Medications That Help You Drink Less

Medication is part of the toolkit

Most people who want to drink less try to do it on willpower alone, and many never hear that medication is an option. Several prescription medicines have decades of research behind them, and a large 2014 review in JAMA found that some of them help people cut down on heavy drinking or stay alcohol-free. They do not replace the rest of your plan, but they can make that plan easier to stick to.

This article covers the four names you are most likely to hear from a doctor in Europe. All four need a prescription, and none of them is right for everyone. Read what follows as background for a conversation with your GP, not as advice to take anything.

Naltrexone takes the edge off the reward

Naltrexone blocks part of the pleasant effect alcohol has in the brain. Studies show that people taking it tend to have fewer heavy drinking days. It can be started while you are still drinking, so it fits a goal of fewer drinks or none.

Most often it is taken as one tablet a day. Some doctors prescribe it in a targeted way instead, with a tablet taken only before situations where you expect to drink. A Finnish trial tested this targeted pattern with encouraging results, and it is often called the Sinclair method after one of the researchers. It has been studied far less than daily use, so ask your doctor which pattern suits you.

Naltrexone does not mix with opioid painkillers or other opioids. It blocks their effect and can bring on withdrawal in someone who takes them regularly, so tell your doctor about every medicine you use. Your doctor may also check your liver first.

Nalmefene was approved to help people drink less

Nalmefene works in a similar way to naltrexone, but it was approved specifically to reduce drinking rather than to stop it. It has been approved in the EU since 2013, and doctors across the Nordic countries can prescribe it for adults with alcohol dependence who drink at a high-risk level but do not need a medically supervised detox first.

It is taken as needed. On a day when you think you might drink, you take one tablet one to two hours beforehand, and never more than one tablet a day. The approval expects it to come with ongoing support, so a prescription usually includes follow-up with your doctor or a nurse. The same caution about opioids applies.

Two options for staying alcohol-free

Acamprosate is for people who have already stopped drinking. It is thought to ease the restlessness, anxiety and poor sleep that some people feel in the weeks after quitting, and studies show it helps people stay alcohol-free. It is taken several times a day.

Disulfiram works the opposite way. It makes you feel ill if you drink, with flushing, nausea and a pounding heart, so it acts as a hard backstop for people whose goal is no alcohol at all. Because that reaction can be serious, it is not used to cut back, and research suggests it works best when someone supervises the daily dose. You need to have stopped drinking before the first tablet.

Not for everyone

Each of these medicines can cause side effects, such as nausea, headache, dizziness or an upset stomach. Each also has situations where a doctor will advise against it, including pregnancy, some liver and kidney conditions, and clashes with other medicines. That is why they are prescription-only. A doctor weighs your health, your goal and your history, and sometimes the right answer is a different medicine or none at all.

When withdrawal needs a doctor

If you drink heavily every day, stopping suddenly can be dangerous. Talk to a doctor first. Some signs need medical care right away, not an appointment next week. Watch for severe shaking, heavy sweating, a racing heart, confusion, seeing or hearing things that are not there, or a seizure. If any of these show up after you cut down or stop, seek urgent care.

Starting the conversation

Every one of these medicines starts with a GP appointment, and you can keep it simple. Say that you want to drink less, that you have read medication can help, and that you would like to know whether it could help you. Bring your weekly standard drink count from the app and a note of what you have already tried. Expect a few questions about your drinking and possibly a blood test, which is routine.

If medication is not right for you now, the appointment still counts. Your doctor knows what you are working on, and other support stays open whenever you want it.