Treatment of Alcohol Use Disorder

First-Line Treatment Options

The American College of Physicians recommends acamprosate, disulfiram, or naltrexone as first-line options to reduce relapse in alcohol-dependent patients, with the decision among these three made based on patient preferences, motivation, and availability 1

The European Association for the Study of the Liver recommends baclofen as the preferred medication for patients with alcoholic liver disease, as it has demonstrated safety and efficacy in promoting alcohol abstinence in patients with liver cirrhosis 2
Baclofen effectively reduces alcohol craving and helps maintain abstinence in patients with liver disease 2
Naltrexone is not recommended for patients with alcoholic liver disease due to risk of hepatotoxicity, as suggested by the National Institute for Health and Care Excellence 2
Disulfiram should be avoided in patients with severe alcoholic liver disease due to possible hepatotoxicity, according to the American Association for the Study of Liver Diseases 2

Gabapentin at 1800 mg/day is recommended as a second-line treatment, particularly in patients with liver disease or when first-line treatments are contraindicated, with a significant linear effect on complete abstinence rates: 4.1% (placebo) vs 11.1% (900 mg) vs 17.0% (1800 mg), with p=0.04 2