Are medications for alcohol addiction safe long-term?
Concerns about the safety of medications for alcohol addiction - particularly about whether they are themselves addictive, or whether long-term use poses health risks - are among the most common reasons people hesitate to consider pharmacological support for their recovery. These concerns are understandable, but in most cases they reflect misconceptions that are worth addressing directly with accurate clinical information. The short answer is that the two most widely used medications, naltrexone and acamprosate, have well-established safety profiles and are not addictive - making them appropriate for long-term use in the context of ongoing clinical monitoring.
Is Naltrexone Safe for Long-Term Use?
Naltrexone has been in clinical use for alcohol use disorder since FDA approval in 1994, and its long-term safety profile is well-established through decades of post-marketing surveillance and multiple long-duration clinical studies. Key safety considerations include:
- Non-addictive: Naltrexone does not produce euphoria, sedation, or any pleasurable effect. It does not create physical dependence or withdrawal symptoms when stopped. There is no evidence of abuse or misuse potential, and it can be discontinued without a tapering protocol.
- Hepatotoxicity risk: At very high doses - substantially above the therapeutic doses used for AUD (50mg oral or 380mg injectable monthly) - naltrexone can cause liver toxicity. At therapeutic doses, the risk of clinically significant liver injury is low, though baseline liver function tests and periodic monitoring are recommended, particularly in people with pre-existing liver disease. In people with severe hepatic impairment (decompensated cirrhosis), naltrexone is contraindicated.
- No tolerance development: Naltrexone does not become less effective with prolonged use - there is no evidence of tolerance to its anti-craving or anti-relapse effects over time.
- Opioid interactions: The most significant ongoing consideration with long-term naltrexone use is that it blocks opioid receptors - meaning that opioid pain medications will be ineffective at normal doses while naltrexone is active. This is clinically manageable but requires clear communication with all treating physicians, particularly in the context of surgical or emergency care.
Is Acamprosate Safe for Long-Term Use?
Acamprosate has an excellent long-term safety profile and is among the best-tolerated medications used in addiction treatment. Its key safety characteristics include:
- Non-addictive: Like naltrexone, acamprosate has no abuse potential, produces no euphoria or dependence, and can be discontinued without tapering.
- Renal clearance: Acamprosate is cleared by the kidneys rather than the liver - making it safe to use in people with liver disease who cannot take naltrexone. However, it is contraindicated or requires dose adjustment in people with significant renal impairment, and renal function should be monitored during long-term use.
- Minimal drug interactions: Acamprosate has very few significant drug interactions, contributing to its good safety profile even in people taking multiple medications for co-occurring conditions.
- Common side effects: The most frequently reported side effects are gastrointestinal - diarrhoea, nausea, and flatulence - which are typically mild and often diminish with continued use. Acamprosate has not been associated with serious adverse effects at therapeutic doses in long-term studies.
Is Disulfiram Safe for Long-Term Use?
Disulfiram requires more careful monitoring with long-term use than naltrexone or acamprosate, due to several important considerations:
- Hepatotoxicity: Disulfiram can cause liver inflammation and damage (hepatotoxicity) independent of the disulfiram-alcohol reaction - a risk that requires baseline liver function testing before initiation and periodic monitoring throughout treatment. People with significant liver disease should generally not take disulfiram.
- Neurological effects: Long-term disulfiram use has been associated with peripheral neuropathy and, in rare cases, optic neuritis. These effects are uncommon but require clinical monitoring.
- Psychiatric effects: Disulfiram can exacerbate depressive symptoms and psychotic episodes in vulnerable individuals, requiring psychiatric monitoring during long-term use.
- Duration of use: Most clinical guidelines recommend disulfiram as a medium-term intervention - typically six months to one year - rather than indefinitely, reflecting both the monitoring burden and the evidence that it is most useful as a time-limited deterrent during the early phase of recovery rather than as a lifelong treatment.
How Long Should Medications Be Continued?
There is no universal answer to the optimal duration of medication treatment for alcohol use disorder - it depends on the individual's clinical trajectory, their relapse risk, their response to the medication, and their recovery progress. What the research does clearly suggest is that premature discontinuation - stopping medication before stable recovery has been established - substantially increases relapse risk. Many clinical guidelines suggest a minimum of six to twelve months of pharmacotherapy for AUD, with consideration of longer-term maintenance for people with severe addiction, multiple prior relapses, or ongoing high relapse risk.
The decision to discontinue medication should always be made collaboratively with a prescriber and coordinated with other components of the treatment plan. Stopping medication should not be the end of support - it should be accompanied by a clear plan for how sobriety will be maintained through therapy, peer support, and other recovery resources.
