Table 1.

Summary of currently available pharmacological and psychosocial interventions of AUD.

Pharmacological Interventions	FDA approved for AUD	Clinical summary	References
Disulfiram	Yes	Disulfiram exhibits an antidipsotropic effect characterized by nausea, tachycardia, and flushing. This drug works to decrease drinking through these severe physical symptoms.	(9, 21, 22)
Naltrexone	Yes	Naltrexone is a mu opioid antagonist that reduces reward reinforcement and alcohol craving.	(12, 13, 15, 22–25)
Injectable naltrexone	Yes	Injectable Naltrexone is an intramuscular gluteal injection that has been shown to increase patient compliance and minimize nonadherence due to its monthly administration as opposed to a daily ingestion. By bypassing first-pass metabolism, the injection also yields a more consistent blood level of Naltrexone.	(9)
Acamprosate	Yes	Acamprosate is a glutamate antagonist that promotes abstinence by normalizing the hyperglutamatergic state developed from continued alcohol dependence. It is thought to balance the glutamatergic and GABAergic systems associated with chronic alcohol exposure and alcohol withdrawal and target relief craving.	(12, 17, 22)
Topiramate	No	Topiramate is FDA-approved to treat epilepsy and migraines but can also be prescribed to treat AUD. Topiramate works by diminishing craving.	(12, 14, 22)
Gabapentin	No	Gabapentin is originally meant to treat epilepsy and neuropathic pain. It has been prescribed to treat AUD because it is a GABA agonist and glutamate antagonist.	(9)
Baclofen	No	Baclofen is a GABAB receptor agonist that is FDA-approved to treat spasticity from multiple sclerosis. Baclofen has been associated with sustained abstinence; it is also linked to adverse effects like sedation, numbness, and slurred speech.	(9, 12, 18)
Ondansetron	No	Ondansetron is FDA-approved for treating nausea in chemotherapy. It is a 5-HT3 receptor antagonist that reduces the release of dopamine and has been prescribed to reduce alcohol consumption in patients with AUD.	(9)
Varenicline	No	Varenicline is a partial α4β2 nicotinic acetylcholine receptor (nAChR) agonist originally prescribed for nicotine dependence. Because of the comorbid reward pathways between nicotine use disorder and alcohol use disorder, Varenicline sems promising as a potential treatment route for AUD.	(9)
Nalmefene	No	Nalmefene is an antagonist at the mu and delta opioid receptors and a partial agonist at the kappa opioid receptor. It is approved for decreasing alcohol consumption by reducing craving in Europe but not in the United States. One meta-analysis illustrated that Nalmefene was associated with a reduction in binge drinking and total alcohol consumption.	(12)
Selective serotonin reuptake inhibitors and serotonin-related drugs	No	Selective serotonin reuptake inhibitors (SSRIs) are FDA-approved for the treatment of depression and anxiety disorders – like Sertraline. Given that AUD is often comorbid with depression and anxiety, SSRIs present a promising avenue as a treatment option.	(26–29)
Provider-based and psychosocial interventions		Clinical Summary
Alcoholics anonymous		Alcoholics Anonymous (AA) is a self-supporting, informal society whose purpose lies in staying sober and helping others achieve sobriety. This fellowship is a purely nonprofessional social intervention where members find strength in each other to reach and maintain sobriety.	(30)
12-step facilitation		12-Step Facilitation (TSF) covers 12 weekly sessions that encourages involvement in AA through understanding, acceptance, and engagement. It is an individual therapy and is meant to promote long-term abstinence.	(30)
Motivational enhancement therapy		Motivational Enhancement Therapy (MET) works by accentuating the motivation and commitment to change. In MET, therapists work with the patient to help him/her recognize the problems consequent to his/her drinking habits in an empathetic, cooperative, and nonconfrontational manner.	(31)
Cognitive behavioral therapy		Cognitive Behavioral Therapy (CBT) enables the patient to come to terms with his/her feelings and behaviors associated with excessive alcohol consumption. The therapist teaches the patient coping skills to handle cravings and triggers and works with the patient to develop relapse prevention plans.	(19, 20)
Brief interventions		Brief Interventions (BIs) are single, sixty-minute sessions with a health-care professional. Meta-analyses have shown that in individuals with mild AUD, BIs are powerful in reducing alcohol consumption. However, in individuals with moderate-to-severe AUD, BIs are found ineffective, as these patients require more long-term solutions.	(32)
Cue-exposure therapy		Cue-Exposure Therapy (CET) is a type of classical conditioning therapy whereby the patient is repeatedly exposed to alcohol-related stimuli without actually consuming alcohol. The goal of CET is to decrease craving and increase self-efficacy for coping with strong desires to drink in high-risk contexts.	(33, 34)
Aversion therapy		In Aversion Therapy, alcohol is repeatedly paired with an unpleasant stimulus like an electric shock or emetic drug to condition the patient to associate alcohol consumption with negative feelings/thoughts.	(35, 36)
Mindfulness-based therapies		Mindfulness-based therapies center on present-day awareness and nonjudgmental perceptions on one's current state. In AUD, it is used to handle cravings and prevent relapse. One meta-analysis demonstrated that mindfulness-based therapies had significant effects on the reduction of craving.	(37)