medication for alcoholism to reduce cravings

Naltrexone

OTHER MEDICATIONS

Naltrexone is one of the most common medications for alcohol use disorder. It reduces your motivation to drink by blocking the reinforcement or “reward” from alcohol. This medication boasts a high success rate, and is ideal for people who want to cut back or gradually quit drinking.

Naltrexone is best for:

  • Limiting alcohol cravings   
  • Treating physical addiction   
  • Changing habits over time   
  • Establishing moderation as an option

Is it right for you? Skip to pros and cons of Naltrexone

Table of Contents

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What Is Naltrexone?

Naltrexone is an anti-craving medication prescribed to treat alcohol use disorder, often sold under the brand names Revia, Depade, and Vivitrol. It was originally approved to treat opioid addiction, and is still commonly used for this purpose as well.1

How Does Naltrexone Work For Alcohol Use Disorder?

Here’s how naltrexone works:

  • When someone uses an opioid drug like heroin or oxycodone, naltrexone stops the person from feeling the pleasure or sense of euphoria they usually do. That’s because naltrexone is an opiate antagonist—meaning it blocks the body from responding to endorphins.
  • Although alcohol isn’t an opioid drug, researchers have found that naltrexone works in a similar way with drinking, by blocking the alcohol-induced endorphin rush.
  • When a person drinks on naltrexone, other intoxicating effects of alcohol will still be present, but the pleasurable aspects will decrease. Over time, this teaches the brain to expect less pleasure from alcohol, making it easier to stop after the first or second drink.

How Effective Is Naltrexone?

Naltrexone already has a long track record in effective addiction treatment.2 It’s been FDA-approved to treat opioid addiction since the 1980s, and approved to treat alcohol use disorder (AUD) since 1995. It appears useful for other addictions as well, including nicotine dependence,3 and behavioral addictions like gambling, pornography and overeating.

When it comes to alcohol use, research on naltrexone shows that it effectively reduces heavy drinking and cravings,4 and reduces the chance that someone will return to unhealthy drinking behaviors.5 Exact success rates vary, but the Sinclair Method, which uses naltrexone, has a 78 percent success rate.6

How Do You Take Naltrexone?

There are several ways of taking naltrexone for alcohol use disorder, including a once-daily pill, a tablet one hour before you drink alcohol, and a monthly injection.

  • One option is to take a single naltrexone pill each morning. This can be useful if you drink most days, as it will block the endorphin rush from any alcohol you consume. It can also help reduce your overall cravings for alcohol.
  • Alternately, you can take a dose of naltrexone one hour before you plan to drink, as per the Sinclair Method. This is especially helpful for binge drinkers, or for people who want to continue drinking moderately after recovering from AUD.    
  • If you’re committed to taking naltrexone for alcohol cravings, but concerned you’ll forget and miss doses, you can also get a monthly injection (sold under the brand name Vivitrol). While this is significantly more expensive, it eliminates the risks and guesswork, and will protect you for 30 days. 

Research has shown that for naltrexone to be effective, it’s extremely important to take as directed.7 Some people may miss doses because they forget, or want to feel more of a buzz when drinking. Unfortunately, even skipping one or a couple could make the next doses less effective. That’s why counseling is beneficial alongside the medication. Our coaches can help you make a plan to stick to your naltrexone schedule.

The Sinclair Method (TSM)

One of the better-known ways of taking naltrexone for AUD is the Sinclair Method, developed by Dr. John David Sinclair in the later 20th century.

Dr. Sinclair was a pioneer of medication-assisted treatment, and was among the first to discover that naltrexone could combat addiction while a person was still consuming alcohol. This approach remains controversial for some because it doesn’t require a person to quit completely. However, it has one of the highest success rates in treating AUD—up to 78 percent of people on TSM overcome their addiction.8

The key to the Sinclair Method is a concept known as pharmacological extinction:

  • A person following TSM takes a single dose of naltrexone an hour before drinking, then consumes alcohol as normal.    
  • Naltrexone blunts the pleasurable effects of alcohol, making the experience less rewarding. 
  • Over time, this rewires a person’s brain to stop expecting the same “buzz” when they drink.
  • The end result is that many people completely lose interest in drinking alcohol. 

