Alcohol use disorder (AUD) is increasingly prevalent in the US and has severe consequences. Only four medications—disulfiram, oral naltrexone, naltrexone IM, and acamprosate—are FDA-approved for its treatment. This review examines the efficacy of these approved drugs and explores off-label pharmacologic options such as gabapentin, baclofen, oxytocin, N-acetylcysteine, calcium carbonate, and psilocybin. The goal is to identify the most effective treatment for individuals with AUD, helping providers reduce the disease's prevalence.
Esketamine, approved in 2019 as a rapid-acting intranasal spray for treatment-resistant depression, is self-administered under clinical supervision and generally well tolerated, with mild, temporary, and dose-dependent adverse reactions that improve over time. Although difficulty remembering or thinking is listed as a possible adverse reaction, neurocognitive evaluation is not part of initial patient assessment. This case report describes a patient whose neurocognitive symptoms worsened with esketamine treatment, leading to discontinuation of the therapy.