Are There Any Medications That Should Not Be Used Long-Term?
Benzodiazepines - while essential for the acute management of alcohol withdrawal - are generally not appropriate for long-term use in people with alcohol use disorder due to their significant abuse and dependence potential. The same neurobiological vulnerabilities that make a person susceptible to alcohol addiction also increase the risk of developing benzodiazepine dependence, and cross-dependence between alcohol and benzodiazepines is well-documented. After the acute withdrawal phase, benzodiazepines should be tapered and discontinued, with transition to non-addictive pharmacological support if ongoing medication is indicated.
At Cornerstone SoCal, all medication decisions - including duration, monitoring, and discontinuation planning - are made by experienced addiction medicine clinicians who consider the full clinical picture. Our goal is medication management that is safe, effective, and integrated with the broader treatment plan in service of lasting recovery.
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What Clients Say About Cornerstone
4.6
Based on 232 reviews
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Chris Lee
02:17 24 Mar 25
I was sentenced to spend 6 months at Cornerstone from 2/2018-8/2018 and have remained clean since. During my time there, Dr. Stephanie Herring provided invaluable support during one of the hardest times of my life. I greatly appreciate the support I experienced during my time at Cornerstone. I was given the opportunity to figure out how recovery works for me and am happy with my life.
Forrest Rooney
00:19 16 Mar 25
Cornerstone was there for me at one of the lowest points in my life. I had been flown suddenly to California by a rehab called Sobertech. I didn't find out until arriving in Laguna Beach that they told me false info. I was lucky enough to find a hospital to stay at where I heard about cornerstone. It was an amazing part of my life. I cherish those memories. And while life hasnt been easy I'm still off Dope to this day. I'd love to give back somehow. They really cared. And it was a blessing I found them. Forever grateful to cornerstone and all the amazing folks I met employees and patients alike. 🙏
Alejandro Arvizu
00:05 08 Mar 25
I will like to thank my case manager Jennifer Sandoval for meeting all needs for my recovery and been very helpiful in my transition back to society.I will also like to thank all the nurses and staff for giving it all they got on making me feel at home away from home.
Collin Gibellino
23:05 03 Feb 25
Maria, Diane, Dr Herring, Ashley, and all the nurses are top notch. I couldn’t be happier with everyone and everything here. My experience has been absolutely life changing. Love everyone here. 10 stars if I could and if u waste your time going anywhere else you’re a fool.
David Zailer
21:33 23 Nov 24
I came to Cornerstone in 1999 overwhelmed and angry. My health was fragile due to my alcohol and drug use and I had legal troubles because of drugs.
I wound up in Cornerstone's Alternative Sentencing Program. I had two Case Managers while I was there: Robert M and Crystal O. They did their job quite differently and yet both were powerfully effective.
Fast forward twenty-five years: I continue the sobriety Cornerstone gave me through the strong boundaries and support of their program and staff. I also now work 'in the field' of addiction recovery as an author and communicator.
As a professional, I enthusiastically recommend all of Cornerstone's programs, with special mention of the integrity of their Alternative Sentencing Program headed by Dr. Stephanie Herring; a renowned leader in this life-saving work.
David Zailer — Author of OUR JOURNEY HOME, WHEN LOST MEN COME HOME, and DEATH OF A FISHERMAN. Founder of Operation integrity
I wound up in Cornerstone's Alternative Sentencing Program. I had two Case Managers while I was there: Robert M and Crystal O. They did their job quite differently and yet both were powerfully effective.
Fast forward twenty-five years: I continue the sobriety Cornerstone gave me through the strong boundaries and support of their program and staff. I also now work 'in the field' of addiction recovery as an author and communicator.
As a professional, I enthusiastically recommend all of Cornerstone's programs, with special mention of the integrity of their Alternative Sentencing Program headed by Dr. Stephanie Herring; a renowned leader in this life-saving work.
David Zailer — Author of OUR JOURNEY HOME, WHEN LOST MEN COME HOME, and DEATH OF A FISHERMAN. Founder of Operation integrity
Kimberly Lish
14:59 03 Nov 24
We are so happy to hear that Doctor Herring has returned to Cornerstone. Our attorney referred us to her 13 years ago. We are eternally grateful for her and Cornerstone and their Alternative sentencing program.
She was there for us in our scariest moments and stood by our family through it all! She was truly a guardian angel and has helped thousands of people and their families.
Dr. Herring continues to stay in contact with us and shows us nothing but genuine love and support! We LOVE her and are so grateful for her support through all the court proceedings and her heart and compassion. She has become part of our family!❤️
We’d recommend Cornerstone to anyone that needs substance abuse and mental health treatment who have legal charges.