For many, TSM eliminates the long-term struggle linked to sobriety. Essentially, the addiction becomes extinct.

While there are several other variations on taking naltrexone for alcohol use disorder, TSM remains one of the most effective strategies. Ria Health offers full medical and coaching support to help people succeed on the Sinclair Method—100 percent online.

What Is the Ideal Dose For Naltrexone?

The recommended dosing of naltrexone varies depending on the individual. At Ria Health, we often start patients at 25mg and gradually increase to 50mg. But depending on how fast a person metabolizes the drug and what side effects they experience, the ideal dose may be above or below this range. Low-dose naltrexone (which can mean doses below 5mg) is under investigation for AUD, but the jury is still out.

How Does It Feel To Drink on Naltrexone?

If you consume alcohol after taking naltrexone, you generally won’t feel the same “buzz.” Consuming large amounts of alcohol will still impair your coordination and judgment, but you won’t feel the same amount of pleasure. Many people start to lose interest after one or two servings of alcohol, because it isn’t having the desired effect.

Read more: What’s It Like To Drink on Naltrexone?

How Long Does It Take For Naltrexone to Work?

The pill itself takes about an hour to fully kick in. As for treatment with naltrexone, people often experience some improvement the first time they take the medication, but it usually takes some time for naltrexone to fully eliminate alcohol cravings.

Your doctor will supervise your treatment to determine how long you should take the medication. Typically, patients see the best results when they take naltrexone as needed for a few months or longer.

Does Naltrexone Help With Alcohol Withdrawal?

Naltrexone can help people gradually reduce their drinking, and thereby avoid severe withdrawal symptoms. However, other medications such as benzodiazepines, or off-label AUD solutions such as gabapentin, may be more helpful for acute withdrawal or detox. Naltrexone is generally best for cutting back or maintaining abstinence, rather than quitting cold turkey. If you plan to stop drinking abruptly, talk to your doctor first.

Why Naltrexone Helps People Change Their Drinking

Naltrexone does not stop alcohol from having any effect on you, nor does it make you feel ill when you drink. Instead, it changes 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 a person takes 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 for alcohol use disorder 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, and only makes them feel 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 treatment 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.

Read more: How Naltrexone Works on Your Brain

Download Our Naltrexone Guide

Learn more about Naltrexone by downloading our guide. Just enter your email address and we will send you a PDF file right to your inbox to download. 

Naltrexone e-book

Side Effects of Naltrexone

Fortunately, naltrexone has no known fatal side effects or severe allergic reactions. However, some people experience:

  • Headache
  • Drowsiness
  • Stomach pain
  • Loss of appetite
  • Dizziness
  • Nausea or vomiting
  • Nervousness
  • Insomnia
  • Joint Pain
  • Rash
  • Muscle Cramps
  • Restlessness
  • A feeling of intoxication
  • Weight loss

The most commonly reported side effects of naltrexone are headaches and nausea.9 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, consult with your doctor. There are many other medication options for alcohol use disorder.

Naltrexone can have other rare but serious side effects.10 Although it’s unlikely, you should contact your health provider if you experience:

  • Elevated blood pressure 
  • Increased heart rate 
  • Confusion 
  • Depression or suicidal thoughts 
  • Nightmares 
  • Blurry vision 
  • Allergic pneumonia (symptoms such as coughing, wheezing or breathing problems)

Like most drugs, it’s possible to overdose on naltrexone, possibly leading to coma or death. Do not take more than the recommended dose.

Read more: Dr. John Mendelson on Naltrexone Side Effects

The “Nalover”

One naltrexone side effect some people experience has earned the nickname “nalover.” This is essentially a type of hangover experienced by people on the medication. We conducted an informal survey to learn more about this in 2019, and found that more than a third of participants never experienced a “nalover.” However, more than 15 percent who responded to us experienced it frequently, and described it as more severe than a normal hangover.

Read more: What is a Nalover?

