Table 1 Mr. R’s reported experiences with medications for alcohol use disorder

Naltrexone (oral)

2016

50 mg daily

“I think that worked fairly well. I still take it every now and then even when I’ve had the [intramuscular naltrexone]. I think it works for when I start to crave.”

Naltrexone (intra-muscular)

2019

380 mg monthly

“I wouldn’t really feel much…of it, like slowing me down…I don’t know what it was supposed to do. Whatever it’s supposed to do, I don’t think it was doing it and I think I was just doing it. Maybe it works on other people differently, but it definitely didn’t work on me because I just drank a lot if I relapsed like I did this last time, and I don’t know if that’s like a common thing: if you relapse on [intramuscular naltrexone] you drink a lot.”

Acamprosate

2016

666 mg three times daily

“And that really was helpful…my doctor said it was for like cravings and stuff like that.”

Question: Was it very difficult to take it so many times in the day or not really?

“Yeah it was difficult because I would forget to take it like three times a day. It goes two pills and [I’d forget], but I’d eventually like catch up to it or whatever.”

Disulfiram

2021

250 mg daily

“I would use [it] off and on though, because I just felt like I didn’t need to take it because I…wasn’t gonna drink or anything. And then when I had my big relapse in September, I wasn’t taking it either. Well, I was taking a little bit before that, but then I stopped taking it because I was setting myself up to drink and then…when I decided to go ahead and drink, the other self took over. I went ahead and just started drinking and I didn’t get sick or anything because it was like, over 24 h from taking it so, you know, it just wasn’t in my system anymore.”

Question: Have you ever had a disulfiram reaction?

“I don’t think so. I don’t know, I may have because a couple times when I started drinking, I threw up right away. But then I’ll end up continuing to drink.”

Post-encounter correspondence:

“However just to let you know I still am taking [disulfiram]. It is my belief that it helps me deter myself from drinking.”

Gabapentin

2018

600 mg three times daily

“That one helps with like…relaxation and slowing me down. And it helps me to…kind of regain like a little bit of more self-awareness. It did help me focus actually, and to help me feel better. [But] if when I start [taking] it with alcohol though, it just made me tired.”