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What Are Alcohol Shakes And Tremors?

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If you’re asking yourself this question, you may have heard about the risks of withdrawal symptoms when quitting alcohol cold turkey or significantly reducing your alcohol consumption. Seeking more information about alcohol shakes or tremors is helpful in understanding both alcohol dependence and alcohol recovery. However, if you believe you are currently experiencing shakes, tremors, or any other alcohol withdrawal syndrome side effects, please contact your health care provider immediately. If this is a medical emergency, please call 911.

For those looking for non-urgent information about shakes and tremors to inform conversations with your healthcare provider and/or loved ones, I’m here to share more about the causes and signs of these alcohol-induced symptoms. Alcohol shakes and tremors are uncomfortable and potentially life-threatening signs of alcohol withdrawal that typically occur 6-24 hours after alcohol was last consumed  and reach their peak within 24 to 72 hours.¹ To understand why they occur, let’s dive into the brain chemistry of withdrawal.

The chemical explanation behind alcohol withdrawal 

Alcohol can affect brain chemistry while we are drinking and after we stop. Frequently asked questions from my patients include ‘is alcohol a stimulant or depressant?’ and ‘why do I feel so horrible when I stop drinking?’ A sudden cessation or reduction in alcohol intake can lead to alcohol shakes and tremors, among other alcohol withdrawal symptoms. That’s why before you cut back on consuming alcohol, it’s crucial that you connect with a health care provider to discuss your safest course of action. Regardless of your drinking habits, whether you classify them as long-term daily use, binge drinking, or otherwise, it’s always recommended to check in with a professional. Now, let’s dive into the chemistry of alcohol withdrawal.

In a normal state, your brain keeps you alert and calm by keeping what’s called your inhibitory and excitatory systems in balance. This is also known as E-I balance. Alcohol throws off this balance by enhancing the activity of a major inhibitory chemical in your brain called GABA, resulting in you feeling relaxed and drowsy. As you continue to drink regularly and spend more time in the inhibited state, your brain tries to find E-I balance again. The brain seeks this balance by reducing your natural inhibitory activity (because alcohol is already unnaturally increasing inhibitory chemicals) and increasing excitatory activity. 

When you suddenly stop drinking or decrease alcohol consumption significantly, you remove the unnatural inhibitory chemicals, and your inhibitory and excitatory systems are imbalanced. Your inhibitory system is depressed, and your excitatory system is overly enhanced. This leads to an overexcitation of your brain and the development of signs and symptoms of alcohol withdrawal, including the possibility of shakes, tremors, and other symptoms. 

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Symptoms of alcohol withdrawal 

Alcohol withdrawal can have mild to severe symptoms. Severe withdrawal symptoms can be life-threatening, and it’s crucial to both be aware of them, and discuss potential risks with your healthcare provider.

Alcohol shakes and tremors

One possible symptom is alcohol shakes and tremors, which refers to an uncontrollable shaking or involuntary quivering, commonly in the hands and feet. In addition to alcohol withdrawal shakes and tremors, people may experience anxiety, sweating, agitation, headache, nausea, and vomiting. 

About 80% of people who are dependent on alcohol experience withdrawal symptoms to some degree, though most improve within a week without complications.² However, in more severe cases, people may have auditory, visual, or tactile hallucinations, among other symptoms. A common tactile hallucination is feeling a bug crawling under your skin. If you’re experiencing symptoms, including shaking hands when not drinking alcohol, you should check in with your healthcare provider. They will work with you to provide the safest course of action, and also provide relief by answering your questions.

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Hallucinations

Hallucinations can occur without any prior symptoms and are most likely to develop 8 hours after the last drink and peak at 24-96 hours.² If you believe you are experiencing withdrawal symptoms, you should seek medical attention immediately at your local emergency room and call 911 in case of emergency. 