Naltrexone Safety

A recent review of research concluded that there were only a few safety concerns related to taking naltrexone for alcohol use disorder. The main situations in which you might want to avoid naltrexone altogether are:

  • If you are taking opioid pain medications to manage a chronic condition. These will be blocked by naltrexone, producing unintended withdrawal and disrupting pain management.
  • If you have any kind of liver disease. Since naltrexone is processed through the liver, speak to your doctor about safety when taking naltrexone. In advanced cases, a different medication may be advisable.

Overall, to make sure that your naltrexone treatment is both safe and effective, it’s 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.

It’s also important to note that naltrexone does not eliminate all the risks of alcohol. Drinking will feel less pleasurable, but you can still become intoxicated while taking the medication. This means that you need to remain aware of how much you’re drinking. You could still experience bad coordination, impaired judgment, or blackouts. You should never drive a vehicle, and you should make sure you have a plan for getting home safe.

Is Naltrexone Safe To Take During Pregnancy?

How naltrexone may affect a fetus is unknown. Experts believe that it crosses the placenta, meaning that the drug could be transferred to the baby. A review of research on animals showed that naltrexone may cause developmental abnormalities, and may increase risk of miscarriage.11 It’s important to understand that these results may not translate to humans. Also, the doses used in these studies are much higher in comparison.

If you are pregnant or planning on becoming pregnant while taking naltrexone, you should talk to your doctor. Since drinking alcohol while pregnant also has well-known negative impacts, they will weigh the benefits and risks to help you choose the safest option.

Is Naltrexone Addictive?

Naltrexone is considered non-addictive. The medication doesn’t cause physical or psychological dependence, and you shouldn’t feel any sort of buzz, high, or sense of euphoria. Stopping naltrexone should not cause any withdrawal symptoms either. However, getting off naltrexone does mean that alcohol returns to its usual effect, meaning you cannot drink once you stop taking naltrexone.

Does Naltrexone Have any Long-Term Impacts?

Naltrexone can take some time to have its biggest impact on your drinking, and people who want to continue drinking moderately often take the medication indefinitely. For this reason, you may wonder if there are long-term side effects or safety concerns associated with it.

Fortunately, there are no known problems caused by long-term use of naltrexone for alcohol cravings when taken as directed. That said, you should monitor the condition of your liver if you are taking high doses, and you should always have a doctor’s supervision.

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Does Naltrexone Interact With Other Medications?

In general, naltrexone has few interactions with other medications, with one major exception: Opioids.

Naltrexone is used to treat opioid addiction precisely because it blocks these drugs from having their usual effect. If you are taking opioid medications for pain relief, or are dependent on any of these drugs, it’s important to stop taking them 7-14 days before starting naltrexone to avoid acute withdrawal symptoms, or disruption of pain management.

Common pain medications incompatible with naltrexone include hydrocodone, codeine, oxycodone, fentanyl, and tramadol. Diarrhea medications containing diphenoxylate, and cough medicines containing dextromethorphan also wont have their usual effect when you’re taking naltrexone.

Pain medicines that do not contain opioids, such as Tylenol and Motrin, are generally safe to take with naltrexone, but you should check with your doctor about the health of your liver first. As a rule of thumb, always discuss any medication combinations with your medical provider to ensure they are safe for your individual body chemistry.

Read more: Naltrexone Interactions

Is Naltrexone For You?

Naltrexone May Be Helpful 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 Best If:

  • You need to quit drinking immediately
  • You have liver disease
  • You are taking opioid pain medication
  • You are pregnant

Naltrexone is best for people who experience strong alcohol cravings, have trouble stopping drinking once they get started (binge drinking), and find that staying sober through sheer willpower is not sustainable. It is also a good choice for those who wish to still drink moderately on occasion (a glass of wine at a wedding, for example). Naltrexone can help retrain your mind to no longer crave alcohol, and give you back your freedom of choice.

If someone experiences strong side effects from the medication, if they have trouble sticking to their medication schedule, or if they have strong external motivators to drink, naltrexone may not work. For many, drinking alcohol is a coping mechanism. While naltrexone still helps in these situations by reducing physical cravings, it’s often most effective when combined with community or coaching support, as in Ria Health’s program.

Ready to get started with medication-assisted treatment?

Ria Health combines 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.

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