VA Portland Healthcare System Substance Abuse Treatment Program

Antabuse®

Disulfiram is used to support recovery from alcohol use disorder by causing unpleasant physical reactions when alcohol is consumed. It does not reduce cravings but works as a behavioral deterrent to prevent drinking.

Disulfiram blocks the enzyme that breaks down alcohol in the body. If alcohol is consumed, it leads to a rapid buildup of acetaldehyde, causing flushing, nausea, headache, chest pain, and vomiting—often within minutes.

Vivitrol®, Revia®

Naltrexone is an opioid antagonist, meaning it blocks opioid receptors in the brain and prevents opioids from producing effects like euphoria or sedation. It is used to treat both opioid and alcohol use disorders, but does not cause physical dependence or withdrawal.

It helps reduce cravings and the rewarding effects of opioids or alcohol, supporting long-term recovery. Because it blocks opioid effects, it should only be started after a person has fully detoxed from opioids to avoid triggering withdrawal.

Campral®

Acamprosate is used to support recovery from alcohol use disorder by helping to restore brain activity disrupted by long-term alcohol use. It is non-addictive and does not cause withdrawal or euphoria.

Acamprosate stabilizes chemical signaling in the brain, especially glutamate and GABA systems, which are often out of balance in people recovering from alcohol use. It helps reduce cravings and the urge to drink, especially when used consistently alongside counseling.

NicoDerm, Nicorette

NicoDerm is a nicotine replacement patch that releases small, tapered amounts of nicotine throughout the day. Nicorette works the same way, but in the form of a pill or lozenge. Both NicoDerm and Nicorette come in various doses so you can gradually lower your nicotine intake.

NicoDerm and Nicorette allow small amounts of nicotine into the body, which can reduce cravings and the desire to smoke a cigarette, or vape. Reduced cravings and improved comfort during withdrawal can both lower the desire to smoke.

Zyban, Wellbutrin, Pamelor

Zyban, Wellbutrin, and Pamelor can all help with tobacco cravings. Zyban has the same active ingredient as Wellbutrin, bupropion, but is used specifically for tobacco cravings. Wellbutrin can address mood conditions and tobacco cravings. Pamelor is a tricyclic antidepressant, but has off-label use for tobacco cravings. Zyban and Wellbutrin shouldn't be used at the same time; a psychiatrist will monitor dosing and manage potential side effects and drug interactions.

Zyban, Wellbutrin, and Pamelor all affect various neurotransmitter levels inside the brain (specifically, dopamine and norepinephrine), which can reduce tobacco cravings and ease withdrawal symptoms. These medications can be used alongside other smoking cessation tactics, like nicotine patches.