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Medication-assisted treatment for alcohol use disorder

Key points

  • Only 2-3% of people with AUD receive MAT, despite it being safe and effective—advocate for your loved one.
  • MAT works best when combined with counseling, support groups, and a structured daily routine.
  • For dementia patients, start with non-drug strategies (routine, environment changes) before adding MAT.
  • Choose a MAT medication that is safe with dementia drugs—naltrexone and acamprosate are often preferred over disulfiram.
  • Monitor for side effects like confusion or falls, and report to the doctor promptly.
  • You are not alone—use helplines, support groups, and dementia-specialist providers to build a care team.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Step 1: Start by recognizing the signs of AUD. The diagnostic criteria include 11 yes/no questions: Have you tried to cut back unsuccessfully? Is alcohol contributing to a health problem? Do you need more to get the same effect? Answering yes to two or more indicates AUD. If your loved one has dementia, ask their doctor to assess this formally.

  2. Step 2: Have a calm, non-judgmental conversation. Use phrases like: 'I love you and I'm worried about how alcohol is affecting your health. There are medications that can help you drink less safely. Would you be open to talking to your doctor about them?' Avoid blame or shame—focus on health and safety.

  3. Step 3: Find a healthcare provider who prescribes MAT. This could be a primary care doctor, a psychiatrist, or an addiction specialist. You can search for providers through the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator or ask at a local memory clinic.

  4. Step 4: Ask the doctor about the three main medications: naltrexone (reduces cravings and blocks the 'high'), acamprosate (helps maintain abstinence by reducing withdrawal symptoms), and disulfiram (causes severe nausea if alcohol is consumed—use with caution in dementia due to risk of accidental ingestion). Discuss which is safest given your loved one's dementia stage and other medications.

  5. Step 5: Set up a medication routine. For a person with dementia, use a pill organizer, set alarms, or have the medication administered by a caregiver. Some MAT medications are available as monthly injections (e.g., naltrexone extended-release), which can be easier to manage.

  6. Step 6: Combine MAT with non-drug strategies. Encourage regular daily routines, reduce triggers (like keeping alcohol out of the house), and offer meaningful activities to replace drinking time. For sleep issues, try non-drug approaches first (consistent bedtime, avoiding caffeine, morning sunlight) before adding sleep medications.

  7. Step 7: Monitor for side effects and interactions. Common side effects of MAT include nausea, headache, or dizziness. In dementia, watch for increased confusion, falls, or sedation. Report any changes to the doctor immediately. Also, note that alcohol itself can worsen dementia symptoms, so reducing drinking may improve cognition over time.

  8. Step 8: Consider mutual support groups. Groups like Alcoholics Anonymous or SMART Recovery can help, but for a person with dementia, look for groups that are dementia-friendly or offer one-on-one support. Online options may be easier to access.

  9. Step 9: Be patient and celebrate small wins. MAT may take weeks to show full effect. A reduction in drinking—even if not complete abstinence—is a success. Track progress with a simple journal or calendar, and acknowledge every effort.

  10. Step 10: If your loved one is unaware of their cognitive decline (anosognosia), focus on safety rather than insight. Use phrases like: 'I need you to take this pill to help your brain stay healthy' rather than 'You have a drinking problem.' Work with a dementia specialist who can tailor the approach.

What not to do

  • Do not assume MAT is a 'magic cure' or that it works without counseling. It is most effective when combined with behavioral support. Instead, pair medication with therapy or support groups.

  • Do not stop MAT abruptly if side effects occur. Many side effects are temporary. Instead, talk to the doctor about adjusting the dose or switching medications.

  • Do not hide the medication in food or drink without the person's knowledge—this can break trust and is unethical. Instead, have an open conversation about why the medication is needed.

  • Be cautious about using disulfiram in a person with dementia who may accidentally drink alcohol (e.g., from mouthwash or cooking wine); the reaction can be dangerous. Ask the doctor if naltrexone or acamprosate would be safer alternatives.

  • Do not ignore the person's other medications. Some dementia drugs (like donepezil) can interact with alcohol, and MAT may need dose adjustments. Always provide a full medication list to the doctor.

  • Do not give up if the first medication doesn't work. Different people respond to different medications. It may take trying two or three options to find the right one.

Practical tools

  • The 'AUD Checklist' Conversation Starter

    Print or write out the 11 AUD criteria (available from the American Psychiatric Association) and use them as a gentle checklist: 'Let's see how many of these apply—just to understand your health better.' This can make the conversation less confrontational.

  • Medication Tracking Chart

    Create a simple chart with columns for date, time, medication name, dose, and any side effects. Place it near the pill organizer. For a person with dementia, use large print and check off each dose together.

  • The 'Three-Question' Doctor Visit Prep

    Before the appointment, write down: (1) What MAT options are safest for someone with dementia? (2) How will this medication interact with my loved one's current meds? (3) What non-drug strategies should we try first? Bring this list to the visit.

  • Alcohol-Free Environment Setup

    Remove all alcohol from the home, including cooking wines and alcohol-based mouthwashes. Replace with appealing non-alcoholic alternatives like sparkling water with fruit, herbal teas, or non-alcoholic beer (if safe with medications).

  • The 'Small Wins' Journal

    Keep a notebook where you record each day without drinking, or each reduction in amount. Celebrate with a small reward (a favorite snack, a walk, a movie). This builds positive reinforcement for both of you.

  • SAMHSA National Helpline (1-800-662-4357)

    Call this 24/7 helpline to find MAT providers in your area. They can also connect you to support groups and counseling services. It's free and confidential.

Discuss with your clinician

Ask your doctor: 'Is naltrexone, acamprosate, or disulfiram safe for my loved one given their dementia diagnosis and current medications?'

Ask: 'How will this MAT medication interact with cholinesterase inhibitors (like donepezil) or other dementia drugs?'

Ask: 'What is the plan if my loved one accidentally drinks alcohol while on disulfiram? Should we avoid this medication altogether?'

Ask: 'Are there any blood tests or liver function tests needed before starting MAT?'

Ask: 'If my loved one has a history of seizures or liver disease, which MAT options are safest?'

Ask: 'Can we try a non-drug approach first, and if so, for how long before considering MAT?'

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