Which of the following medications works by inhibiting aldehyde dehydrogenase in alcohol use disorder?

Disulfiram is a medication that is specifically designed to aid in the treatment of alcohol use disorder by inhibiting aldehyde dehydrogenase. This action leads to the accumulation of acetaldehyde when alcohol is consumed, resulting in unpleasant symptoms such as flushing, nausea, and palpitations. This aversive reaction to alcohol serves as a deterrent, encouraging individuals to abstain from drinking.

Disulfiram's mechanism highlights the biochemistry of alcohol metabolism where acetaldehyde is a toxic byproduct of alcohol oxidation. Under typical circumstances, acetaldehyde is quickly converted to acetic acid by aldehyde dehydrogenase. However, when disulfiram is taken, the enzyme's activity is inhibited, leading to increased levels of acetaldehyde in the system and causing aversive responses that facilitate behavioral change in those trying to abstain from alcohol.

In contrast, the other medications listed, such as acamprosate, naltrexone, and buprenorphine, operate through different mechanisms. Acamprosate works by modulating glutamate and GABA neurotransmission to stabilize the chemical balance in the brain affected by alcohol withdrawal. Naltrexone functions as an opioid antagonist, reducing the rewarding effects of alcohol. Bu