In pharmacotherapy for alcohol use disorder, which medication is most effective at preventing relapse when added to psychosocial interventions?

• A. Acamprosate
• B. Disulfiram
• C. Gabapentin
• D. Naltrexone

Answer: (D)

Blocking the rewarding effects of alcohol with naltrexone helps prevent relapse when added to psychosocial therapies. Naltrexone, an opioid receptor antagonist, reduces the pleasurable effects of drinking and lowers craving, so patients are less likely to return to heavy drinking. In many trials and reviews, this combination shows a clearer reduction in relapse and fewer heavy-drinking days than other pharmacotherapies when paired with counseling, making it the most consistently effective option for relapse prevention. Adherence can be a challenge with daily dosing, but the injectable long-acting form can help address that and further improve outcomes. By contrast, while acamprosate supports abstinence after withdrawal, and disulfiram’s effectiveness depends heavily on adherence and motivation, neither matches the robustness of relapse-prevention data seen with naltrexone. Gabapentin has some benefit but with less consistent relapse-prevention evidence.