Which of the following medications is used with patients who are highly motivated to quit drinking?

Disulfiram is a medication specifically used to support individuals who are highly motivated to quit drinking alcohol. It works by creating an unpleasant reaction when alcohol is consumed, which can serve as a strong deterrent against drinking. This reaction can include symptoms such as flushing, palpitations, nausea, and vomiting. The effectiveness of disulfiram is significantly enhanced when patients are committed to abstaining from alcohol, as the medication reinforces the motivation to avoid drinking due to the negative consequences associated with its use.

In contrast, while naltrexone and acamprosate are effective in helping manage cravings and maintaining abstinence, they do not create the same immediate negative reinforcement as disulfiram. Naltrexone helps reduce cravings and the pleasurable effects of alcohol, which may benefit a broader range of motivations. Acamprosate is typically used after the detoxification process and is intended to help maintain abstinence, but it does not have the same aversive component as disulfiram, making it less effective for someone who may not be as committed to quitting. Varenicline is primarily used for smoking cessation and is not indicated for treatment of alcohol use disorder.