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Here at Ria Health, our preferred drug of choice is Naltrexone, which blocks opioid-receptors. It’s been approved for the treatment of alcohol dependence since 1995, so it is generally on the formulary for most insurance plans. It can be taken while still drinking without any severe consequences, which can occur when taking Antabuse. Naltrexone’s list of side effects is generally mild, and it’s also taken orally once a day, which can be easier to remember. A once-monthly injectable formulation was approved in 2010, but some studies suggest it may not be as effective as pills when treating alcohol dependence.

Naltrexone’s list of side effects is generally mild, and it’s also taken orally once a day, which can be easier to remember.

But alcohol isn’t an opiate.

I agree with you, alcohol is definitely not an opiate. Then how does it work? To start, we need to discuss the body’s own natural opioid system, which consists of signal molecules—such as endorphins—and their receptors. This system is spread throughout the brain and nervous system, and plays a key role in things like mood and well-being, making it very important to the establishment of addiction. So, in the context of alcohol abuse, every time you take a drink, you feel good, and this system is why. These opioid receptors are necessary in creating the link to establishing the addictive behavior. Naltrexone blocks the opioid receptors, removing that link, and eliminates the reinforcement of the addictive behavior.

Does Naltrexone really work?

One large study, called the COMBINE study from 2006, compared combinations of medications (Acamprosate and Naltrexone) and behavioral modification therapy in the treatment of alcohol abuse. Researchers were looking for a reduction in alcohol consumption, both in number of days without drinking and number of days per week of heavy drinking. They were also looking to see if the improvements acquired through treatment would last after finishing the trial.

They found the greatest improvements were in patients taking Naltrexone or getting behavioral therapy (but interestingly, not when both were combined). On the other hand, patients receiving the other medication, Acamprosate, showed relatively less improvement, and those receiving a placebo showed the least.

…found the greatest improvements in patients taking Naltrexone or getting behavioral therapy

Another more recent study, from 2016, looked at numbers of both heavy-drinking and non-drinking days in college students. Subjects were given either Naltrexone or a placebo and were followed for an 8-week period. In this study, the Naltrexone group—compared to the placebo—didn’t show any significant difference in drinking vs. non-drinking days. But they did report fewer drinks per drinking days, lower estimated BAC (blood alcohol level) per drinking day, and up to 23% fewer days for which drinking was estimated to reach the legal limit. So, here Naltrexone was shown to help reduce the intensity of drinking.

…they did report fewer drinks per drinking days, lower estimated BAC per drinking day, and up to 23% fewer days for which drinking was estimated to reach the legal limit.

As I mentioned earlier, this is in no way a guarantee that Naltrexone will completely eliminate problem drinking. What it might do, however, is reduce that behavior. Patients taking Naltrexone also showed less risk of returning to heavy drinking. On top of that, up to a year after treatment, the Naltrexone patients reported less need for hospital visits, psychiatric medications, or detox medications for their alcoholism.

And it goes without saying, if you’re having difficulties managing your drinking, I”m here to help you.

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