Medication-Assisted Treatment for Alcohol Use Disorder in San Diego

Alcohol use disorder (AUD) is one of the most common — and most under-treated — behavioral health conditions in San Diego County. National data from SAMHSA consistently shows that fewer than 10% of adults who meet criteria for AUD receive any formal treatment in a given year, and among those who do, very few are offered the FDA-approved medications that can meaningfully reduce cravings and relapse risk. That gap is closing, but slowly. For San Diego residents weighing their options, it’s worth understanding what medication-assisted treatment (MAT) for alcohol use disorder actually is, which medications are available, and how MAT fits alongside — not in place of — therapy and structured recovery support.

What “Medication-Assisted Treatment” Means for AUD

Medication-assisted treatment, in the context of alcohol use disorder, refers to the use of one or more FDA-approved medications alongside counseling and behavioral therapies to treat AUD. The goals are practical: reduce cravings, reduce the reinforcing effects of drinking if a slip occurs, and give a person’s brain time to recover from the neurochemical adaptations of chronic alcohol use.

MAT is not a stand-alone cure, and it isn’t a substitute for the harder work of therapy, community support, and life-structure change. What it does — reliably, in the outpatient populations we treat — is lower the day-to-day pressure of cravings enough that a person can actually do that work.

The Three FDA-Approved Medications for AUD

Naltrexone (Oral and Injectable Vivitrol)

Naltrexone is an opioid-receptor antagonist. In the context of alcohol use, it blunts the pleasurable and reinforcing effects of drinking — meaning that if someone on naltrexone does take a drink, the reward pathway doesn’t light up the way it otherwise would. Over weeks, this weakens the learned association between drinking and reward.

Naltrexone comes in two forms:

• Oral naltrexone (50 mg daily) — inexpensive, well-studied, and appropriate for individuals who can reliably take a daily medication.
• Extended-release injectable naltrexone (Vivitrol, 380 mg IM monthly) — a once-monthly injection that removes the daily adherence question entirely. Vivitrol is often the right choice for individuals who have struggled with daily medication routines, or who are transitioning out of residential or IOP care.

Naltrexone requires that a person be opioid-free for at least 7–10 days before starting, because it will precipitate withdrawal in anyone with recent opioid use. For most AUD patients this isn’t an issue; the medical team confirms it during intake.

Acamprosate (Campral)

Acamprosate works differently. Rather than blocking reward, it appears to help restore the balance of glutamate and GABA neurotransmission that chronic alcohol use disrupts. Patients often describe it as reducing the low-grade unease and sleep disturbance that make early abstinence so uncomfortable.

Acamprosate is taken orally, typically two 333 mg tablets three times daily. That dosing schedule is a real consideration — some patients do better with a once-monthly injection like Vivitrol than a three-times-daily oral regimen. But for patients who tolerate the schedule, acamprosate is a well-tolerated medication with a strong evidence base for maintaining abstinence, particularly in the first 3–6 months after detox.

Disulfiram (Antabuse)

Disulfiram blocks the enzyme that breaks down alcohol’s toxic metabolite, acetaldehyde. Drinking any alcohol while on disulfiram produces flushing, nausea, and rapid heartbeat — a strong physical deterrent. Disulfiram works best for highly motivated patients with reliable social support (often a spouse or family member who can help with daily observed dosing).

It is less commonly used as first-line MAT today than naltrexone or acamprosate, but it remains an important option for select patients, particularly those with a history of impulsive drinking who benefit from a hard biological “guardrail” against relapse.

Choosing Between Medications

There isn’t one right answer. In our outpatient AUD population, the choice usually comes down to a few practical questions:

• Is daily medication adherence realistic, or would a monthly injection remove a variable? (Points toward Vivitrol.)
• Is the patient primarily struggling with cravings and the pull of drinking? (Points toward naltrexone.)
• Is the patient struggling more with post-acute withdrawal symptoms — sleep, anxiety, restlessness — that make early sobriety miserable? (Points toward acamprosate.)
• Is the patient highly motivated with a supportive home environment and a history of impulsive slips? (Disulfiram may be worth discussing.)

Some patients do best on a combination — for example, naltrexone plus acamprosate — and the evidence base supports that approach for individuals who haven’t responded to a single medication alone.

Why MAT Alone Isn’t Enough

Every professional guideline — SAMHSA, the American Society of Addiction Medicine (ASAM), the VA/DoD clinical practice guideline — is explicit on this point: MAT for AUD works best when it’s paired with behavioral treatment. Cognitive-behavioral therapy, motivational interviewing, and structured relapse-prevention counseling address the situations and thought patterns that drive drinking, while the medication makes it easier to hold new behaviors in place.

Skipping the therapy piece and treating MAT as a standalone fix produces worse outcomes than either component alone. That’s why every San Diego treatment program that follows evidence-based practice — including ours — integrates medication management with individual therapy, group work, and long-term aftercare planning.

Who’s a Candidate for MAT?

Any adult meeting DSM-5 criteria for alcohol use disorder — mild, moderate, or severe — can be evaluated for MAT. It’s particularly worth discussing with a treatment team if:

• You’ve completed detox but are struggling with cravings in early sobriety
• You’ve relapsed after previous treatment attempts and want additional support
• You’re weighing residential versus intensive outpatient care and want to understand what medication options exist alongside either
• You have co-occurring anxiety, depression, or PTSD that may respond well to a combined treatment approach

There are relatively few absolute contraindications. Naltrexone shouldn’t be used in patients with active opioid dependence or acute hepatitis. Acamprosate requires dose adjustment in significant kidney impairment. Disulfiram has more contraindications and is not appropriate for patients with certain cardiac or hepatic conditions. A medical evaluation sorts all of this out during intake.

MAT for AUD at Pacific Bay Recovery in San Diego

Pacific Bay Recovery provides medication-assisted treatment for alcohol use disorder as part of our full continuum of San Diego addiction treatment — detox, residential, intensive outpatient, and outpatient. Every MAT patient is evaluated by our medical team, matched to the medication (or medication combination) most likely to fit their situation, and enrolled in the behavioral treatment programming that makes MAT work. Follow-up is built into the program: medication response, side effects, and craving levels are tracked and adjusted over time, not set-and-forgotten at week one.

If you or a family member in San Diego is weighing treatment options for alcohol use disorder and want to understand how MAT fits, our admissions team can walk through the evaluation process and answer questions about medications, program structure, and insurance. Call 619-350-8220 or reach out through our contact form to start the conversation.