Seizures

In addition to hallucinations, seizures are another potentially severe symptom of alcohol withdrawal. Withdrawal-related seizures can occur even if you don’t have other symptoms. Seizures can begin as early as 12 hours after the last drink and can last up to 48 hours.² About 5-15% of people withdrawing from alcohol develop seizures.²

The risk is the greatest for people who previously had seizures and those withdrawing from other sedatives such as benzodiazepines. When navigating alcohol treatment, it’s especially important to accurately share your medical history and alcohol consumption history with your provider, so that they can provide the safest and most appropriate care for you. Hallucinations and seizures can also be part of a severe alcohol withdrawal response known as delirium tremens.

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Distinguishing between delirium tremens (DTs) and tremors 

Delirium tremens (DTs) is among the most severe and potentially life-threatening symptoms of alcohol withdrawal. As the name suggests, the signs of delirium tremens include confusion, disorientation, fever, high blood pressure, rapid heartbeat, and drenching sweats. Withdrawal delirium typically begins between 1 to 3 days after the last drink and peaks on the 4 to 5th day.²

What is the difference between the two?

As a physician on the Monument platform, I often hear patients confuse DTs with tremors when first learning about alcohol withdrawal. While DTs symptoms may include alcohol tremors and shakes, DTs is also characterized by other signs of severe alcohol withdrawal, like high blood-pressure and seizures. In comparison, alcohol tremors and shakes are more common than DTs, and can be a sign of mild or severe withdrawal.  

The safest way to ensure you don’t experience dangerous withdrawal symptoms is to first consult with a medical professional to assess your risk and align on the appropriate level of care. Depending on the risk level, medical withdrawal management, commonly known as “detox,” may be recommended. Supervised alcohol detox may require medication and frequent monitoring to be done safely. Furthermore, other medical conditions can mimic acute alcohol withdrawal or post-acute alcohol withdrawal, so it’s important to get immediate medical attention to receive accurate diagnoses and care. 

It’s difficult to predict the course of acute alcohol withdrawal symptoms, which is why it’s recommended to seek expert guidance. Some people have very mild symptoms that resolve quickly, while others have more severe and prolonged courses. There is also the possibility that an individual develops prolonged withdrawal symptoms, also known as post-acute withdrawal syndrome (PAWS), which can last a few weeks to a few months. You can learn more about withdrawal, and PAWS specifically, by taking a closer look at the alcohol recovery timeline

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Understanding alcohol dependence, alcohol use disorder, and withdrawal 

Another question I’m often asked by my patients is ‘are withdrawal symptoms a sign of alcohol use disorder or alcohol dependence?’ Many people use the terms alcohol dependence and alcohol use disorder interchangeably, but they are not the same. 

Alcohol dependence and withdrawals

Technically, alcohol dependence refers to having withdrawal symptoms due to the cessation or reduction of alcohol consumption. So, in brief, alcohol withdrawal symptoms are a sign of alcohol dependence. However, if you experience withdrawal symptoms, you may also meet the clinical criteria for alcohol use disorder, or ‘AUD.’ 

Alcohol use disorder and withdrawals

Defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) as “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences,”  experiencing withdrawals is one of the criteria used to diagnose alcohol use disorder. An individual needs to meet two of eleven criteria outlined by the American Psychiatric Association to be diagnosed with AUD, which may or may not include withdrawal symptoms. 

However, having withdrawals is a strong indication that you’ve been drinking heavily for a prolonged period, and that there is a higher chance of developing or having AUD. To take an AUD assessment, you can sign up for the free Monument Community. If you do meet the criteria for alcohol use disorder, it’s essential to understand that treating alcohol withdrawals is not a treatment for alcohol use disorder. It’s undoubtedly a critical first step in your recovery, but you will likely want to engage in longer-term treatment and support to treat alcohol use disorder itself. 

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Long-term online alcohol treatment

Seeking support to change your relationship with alcohol is something to be proud of, and working with a physician and therapist is a great way to prioritize your health and safety. If in-person supervised alcohol detox is recommended due to the risk of alcohol withdrawal, you are not alone. After safely completing detox and reducing the risk of alcohol withdrawal, many people pursue longer-term care such as online alcohol treatment. Monument connects you to physicians like myself, and licensed therapists who can help you build a treatment toolkit to empower your long-term success. 

