We Use More Than One Medication To Treat Diabetes and Hypertension - Let's Do The Same for Alcohol Use Disorder!

One-med-at-a-time sounds tidy on paper, but alcohol use disorder rarely behaves like a tidy problem. Dr. Reb Close and I sat down to discuss treating alcohol use disorder, and we’ve learned that many patients do better when we treat AUD the way we treat other chronic conditions: with a multimodal plan that targets more than one pathway and stays anchored to the person’s real reason for drinking. 

We walk through how we think about combination medication strategies for alcohol cravings, including naltrexone, acamprosate, gabapentin, baclofen, and topiramate. You’ll hear the practical “why” behind pairing meds, how we set expectations for naltrexone response, and how targeted dosing can give patients more control during high-risk moments. We also talk about monthly extended-release naltrexone (Vivitrol) and how we approach add-on oral dosing without overdoing it. 

Just as important, we keep coming back to the central clinical question: what does alcohol do for you? If drinking is driven by anxiety, insomnia, or trauma, the best AUD treatment may start with sleep, PTSD symptoms, nightmares, or triggers rather than another anti-craving pill. We close by zooming out to what best practice really looks like: therapy or groups, good sleep, nutrition, exercise, treatment of co-occurring mental health conditions, and more than one medication when it fits. 

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To contact Dr. Grover: ammadeeasy@fastmailcom