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FDA-Approved Alternatives Acamprosate [15] Second-line option Similar NNT to naltrexone (approximately 11) Major drawback: Requires 6-9 tablets daily High pill burden significantly impacts adherence More complex dosing for busy ED implementation Safe for patients with liver disease and opioid use disorder Disulfiram [18-21] Works as aversive agent, causing disulfiram reaction from accumulation of acetaldehyde, when combined with alcohol Recent RCTs show no significant benefit for reducing alcohol use Poor adherence due to fear of severe side effects Less likely to be prescribed in the ED, as naltrexone is a better option

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The authors concluded that "those with ASDs are affected by an imbalance between their anti-oxidative and oxidative stress systems, a condition which could be treated with glutathione supplementation"

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