Traditional Pharmacotherapy of Alcohol Dependence

Over a span of about 55 years, 4 medications have achieved U.S. Food and Drug Administration (FDA)-approved labeling in alcohol dependence: disulfiram (1951), oral naltrexone (1994), acamprosate (2004), and naltrexone for extended-release injectable suspension (2006). Although these medications have different mechanisms of action and specific FDA-approved clinical indications, the efficacy of each is increased significantly when the medication is combined with psychosocial therapy. The distinct nature of each medication allows the potential to combine them in treatment—analogous to the treatment of hypertension. While these drugs are the cornerstones of current pharmacotherapy treatment for alcohol dependence, they are still widely underutilized. This article reviews the mechanisms of action, efficacy, safety/tolerability, and clinical use of disulfiram, oral naltrexone, and acamprosate.