Which medication is known to create an aversion to alcohol without decreasing cravings?

Disulfiram, commonly known by the brand name Antabuse, is known for its role in the treatment of alcohol use disorder by creating an aversive reaction to alcohol consumption. It works by inhibiting the enzyme aldehyde dehydrogenase, which leads to the accumulation of acetaldehyde when alcohol is ingested. This accumulation causes unpleasant symptoms such as flushing, nausea, and palpitations, effectively creating a strong deterrent to drinking alcohol.

While disulfiram does not directly reduce cravings for alcohol, its mechanism—making alcohol consumption feel unpleasant—serves to discourage individuals from drinking. This aversive reaction can help reinforce a commitment to abstaining from alcohol, particularly when combined with supportive behavioral therapies and counseling.

In contrast, other medications listed have different mechanisms: Acamprosate and Naltrexone are utilized mainly for reducing cravings and managing withdrawal symptoms, while Topiramate is sometimes used off-label for alcohol dependence but is primarily an anticonvulsant that may have effects on craving reduction through different neurobiological pathways.