What is the initial treatment for alcohol use disorder that can be started while a patient still consumes alcohol?

Naltrexone is the appropriate choice for the initial treatment of alcohol use disorder that can be initiated while a patient is still consuming alcohol. This medication functions primarily as an opioid receptor antagonist, which can help reduce cravings and the reinforcing effects of alcohol, making it effective even in the early stages of treatment.

Naltrexone works by blocking the euphoric effects of alcohol, which can assist patients in reducing their intake and ultimately help them abstain. It is beneficial in that it doesn't require complete abstinence from alcohol before starting treatment, allowing for immediate intervention.

In contrast, disulfiram requires complete abstinence from alcohol before it can be effectively used, as it causes unpleasant reactions when alcohol is consumed. Acamprosate is typically used after abstinence has been achieved, helping to maintain it rather than initiate treatment. Topiramate, while having some promise for alcohol use disorder, is often considered off-label and is not the first-line treatment initiated in patients still actively consuming alcohol.