Medication options, explained without the sales pitch
Two prescription medications are recommended as first-line treatment for alcohol use disorder in Canada. This page explains how they work and differ. What is appropriate for you, if anything, is always your clinician's decision, made with you.
This page is educational. Prescription medications cannot be marketed to the public in Canada, and we do not sell or promise any medication. Completing an assessment gets you an honest clinical evaluation by a licensed BC prescriber, not a guaranteed prescription.
Naltrexone
Fits goals of drinking less or stopping. Naltrexone blocks opioid receptors in the brain, which reduces the rewarding effect of alcohol and, for many people, the strength of cravings. It is recommended as a first-line medication in the 2023 Canadian guideline (CRISM and BCCSU, published in CMAJ), the APA 2018 guideline, and the VA and DoD guideline.
- Can be taken daily, or, in the approach known as the Sinclair Method, about an hour before drinking.
- Supports reduction as well as abstinence, which makes it flexible for people who are not aiming to stop entirely.
- Important: naltrexone must not be combined with opioid medications, including many prescription painkillers. If you take opioids or may need them soon (for example, planned surgery), tell your clinician; other options exist.
- Liver health is considered before prescribing, so the assessment asks about liver conditions.
Acamprosate
Fits a goal of stopping. Acamprosate helps stabilize brain chemistry that has adapted to regular alcohol use, easing the restlessness, unease, and sleep disturbance that can follow stopping. It is also first-line in the Canadian, APA, and VA and DoD guidelines, and it supports people in staying stopped once they have stopped.
- Taken regularly, usually three times daily.
- A good option for people who cannot take naltrexone, including many people who use opioid pain medication.
- Kidney health is considered before prescribing, so the assessment asks about kidney conditions.
Older and other options
Disulfiram is an older medication that causes an unpleasant reaction if alcohol is consumed. It is no longer a first-line choice in most guidelines, but a prescriber can consider it in specific situations. Your clinician may also discuss other evidence-based supports, including counselling and peer support, which work well alongside medication.
How the decision gets made
| Factor | Why it matters |
|---|---|
| Your goal | Reduction points toward naltrexone; abstinence can suit either medication. Both goals are valid, and your goal leads the conversation. |
| Opioid use | Naltrexone cannot be combined with opioids. Acamprosate can be an alternative. |
| Liver and kidney health | Liver conditions matter for naltrexone; kidney conditions matter for acamprosate. |
| Withdrawal risk | If stopping suddenly could be dangerous for you, the plan starts with safety, sometimes including medically supervised withdrawal before or alongside medication. |
| Your preferences | Daily routine versus before-drinking dosing, past experiences, and what feels sustainable to you. |
Never stop heavy daily drinking suddenly on your own. Alcohol withdrawal can be dangerous or life threatening. The assessment screens for withdrawal risk, and your clinician will plan a safe route. If you have severe symptoms right now, please seek urgent care; see Get help now.
Cost and coverage
Medication cost is separate from the assessment. Many private drug plans cover these medications, and PharmaCare may help with eligible medications for eligible residents. The Carebridge pharmacists can check your specific coverage before anything is dispensed, so there are no surprises. Details on pricing and coverage.