Naltrexone is one of the most common medications for alcohol use disorder. It boasts a high success rate and is ideal for people who want to cut back, or change their drinking behaviors.
Naltrexone is best for:
- Limiting alcohol cravings
- Treating physical addiction
- Changing habits over time
- Establishing moderation as an option
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This page will cover everything you need to know about naltrexone, and how it can be used to help you reduce or stop drinking alcohol.
Naltrexone reduces your motivation to drink by blocking the pleasure effects of alcohol. It does this by limiting the endorphin rush many people get from drinking. Naltrexone was originally developed to treat opioid addiction, and although alcohol is not an opiate, the effect of naltrexone is similar.
The chemistry is as follows:
- Opiates like heroin and oxycodone (Oxycontin) imitate the effect of endorphins in your body
- Naltrexone blocks those opiates from having any effect on you
- Habitual drinkers experience a rush of endorphins when they drink (the other name for endorphin is actually “endogenous opiate,” meaning an opiate created by your own body)
- It turns out that naltrexone also blocks this self-generated opiate rush, making it effective for treating alcohol addiction
Naltrexone has been approved for treating opiate dependency since the 1980s, and has been approved by the FDA to treat alcohol use disorder (AUD) since 1995. It now has a long track record as a safe and highly effective medication, and has helped many people quit or reduce their drinking.
One of the strongest original advocates for the use of naltrexone to treat AUD was Dr. John David Sinclair. Through his research, Dr. Sinclair found that a single dose of naltrexone taken an hour before drinking could block the pleasure effects of alcohol, and over time help a person modify their behavior. The long-term result was a phenomenon he termed “pharmacological extinction.” What “extinction” means is that a person no longer feels the urge to drink, and is essentially cured of the cravings and compulsive behaviors that can drive alcohol addiction.
The Sinclair Method (TSM) has a roughly 78% success rate, and has won many supporters and advocates. Among them is the actress Claudia Christian, who successfully overcame alcohol use disorder using the method. Christian was so inspired by the Sinclair Method that she began the C Three Foundation to raise awareness. (Christian is on the advisory board of Ria Health.) Below, she gives an excellent account of how naltrexone helped her and why it can be a life-saving option for some people.
As TSM gains visibility and popularity, it is helping to open a broader dialogue about medication to treat alcoholism. It is also raising the public profile of naltrexone.
In addition to the Sinclair Method, there are a number of other ways of using naltrexone to treat AUD. These include a single, daily dose (whether you plan to drink or not), and the Vivitrol shot.
- Vivitrol can be taken as an injection once a month, eliminating the need to remember your medication. This can be more expensive, but if covered by insurance it can be an easier method for maintenance. This is especially true if you’ve already reduced your drinking, and want to keep things on track.
- A daily dose of naltrexone in pill form is another strong option. This allows you to skip the guesswork that comes with the Sinclair Method. It can also be more affordable.
- Counseling and coaching are not necessarily part of TSM. However, combining other forms of therapy with naltrexone can improve results for some people.
Ultimately, speaking with a doctor about your particular needs can make all the difference. The best way to take naltrexone can vary depending on who you are, and your personal situation.
Naltrexone does not stop alcohol from having any effect on you, nor does it make you feel ill when you drink. What it does is change the balance between the positive and negative effects of alcohol.
When someone has developed alcohol use disorder, it means that the enjoyable results of drinking are making a bigger impression, or having a larger pull than the negative ones. This doesn’t mean that they aren’t aware of the negative impacts—the hangovers, the effect on their relationships or work life, and their overall health. It’s just that in the moment these can become smaller concerns than the urge to drink and experience the more temporary pleasurable effects.
When you take naltrexone regularly, those pleasurable effects are reduced, leaving the negative effects in greater contrast. For many people, this begins a relearning process, both conscious and subconscious.
In some sense, taking naltrexone is about behavior modification through positive and negative reinforcement. A person might learn from experience that drinking feels good, and then develop an instinct or an urge to drink. By shifting the balance using naltrexone, that same person might learn from experience that alcohol has little pleasant effect, other than feeling disoriented and hungover.
Over time, a different instinct, urge, or habit can emerge to replace the old one. It becomes easier to listen to that voice in your head telling you to “only have a few beers.” Eventually, some people find that they can actually ignore alcohol. The advantage of naltrexone is that, rather than quitting cold turkey and always wishing you could have “just one drink,” you may actually get to the point where alcohol no longer matters to you.
