Alcohol use disorder affects about 29 million American adults. Current treatment includes behavioral therapy, mutual support groups, and three FDA-approved medications — naltrexone, acamprosate, and disulfiram — which help about one in four people who take them. Researchers are now testing drugs that may work better and reach the larger group who don't respond to existing options.
What's actually going on in research
Trials are testing drugs that act on specific brain circuits involved in craving and reward, including medications originally developed for other conditions. Research is exploring personalized approaches based on genetic and brain imaging markers that might predict who responds to which treatment. Scientists are also studying medications that reduce alcohol's harmful effects on the liver and brain while people work toward cutting back.
GABA-B receptor drugs
Baclofen and newer drugs targeting GABA-B receptors in the brain may reduce craving and heavy drinking days. Several trials are testing whether these drugs work better than current medications for people with severe alcohol use disorder.
Ghrelin pathway drugs
Medications affecting ghrelin, a hormone involved in appetite and reward, may reduce alcohol craving. Early studies suggest this approach might help people who don't respond to naltrexone.
Neurokinin receptor blockers
Drugs blocking neurokinin receptors, which play a role in stress and emotional regulation, are being tested for alcohol use disorder. This class may help people who drink heavily in response to stress or negative emotions.
What to know before you search
Eligibility typically depends on drinking frequency, liver function, other substance use, and whether someone can safely reduce alcohol while taking study medication.
What types of trials are currently open
- Medication trials — Testing drugs that reduce craving, heavy drinking days, or alcohol's reinforcing effects. Most compare a new drug to placebo while people receive counseling.
- Combination trials — Testing whether combining two medications works better than one alone. Common combinations include naltrexone with other drugs targeting different brain systems.
- Harm reduction trials — Testing medications that protect the liver or brain from alcohol damage while people work on reducing their drinking. These don't require complete abstinence.
- Biomarker studies — Using genetic tests, brain scans, or other markers to match people with the treatment most likely to work for them.
- Digital intervention trials — Testing smartphone apps, virtual therapy, or digital monitoring tools that help people track and reduce drinking between medical visits.
Recently added Alcohol Use Disorder trials
Emotional Reactivity in Severe Alcohol Use Disorder and Major Depressive Disorder Using Eye-tracking, Physiological, and Interoceptive Measures (ERAD)
The goal of this observational study is to investigate emotional recognition and emotional reactivity in individuals with severe Alcohol Use Disorder (sAUD), Major Depressive Disorder (MDD), comorbid sAUD and depressive symptoms (sAUD+DS), and healthy controls. The main questions this study aims to answer are: * Do individuals with sAUD, MDD, sAUD+DS, and healthy controls exhibit different patterns of emotional recognition and emotional reactivity in response to dynamic emotional stimuli? * How are emotional recognition and emotional reactivity related to each other? * How are these emotional processes associated with psycho-affective, socio-emotional, stress-related, interoceptive, and disorder-specific factors? * Do emotional recognition and emotional reactivity predict clinical outcomes at 6- and 12-month follow-up assessments? Participants will: * Complete two experimental sessions involving dynamic emotional facial expression and emotional scene tasks * Provide emotion identification, subjective emotional ratings (type, intensity, and valence), and and self-reported bodily sensations using an emotional body map (InteroMap) * Undergo eye-tracking, pupillometry, electrodermal activity, and cardiac activity recordings during emotional tasks * Complete questionnaires assessing psycho-affective, socio-emotional, stress-related, and disorder-specific factors * Provide saliva and hair samples for cortisol assessment * Participate in follow-up clinical assessments at 6 and 12 months Researchers will compare emotional recognition and emotional reactivity profiles across the sAUD, MDD, sAUD+DS, and healthy control groups, and evaluate their predictive value for future clinical outcomes.
Study on Thiamine Supplementation to REduce braiN Injury Associated With Chronic Alcohol Use in Outpatients With Alcohol Use Disorder
Chronic alcohol use and alcohol use disorder (AUD) affect 10% of the population in France. They are associated with brain damage and cognitive impairment. These complications have a significant impact on patients' agency, autonomy, and ability to participate in their own care. The investigators need to improve our knowledge of medical treatments that can reduce these risks and harms, beyond providing support to quit drinking or reduce consumption. Nutritional and vitamin deficiencies, particularly thiamine deficiency, are involved in the onset of these complications. Thiamine deficiency causes Wernicke encephalopathy, which can lead to Korsakoff syndrome, a very severe episodic memory disorder. Blood tests to measure thiamine levels are not available in routine medical practice. And it is not currently covered by health insurance in France. However, the systematic prescription of thiamine is recommended during alcohol withdrawal by medical associations and health institutions in France and internationally. However, there are no clinical trial data in the international scientific literature demonstrating the medical benefits and required dosage of systematic supplementation outside the withdrawal period when alcohol use continues or when the patient does not seek alcohol abstinence. People who use multiple psychoactive substances, are in precarious situations, and are receiving treatment for substance use disorders at addiction treatment centers are particularly vulnerable to malnutrition and vitamin deficiencies. In this context, the place of systematic thiamine prescription arises with the aim of reducing risks and brain damage in patients who do not wish to or cannot stop their chronic alcohol use. One of the limitations of previous studies has been the lack of a suitable, reproducible, minimally invasive, inexpensive, and sensitive biomarker of therapeutic response. In this study, the investigators will use plasma neurofilament light chain (NFL) levels, an innovative biomarker. In two recent studies, the study team demonstrated the relevance of this biomarker and its effectiveness in measuring brain suffering in patients with AUD and its kinetics during during inpatient alcohol withdrawal. The hypothesis the invastigators are working on is that, in a population at high risk of vitamin and nutritional deficiency and who are chronic alcohol users, systematic supplementation with thiamine (vitamin B1) would reduce the brain suffering associated with this deficiency and chronic alcohol use. To answer this question, the investigators conduct a randomized, open-label pilot study. The primary objective is to test the efficacy of thiamine supplementation in reducing brain suffering as measured by plasma NFL level in chronic alcohol users with alcohol use disorder. Secondary objectives are to perform analyses of potential moderating factors of the treatment effect (per-protocol analysis based on good adherence, presence of morning alcohol withdrawal symptoms, reported morning alcohol use) and to use plasma glial fibrillary acidic protein (GFAP) and total plasma total tau protein as alternative biomarkers. the investigators include adult patients under the age of 65 with alcohol use disorder who are currently chronic active alcohol users reporting daily intake of at least 40g of alcohol, who are being treated in outpatient addiction treatment center, and who may have another substance use disorder as a comorbidity. This pilot study compares a group receiving 500 mg of thiamine supplementation in the morning and evening (1000 mg/day) over a period of 14 days with a control group receiving no supplementation. In order to measure the brain injury induced and its reduction, the investigators will measure plasma NFL level. Two measurements are performed, before supplementation begins (baseline, on day 0) and after two weeks of supplementation (follow-up visit, on days 14, 15, or 16). The primary judgment criterion is the change in plasma NFL level between baseline and follow-up, comparatively between the treatment group and the control group (time x treatment interaction). A repeated measures analysis of variance (ANOVA) test, adjusted for age and sex, is used.
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