She was there for us in our scariest moments and stood by our family through it all! She was truly a guardian angel and has helped thousands of people and their families.
Dr. Herring continues to stay in contact with us and shows us nothing but genuine love and support! We LOVE her and are so grateful for her support through all the court proceedings and her heart and compassion. She has become part of our family!❤️
We’d recommend Cornerstone to anyone that needs substance abuse and mental health treatment who have legal charges.
Tim O'FLAHERTY
01:50 30 Oct 24
My experience at Cornerstone was amazing. I was committed to changing myself, and they gave me all the tools I needed to do it. You will meet with the Lead Doctor and the Head Nurse, and they will help you get through those first few days of detox. I really needed them. The entire staff is very professional and kind (Maria💚). The facilities are spotless and the food is really good. You will spend time in groups getting to know people who are going through exactly what you are.
They really sincerely care about you.
And if you're serious about getting your life changed, I recommend Cornerstone.
Tim O'Flaherty
They really sincerely care about you.
And if you're serious about getting your life changed, I recommend Cornerstone.
Tim O'Flaherty
David N
20:26 17 Sep 24
Staff members are super nice and friendly. Dr. Stone does his best to keep you comfortable thru detox. Highly recommend this place. I called 4th of July and left a message, they text me back right away that same day.
Ed Hernandez Silva
00:59 26 Jul 24
Saved me by pulling me out of the cycle. I was in a very very bad place. They Uber'd me about 60 miles and I'm now 6 days from 90. I'm so much happier now. Dr stone and his staff truly care. I thank God everyday for this organization. If you can't stop, are alone, feel like no one loves you; call them please. After hours calls will forward to someone who will help. They answer their messages too. That's how I did it at 0330 hrs.
Patrick Fraser
10:25 09 Jul 24
1228 days clean from Painkillers thanks to cornerstone. I left another rehab facility after 28 days with little to no knowledge of PAWS. I soon relapsed. I stayed at cornerstone for a month and did 3 more months outpatient meetings. They kept me on the medication needed to stay off pills and I was able to see my therapist Dr Tanagho (which I still do to this day). When I felt strong enough to come off Suboxone I got put on Sublocade injections and have felt no withdrawals. Raul helped me get on disability the whole 4 months and i didn't have to worry about paying bills. I was able to focus on taking back control of my life.
The Food was awesome. I was able to quit my job that was driving me nuts and finally follow my dream of coaching full time in the sport I love. I have no doubt Cornerstone saved my life, I have no doubt I'd be dead if it wasn't for them. Thanks to Titus, Maria, Diane, my counselor Raul, Jennifer at intake, all the drivers whose name I forgot. God bless you all, 1228 days straight and I'm not looking back. I can't recommended this place anymore, if your sick of it all and ready to move on, Go to Cornerstone.
The Food was awesome. I was able to quit my job that was driving me nuts and finally follow my dream of coaching full time in the sport I love. I have no doubt Cornerstone saved my life, I have no doubt I'd be dead if it wasn't for them. Thanks to Titus, Maria, Diane, my counselor Raul, Jennifer at intake, all the drivers whose name I forgot. God bless you all, 1228 days straight and I'm not looking back. I can't recommended this place anymore, if your sick of it all and ready to move on, Go to Cornerstone.
JONATHAN MACIAS
23:16 25 Jun 24
My experience here at Corner Stone has honestly been great. I’ve been to one other treatment center, but nothing compares to the focus and determination that these counselors and people put into us. I’m very fortunate to have come through this program and met the people that I have met.
My suggestion for anybody that is planning on coming here is to do this for yourself and not no one else because when you fix whatever you have going on mentally or emotionally and get the tools that will help you succeed in turbulent times you will be successful not only one day at a time But you will also have a beautiful journey up ahead.
-Difficult roads lead to beautiful beginnings-
My suggestion for anybody that is planning on coming here is to do this for yourself and not no one else because when you fix whatever you have going on mentally or emotionally and get the tools that will help you succeed in turbulent times you will be successful not only one day at a time But you will also have a beautiful journey up ahead.
-Difficult roads lead to beautiful beginnings-
King Taylor
16:08 25 Jun 24
My experience at CornerStone has been really great. Not only all the staff members like Emily, a BCH TECH, or my case manager Maria Carter who really cares, I've met some very Ginuwine people who are serious about helping you regain control over your life and away from drugs and alcohol.
Mike Louros
02:43 14 May 24
Cornerstone helped me turn my life around. All the staff were amazing, always helpful and supportive of my goals. Thank you cornerstone for everything! I truly appreciate you all so much.