Thankfully, the answer appears to be no. The pleasures of eating, exercise, or sex do not seem to be affected by the presence of naltrexone in a person’s system. The best explanation for this is that these endorphins (as well as serotonin) are released in your body through a different process. Dr. John Mendelson explains below:
This doesn’t mean naltrexone is without drawbacks, however…
While naltrexone can be very useful for reducing alcohol cravings, or physical dependence on alcohol, it can’t necessarily remove a person’s external motivations to drink.
This can be particularly challenging for people who struggle with stress, anxiety, or depression, and use alcohol to self-medicate. While cravings or immediate pleasure effects may be reduced on naltrexone, the use of alcohol as a coping mechanism can remain a more powerful motivation to drink. Gabapentin, which has been shown to reduce anxiety and alcohol cravings at the same time, might be a better option in these cases. It can also make a difference to combine medication with counseling and support.
Aside from differences in psychology and personal experience, there are also chemical and biological differences between people. Absorption of naltrexone by the body can vary between five and 40 percent, so some people may need much higher doses than others.
Then, as with any medication, there are side effects…
Fortunately, naltrexone has no known fatal side effects or severe allergic reactions. However, some people experience:
- Severe stomach discomfort, including nausea and diarrhea
- A feeling of intoxication
- Strange dreams
- Weight loss
For most people, these side effects occur in the first week, and then go away. Often, by starting with a lower dose and working your way up, and taking the medication with food, these issues can be eliminated. However, in as many as 10 percent of cases the side effects are severe enough—and persistent enough—that naltrexone won’t work for you. If this is the case, there are many other medication options.
Another naltrexone side effect that has yet to be studied in depth is the “nalover”—essentially a type of hangover experienced by people on the medication. We conducted an informal survey on Reddit and Facebook to learn more about this, and here is what we found:
More than a third of participants never experienced a nalover. However, more than 15 percent experienced it frequently.
Of the people who experienced nalovers, the majority said they were more severe than a normal hangover.
Of the nalover symptoms reported, fatigue seemed to be the strongest and most common, followed by thirst, headache, loss of appetite, and nausea.
As an informal study, there is not enough data to draw conclusions. But many people on naltrexone will experience this side effect, to one degree or another.
Read the full article here
In a few specific cases you may want to avoid naltrexone altogether:
- If you have alcoholic hepatitis, the medication can make the condition worse.
- If you are taking opioid pain medications to manage a chronic condition, those will be blocked by naltrexone as well, which may produce a withdrawal you didn’t intend and disrupt your pain management.
To make sure that your naltrexone treatment is both safe and effective, it’s generally best to have the advice of a trusted physician. Adjustments to dosage, especially above 100mg, should be monitored, as should side effects and pre-existing conditions.
As word about naltrexone spreads, the availability of legitimate prescriptions is lagging behind in some places. The result is that many people are ordering naltrexone online. This can seem like a good idea at the time, but it is important to be aware of the risks involved. If you find yourself ordering from a non-FDA-approved source, beware of the following:
- Inconsistent dosage or unlisted additives
- Excessive cost
- Interruption by customs agents
- Lack of medical supervision or support
Where possible, play it safe. There may be better options in your state than ordering from an unknown overseas pharmacy.
Naltrexone May Help If:
- You struggle with alcohol cravings
- You are interested in moderation
- You want to cut back gradually
- You have a family history of alcoholism
Naltrexone May Not Be the Best Choice If:
- You need to quit drinking immediately
- You have liver disease
- You are taking pain medication
In summary, naltrexone is best for people who have a habitual dependency on alcohol, drink compulsively, and have physical addiction symptoms. It may not be as effective for those who drink to manage emotional stress, or who struggle with mental illness. Additionally, although naltrexone can help you achieve abstinence, there are other medications which may do this more directly.
Naltrexone is the path to take if you want to cut back over time, want the option of moderation, and most importantly, want to reset your mental and physical reactions to the idea of alcohol. As Claudia Christian puts it, it can feel like a miracle to suddenly realize that you no longer care about whether or not you can drink. Naltrexone can bring about that shift in your psychology, and help you make a permanent change.
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Ria Health offers treatment for alcohol use disorder via telemedicine
We combine prescription medication, recovery coaching, and digital tracking tools to create custom plans for each member's needs. The program is covered by many insurance plans, and can be done 100 percent from your smartphone or personal device.