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Naltrexone vs Disulfiram (Antabuse)

One makes drinking punishing. The other makes it less rewarding. They suit very different people.

Medically reviewed by Dr. Nageley Michel, DNP, PMHNP, FNP, Board-Certified Psychiatric Nurse Practitioner  ·  Published 2026-09-09

Naltrexone and disulfiram are both used for alcohol use disorder, and they work in fundamentally opposite ways. Choosing between them is mostly a question of what you want treatment to do.

Disulfiram: deterrence

Disulfiram blocks an enzyme in alcohol metabolism, causing acetaldehyde to accumulate. Drinking on it produces flushing, nausea, vomiting, headache and a racing heart. The medication does not reduce craving at all — it makes acting on craving physically unpleasant.

That design has a clear implication: it requires total abstinence, and its effectiveness depends heavily on actually taking it. Someone who wants to drink can simply skip a dose.

Naltrexone: reduced reward

Naltrexone blocks opioid receptors so alcohol produces less reward. It works on the craving itself rather than on the consequences of acting on it, and it is compatible with a goal of drinking less rather than not at all.

Which suits which situation

Disulfiram can suit someone firmly committed to abstinence who wants a hard barrier — particularly where taking it is supervised. It is a poor fit for anyone whose goal is moderation, by design.

Naltrexone suits people still drinking, people aiming to cut down, and people who want craving itself reduced rather than a deterrent bolted on.

If you drink daily or heavily Stopping suddenly after sustained heavy drinking can cause withdrawal that is medically serious — shaking, sweating, a racing heart, confusion, or seizures. Do not stop on your own to "get ready" for treatment. Tell a provider how much and how often you drink; that shapes how treatment is started safely. If you are in medical distress, call 911.
Safety check Naltrexone is not safe to combine with opioids, including prescription pain medication. A provider screens for this and other contraindications during evaluation. Individual results vary, and naltrexone is not a substitute for emergency or detox care.

Talk it through with a provider

A 45–60 minute video evaluation with a board-certified psychiatric provider. Same-week appointments are typical.

Book an Evaluation → Check My Drinking

Common questions

Not inherently. Disulfiram can be effective when taken consistently, often with supervision, but it depends entirely on adherence and requires abstinence. Naltrexone works on craving and suits a wider range of goals.

Switching is possible and is a clinical decision. There are timing considerations, so it should be done with your provider rather than independently.

Both have established safety profiles when prescribed appropriately, but their risks differ. Disulfiram carries the risk of a severe reaction if alcohol is consumed. Naltrexone must not be combined with opioids. Your provider will screen for what applies to you.

Related reading

Naltrexone vs Acamprosate: Which Is Right? Can You Drink Alcohol on Naltrexone? Naltrexone for Alcohol: How It Works

This article is general health information, not medical advice, and does not create a provider–patient relationship. Only a licensed provider can diagnose alcohol use disorder or determine whether a particular treatment is appropriate for you, after a full evaluation. Individual results vary. EnnHealth provides outpatient telehealth care and is not a detox or emergency service.