That treatment toolkit may include medication to stop drinking, online alcohol therapy, and/or alcohol support groups. In addition to working with an expert Care Team, finding community  with other people with shared challenges and experiences can provide additional encouragement and accountability. Regardless of your pathway to recovery, your experience is valid, and you deserve to feel safe and supported. To connect with a physician to discuss your personal needs and goals, explore your treatment plan options today. 

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Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

 

  1. Miller S. The ASAM Principles of Addiction Medicine. Wolters Kluwer Health; 2018.
  2. Maldonado JR. Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines. Crit Care Clin. 2017;33(3):559-599. doi:10.1016/j.ccc.2017.03.012
  3. Becker HC. Kindling in Alcohol Withdrawal. Res World. 1998;22(1):9.
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How Does Disulfiram Work?

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Disulfiram, also known as Antabuse, is one of the FDA-approved medications used to treat alcohol use disorder (AUD). Medication to stop drinking can make an incredibly meaningful difference in the recovery journey, especially when paired with specialized alcohol therapy. The effects and recommended uses of disulfiram are specific to each individual, and it’s best to consult your physician to see if disulfiram is the right fit for you. To help you learn more about disulfiram and arm you with information to bring to your physician, I’ve answered frequently asked questions about disulfiram from my patients on the Monument platform. 

How does disulfiram work?

Disulfiram works by changing how your body responds to alcohol. Disulfiram inhibits the metabolism of alcohol, and as a result, it makes you sick if you consume alcohol. Knowing that you will be sick if you drink can act as a psychological deterrent to prevent alcohol consumption. Given disulfiram’s effect, it is suitable only for those looking to abstain entirely from alcohol. 

Some people say that taking disulfiram is like removing the choice to drink. However, unlike naltrexone, another FDA-approved medication to help people reduce their  alcohol consumption, disulfiram is not shown to decrease cravings. If your physician prescribes you disulfiram, it should be seen as one tool to help you stop drinking alcohol. Developing new behavioral patterns and coping mechanisms is critical for long-term sobriety. Engaging in specialized alcohol therapy is an effective way to work on making these sustainable changes. Modalities like cognitive behavioral therapy (CBT) can help you cope with cravings, build drink refusal skills, develop healthier coping mechanisms, and address co-occurring mental health conditions like anxiety and depression. That’s why Monument’s online alcohol treatment plans include customizable options for both therapy and physician care with medication management. 

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How does disulfiram react with alcohol?

Normally, alcohol breaks down to acetaldehyde, otherwise known as ethanol, after consumption. Without the presence of disulfiram, enzymes then break down the ethanol into acetic acid. Disulfiram works to inhibit these enzymes. Therefore if you were to consume alcohol while taking disulfiram, ethanol would not get broken down. Accumulated ethanol in the body causes uncomfortable and unpleasant symptoms, such as flushing, headache, nausea, vomiting, sweating, shortness of breath, dizziness, fainting, confusion, blurred vision, abdominal and chest discomfort, low blood pressure, etc. This is called the disulfiram-ethanol reaction. Many of these unpleasant symptoms (which can even be dangerous at times) can be explained by the fact ethanol increases histamine levels in your body. Since histamine is also released in allergic reactions, you can think of disulfiram as making you allergic to alcohol. 

The severity of the disulfiram alcohol reaction depends on the dosage of disulfiram and the amount of alcohol ingested. For some people, these adverse effects last about 30-60 minutes and resolve on their own. However, in some cases, a severe reaction can last longer than several hours and result in more severe symptoms such as heart failure, seizure, and even death.

If you consume alcohol while taking disulfiram and experience symptoms such as trouble breathing, seizures, loss of consciousness, and chest/jaw/left arm pain, you should seek medical attention immediately. 

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What should I expect when taking disulfiram?

