The small number of patients studied, the high rate of loss to follow-up, and the fact that gabapentin is used to produce intoxication, particularly by people with a substance use disorder, argues against its use as a first-line treatment for AUD. A meta-analysis of topiramate’s efficacy showed clinically significant associations with improvements on multiple alcohol-related outcomes.18 Consistent with that evidence, topiramate, disulfiram, acamprosate, and naltrexone are all recommended as appropriate first-line treatments in the practice guideline published by the Department of Veterans Affairs/Department of Defense.60 Preceding the publication of the practice guideline, the use of topiramate to treat AUD doubled in the Veterans Affairs Health System in a three-year period.61