ChooseMelissa Evans
23:26 13 May 24
I received "outstanding" treatment during my time at Cornerstone Rehab. The knowledge and coping skills I have gained will definitely keep me on track throughout my sobriety. The staff from the Rehab Techs, Nurses, Case Manager(Maria Carter), Drivers and my House Manager all the way to the management team were always very professional and willing to assist with all of my needs.
Drew Sutter
19:15 04 Apr 24
I am extremely grateful to the entire staff at Cornerstone. Case managers are always available to listen, and help you adapt. The doctors and nurses are very precise and safe at every stage of recovery. The techs and site managers are always available to make you comfortable and to answer questions.
I came in very uncomfortable, as expected. But I had all of my questions answered, given the tour, shown the schedule, and introduced to people and other elements, in line with my comfort level.
Aside from the staff, they allow you to live with and establish co-dependency with other patients. Some with very similar problems, and some with a different set. Group sessions, activities, and living together all come down to one commonality though - finding the path and the strength to recovery.
A very special shout to Case Manager, Maria Carter too - I have never known anyone who exudes hope and positive energy like her. She listens to you, and hears you. Truly dedicated to making us successful.
I came in very uncomfortable, as expected. But I had all of my questions answered, given the tour, shown the schedule, and introduced to people and other elements, in line with my comfort level.
Aside from the staff, they allow you to live with and establish co-dependency with other patients. Some with very similar problems, and some with a different set. Group sessions, activities, and living together all come down to one commonality though - finding the path and the strength to recovery.
A very special shout to Case Manager, Maria Carter too - I have never known anyone who exudes hope and positive energy like her. She listens to you, and hears you. Truly dedicated to making us successful.
julie snyder
18:50 18 Mar 24
“I cannot express enough gratitude for the exceptional care and support I received at Cornerstone of Southern California. From the moment I walked through the doors, I felt welcomed and understood. The staff members were not only highly professional but also genuinely compassionate, guiding me through every step of my journey towards recovery.
The program’s evidence-based therapies with personalized attention, provided me with the tools and insights necessary to confront my addiction and reclaim control of my life. The therapeutic environment fostered a sense of community and understanding, allowing me to connect with others who were on similar paths.
Moreover, the facility’s amenities were top-notch, offering a comfortable and safe environment conducive to healing and self-reflection. The serene surroundings and well-appointed accommodations added to the overall positive experience.
Thanks to the comprehensive support and resources available at Cornerstone of Southern California, I have emerged stronger, healthier, and more hopeful than ever before. I wholeheartedly recommend this center to anyone seeking effective and compassionate treatment for addiction. It truly changed my life for the better.”
The program’s evidence-based therapies with personalized attention, provided me with the tools and insights necessary to confront my addiction and reclaim control of my life. The therapeutic environment fostered a sense of community and understanding, allowing me to connect with others who were on similar paths.
Moreover, the facility’s amenities were top-notch, offering a comfortable and safe environment conducive to healing and self-reflection. The serene surroundings and well-appointed accommodations added to the overall positive experience.
Thanks to the comprehensive support and resources available at Cornerstone of Southern California, I have emerged stronger, healthier, and more hopeful than ever before. I wholeheartedly recommend this center to anyone seeking effective and compassionate treatment for addiction. It truly changed my life for the better.”
Elly Clemens
17:40 06 Mar 24
I am so grateful for Cornerstone. since entering this program I have been gifted hope back into my life. I have gained the courage to enroll in school, the opportunity to rebuild family relationships, and build a sober network and life! this program supported me in a way that made restarting in a new state possible. I have been in treatment many times before here, but gained new insight and tools past my previous knowledge. I love that the transition has been smooth from PHP all the way to sober living. My therapist was absolutely amazing and my case management team was incredible as well!
Chad Klaich
01:32 06 Mar 24
Cornerstone has been such a blessing in my life. Out of all the treatment centers I could’ve gone to, I’m so fortunate I landed here. The staff was helpful, and friendly. It felt as if they knew from experience what I was going through. My case manager Diane, was instrumental in helping rebuild my life and getting me out onto the road of recovery. I absolutely love my sober life today and I can’t imagine I would be here without Cornerstone!
Shan Mir
22:58 31 Jan 24
It was literally the turning point in my life. Staff were incredible and the curriculum was just what the doctor ordered. I'm so grateful for Cornerstone. Just celebrated my 1st year of sobriety last December and I would definitely recommend Cornerstone to anyone who truly has a desire to solve the drink or drug problem.
Shan Mir
Shan Mir
