Which medication for alcohol use disorder does NOT reduce cravings?

Disulfiram is a medication used to aid in the treatment of alcohol use disorder, but it operates in a different manner than the other options regarding cravings. Its primary mechanism is to produce an aversive reaction when alcohol is consumed. This occurs because disulfiram inhibits the enzyme acetaldehyde dehydrogenase, leading to a buildup of acetaldehyde when alcohol is ingested, which results in unpleasant symptoms such as flushing, nausea, and palpitations.

This deterrent effect discourages individuals from drinking alcohol, but disulfiram does not have a direct role in reducing the craving for alcohol itself. In contrast, naltrexone works to block opioid receptors involved in the reward pathway of drinking, thus reducing cravings and the pleasurable effects of alcohol. Acamprosate balances neurotransmitters in the brain, helping to reduce cravings during abstinence, and topiramate has been shown to diminish cravings through its effects on various neurotransmitter systems, including GABA and glutamate.

Thus, while disulfiram can play an important role in a comprehensive treatment plan by discouraging alcohol consumption, it does not specifically target the reduction of cravings.