American Board of Family Medicine (ABFM) Practice Exam

Which medication is most effective in preventing relapse in alcohol abuse?

1. Acamprosate

2. Naltrexone

3. Disulfiram

4. Topiramate

The correct answer is: Naltrexone

Naltrexone is particularly effective in preventing relapse in alcohol use disorder due to its mechanism of action as an opioid receptor antagonist. By blocking the effects of endogenous opioids, naltrexone reduces cravings for alcohol and diminishes the pleasurable effects associated with drinking, which can aid in maintaining abstinence after initial recovery. Clinical studies have demonstrated that patients receiving naltrexone show significantly fewer days of heavy drinking and a reduced risk of relapse compared to those not receiving the medication. In contrast, while acamprosate, disulfiram, and topiramate may also be utilized in treating alcohol use disorder, they function differently. Acamprosate is aimed at reducing post-cessation cravings, but its effectiveness may not be as pronounced in preventing relapse in comparison to naltrexone. Disulfiram operates by creating an aversive reaction to alcohol consumption, which can encourage abstinence, but does not directly address cravings. Topiramate has been employed off-label with some success in alcohol dependence, but its primary indications are for seizure disorders and migraine prevention, which can limit its use in this context. Naltrexone stands out as a first-line pharmacotherapy specifically for preventing relapse, integrating its unique mechanism to target the neurobi