Prazosin-Related Reductions in Daily Craving Mediate Treatment-Related Daily Alcohol Use Outcomes in Alcohol Use Disorder
In brief
Prazosin cuts daily alcohol craving, driving two thirds of drinking reduction
In a 12-week double-blind trial, patients taking prazosin reported significantly lower daily craving, and this drop predicted a 66% greater reduction in next-day alcohol consumption compared with placebo. The results suggest prazosin's anti-craving effect may be the key mechanism behind its ability to lower drinking, though longer-term outcomes remain to be studied.
- Journal
- Biological psychiatry global open science (Q1)
- Published
- 19 June 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Stephanie Wemm, Rachel Hart, Gretchen Hermes, Zachary Harvanek, Rajita Sinha
- PMID
- 42572561
- DOI
- 10.1016/j.bpsgos.2026.100772
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 11 August 2026): Prazosin reduces daily craving, mediating lower alcohol intake in AUD
Abstract
BACKGROUND: Prazosin has been shown to reduce drinking, particularly in individuals with alcohol withdrawal symptoms, possibly due to reducing craving as shown in experimental studies. However, it is unclear whether prazosin decreases daily changes in alcohol craving and whether such changes drive prazosin-related changes in alcohol intake in the treatment of alcohol use disorder (AUD). METHODS: Using an intensive daily-level longitudinal design embedded within a 12-week, double-blind, placebo-controlled, randomized clinical trial of prazosin (16 mg/day) versus placebo (PBO) for the treatment of AUD, we examined treatment effects using daily phone surveys of alcohol craving and intake. Participants were treatment-seeking individuals (52 on prazosin, 45 on placebo, 97% of the treated sample) who met current criteria for AUD and who provided a total of 4289 daily surveys over the 12-week treatment period. RESULTS: Prazosin but not PBO significantly reduced daily craving (estimate [Est] = -0.902, 95% credibility interval [CI] [-1.296 to 0.475]), and this craving reduction predicted lower next-day drinking for participants taking prazosin (Est = -1.317, 95% CI [-2.196 to -0.599]) but not PBO (Est = -0.491, 95% CI [-1.147 to 0.087]), which represented a 66.7% versus 26.7% craving-mediated reduction in alcohol intake. CONCLUSIONS: Utilizing an intensive daily longitudinal design and random slope modeling, the current study examined daily craving change as a dynamic process associated with changes in daily alcohol intake during treatment. The findings support prazosin's anticraving mechanism of action underlying prazosin-related reductions in alcohol intake.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.