FDA-approved alcohol use disorder drugs remain barely prescribed in US

America is suddenly having earnest conversations about alcohol—its health risks, moderation strategies, and the cultural hangover of a decade of “wellness” content. What it still mostly avoids discussing is the boring part: treating alcohol use disorder (AUD) like a medical condition.

Business Insider highlights an awkward fact that should embarrass both the healthcare establishment and the pharmaceutical-industrial complex: the US has three FDA-approved medications for AUD—naltrexone, acamprosate, and disulfiram—yet only about 2% of Americans diagnosed with an alcohol disorder receive any of them. For comparison, the article notes that roughly 85% of people diagnosed with diabetes get approved treatments.

The mismatch is not because the drugs are exotic, risky, or unproven. They are decades old, mostly generic, and, as addiction physicians quoted by Business Insider argue, useful for some patients with relatively few drawbacks.

Naltrexone, originally developed for opioid use disorder, blocks the euphoric “reward” of drinking. People can still become impaired, but the warm buzz is blunted—an unglamorous mechanism that matters because addiction is partly reinforcement learning with a blood supply. Some patients use it via the “Sinclair Method,” taking the pill about an hour before drinking to weaken the reward association over time. The drug also exists as a monthly injection.

Acamprosate works differently: it aims to restore neurochemical balance after heavy alcohol use and can reduce cravings, and it is reportedly prescribed more commonly in Europe.

Disulfiram is the classic deterrent: it makes drinking physically unpleasant by blocking alcohol metabolism. It is less used, largely due to predictable noncompliance—people who want to drink often prefer not to take the pill that punishes them for it.

So why the near-total underuse? Business Insider’s reporting points to a mix of institutional inertia and perverse incentives. Many clinicians receive little training in addiction pharmacology. Treatment pathways still default to counseling-only models, twelve-step referrals, or detox-first approaches. Meanwhile, the public conversation is captivated by shiny new candidates, especially GLP-1 drugs such as Ozempic and Zepbound, which researchers are studying for potential reductions in alcohol consumption.

The GLP-1 story may turn out to be real. But it is also a perfect illustration of how healthcare attention is allocated: novel, branded, high-margin drugs get headlines and continuing-med-ed buzz; cheap generics get forgotten—even when the evidence base is already “good enough” to help many people.

The tragedy is not that government hasn’t mandated more treatment. It’s that a heavily cartelized medical system—with licensing barriers, reimbursement distortions, and risk-averse institutional protocols—manages to underdeliver even on the tools it already possesses.

If addiction is to be treated like diabetes, the first step is not another awareness campaign. It’s making it normal for doctors to prescribe the existing medications, for patients to access them without moral theater, and for treatment providers to compete on outcomes instead of ideology.