoS One, 2014
• Kaner EF, Beyer FR, Muirhead C, et al. Effectiveness of brief alcohol interventions in primary care populations, Cochrane Database of Systematic Reviews, 2018
• Beck AK, Forbes E, Baker AL, et al. Systematic review of SMART Recovery: Outcomes, process variables, and implications for research, Psychology of Addictive Behaviors, 2017
• Zemore SE, Lui CK, Mericle AA, et al. Second-wave mutual-help groups: Examining effectiveness for individuals with alcohol use disorders in the longitudinal, U.S. national PAL Study cohorts, International Journal of Drug Policy, 2026
• NHS. Alcohol misuse: treatment