Less than 2% of the 29 million Americans with alcohol use disorder receive naltrexone or any FDA-approved medication, despite 30+ years of availability

Despite four FDA-approved medications for alcohol use disorder (naltrexone since 1994, acamprosate, disulfiram, and injectable naltrexone), fewer than 2% of the estimated 29 million Americans with AUD receive any pharmacotherapy. Among patients admitted to substance use disorder treatment facilities, naltrexone prescription rates range from only 0.5% to 1.6%. Why it matters: the vast majority of people with alcohol use disorder receive no medication that could reduce their cravings and drinking, so they rely solely on behavioral interventions and willpower with higher relapse rates, so alcohol remains the third leading preventable cause of death in the U.S. (approximately 178,000 deaths annually per CDC), so the enormous clinical evidence base for AUD medications is functionally irrelevant to patient outcomes, so a treatable chronic disease is managed as if no pharmacological treatments exist. The structural root cause is that alcohol use disorder treatment in the U.S. developed primarily through the 12-step and rehabilitation center model which views abstinence through behavioral and spiritual means as the only legitimate recovery path, most primary care physicians receive minimal training in AUD pharmacotherapy during medical school and residency, and the cultural normalization of heavy drinking combined with stigma around the label 'alcoholism' prevents both patients from seeking medication and physicians from proactively offering it.