We Use More Than One Medication To Treat Diabetes and Hypertension - Let's Do The Same for Alcohol Use Disorder!We Use More Than One Medication To Treat Diabetes and Hypertension - Let's Do The Same for Alcohol Use Disorder!
Addiction Medicine Made Easy
Dr. Casey Grover and Dr. Reb Close talk through why using more than one medication for alcohol use disorder can make sense, tying choices to each person’s reason for drinking. The discussion highlights practical combinations, patient stories and the importance of addressing mental health and lifestyle alongside anti-craving meds.
22:09•28 Sept 2026
Rethinking Alcohol Use Disorder: Why One Medication Often Isn’t Enough
Episode Overview
- Treat alcohol use disorder more like other chronic conditions by combining medications that act on different pathways.
- Select medications based on the person’s specific "why" for drinking, such as anxiety, euphoria, insomnia or co-occurring stimulant use.
- Naltrexone is often paired with agents like gabapentin, acamprosate or topiramate to improve overall effectiveness and address multiple needs.
- Some patients respond better when underlying mental health issues such as PTSD are treated directly rather than adding more anti-craving drugs.
- Medication works best as part of a broader plan including counselling, groups, sleep, nutrition, exercise and treatment of co-occurring conditions.
“"What addiction is: people don't like how they feel. They want to feel better. They want some control. And they want to feel better quickly."”
What drives someone to seek a life without alcohol? This episode of *Addiction Medicine Made Easy* takes that question and turns it into a practical, clinic-ready conversation for anyone interested in better treatment of alcohol use disorder. Dr. Casey Grover and his colleague (and spouse) Dr. Reb Close sit down for a relaxed "chitty chat" about why using just one medication for alcohol use disorder often isn’t enough.
Drawing on comparisons to diabetes, hypertension and multimodal pain management, they argue that it makes far more sense to combine medicines that work on different pathways than to rely on a single "hammer and nail" approach. You’ll hear them talk through real-world strategies: starting most patients on naltrexone plus a second medication based on the person’s "why" for drinking.
For alcohol and anxiety, that might be naltrexone with gabapentin; for alcohol with stimulant use, naltrexone with topiramate; for people who can’t take naltrexone, options like acamprosate paired with gabapentin or other agents. They also touch on more nuanced choices such as using GLP-1 drugs in certain older patients and carefully considering baclofen because of its withdrawal risks. The conversation stays grounded in patient stories.
One standout example is a man who only found lasting sobriety after combining naltrexone and topiramate, and another patient whose drinking eased dramatically once her untreated PTSD was correctly addressed with antidepressants and trauma-focused medications rather than more anti-craving drugs. Throughout, the tone is warm, pragmatic and firmly patient-centred. The key message is simple: understand why someone drinks, treat that "why", and don’t be afraid to use more than one medication alongside counselling, sleep, nutrition, exercise and mental health care.
If you’re curious how clinicians can rethink alcohol use disorder beyond "one med at a time", this conversation might spark some fresh questions for your own practice or recovery journey.
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