When you are taking disulfiram, you should avoid anything that contains alcohol. People taking disulfiram can accidentally consume alcohol and become sick. Products that may contain alcohol include mouthwashes, cough mixtures, sauces, vinegars, and lotions. Be especially careful when you eat out. As I mentioned previously, the disulfiram reaction with alcohol can be severe and dangerous. Do not test the effectiveness of the medication by drinking alcohol.

Any side effects or factors to consider when taking disulfiram?

In most cases, disulfiram can be taken long-term without significant side effects if alcohol is not consumed. You do not build a tolerance to disulfiram, and there are no withdrawal symptoms associated with the discontinuation of disulfiram. However, you should follow up with your treatment provider regularly to assess whether it is safe for you to continue or stop using disulfiram. 

As noted above, you should not have alcohol in your system when starting disulfiram. To be safe, you should consult with your physician about your plan to begin treatment, which will include waiting at least 24 hours before beginning disulfiram to avoid the disulfiram-ethanol reaction.

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When you plan to stop drinking, regardless of if you plan to use medication or not, you should consult with a medical professional to find a safe course of action. Quitting alcohol cold turkey can be dangerous for alcohol dependent patients, and a physician can provide next steps to ensure your needs are safely met. 

Ifyou believe you are experiencing acute alcohol withdrawal symptoms, you should contact your health care or treatment provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. Quitting cold turkey can be life-threatening, and proper withdrawal management is critical for your safety. 

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Who does disulfiram work for?

Due to its chemical interactions, disulfiram treatment is for people committed to complete alcohol abstinence. If your goal is to drink in moderation, disulfiram is not the right choice. Also, if you have a history of heart disease, diabetes, hypothyroidism, epilepsy, kidney disease, or liver disease, you may not be a good candidate for disulfiram. After signing up for Monument’s online alcohol treatment program, you will connect with a physician to discuss your medical history, needs, and goals. They will then prescribe either naltrexone or disulfiram if they deem it safe and appropriate for you. 

Disulfiram treatment is most effective when consistent. However, it’s not uncommon for people to either forget to take it or stop taking it once they feel more confident in their sobriety. For these reasons, I recommend to patients that they ask a family member or friend to help keep them accountable. Attending therapist-moderated alcohol support groups and engaging in alcohol therapy are also effective ways to receive meaningful accountability and support in tandem with medication. 

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Medication assisted treatment for alcohol use disorder is becoming more widely known. It is especially effective when combined with other treatment modalities, such as therapeutic and community-based support. This holistic, evidence-based approach is broadly considered the ‘gold standard’ in alcohol use disorder treatment among medical professionals. The first step is to meet with a physician to discuss your specific history and goals and to create a treatment plan tailored exactly to you. Exploring changing your relationship with alcohol is a brave step in itself, and there are many different tools to help get you from where you are to where you want to be.  

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Important Safety Information

Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use in patients with active liver disease must be carefully considered in light of its hepatotoxic effects. In the treatment of alcohol dependence, common adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list.

The most common side effects of Disulfiram may include drowsiness, tiredness, headache, acne, and metallic-like taste in the mouth. Call your doctor if you have signs of serious side effects such as decreased sexual ability, vision changes, numbness of arms or legs, muscle weakness, mood changes, seizures, or confusion. Do not take Disulfiram if you are allergic to any of the ingredients. If you begin to have signs of an allergic reaction, then seek immediate medical attention. Avoid consumption of alcohol while taking this medication, as it may lead to adverse side effects. Talk to your doctor about the history of your medical conditions including if you have or have had diabetes, underactive thyroid, brain disorders, liver or kidney disease, personal or family history of regular use/abuse of drugs. Certain drug interactions may lead to serious adverse side effects. Let your doctor know about any other medications you are taking. This is not a complete list of potential adverse events associated with Disulfiram. Please see Full Prescribing Information for a complete list.*Monument Inc. provides administrative and business support services to independent medical and clinical practices and providers. Monument Inc. does not provide medical or clinical services and does not own medical or other clinical practices. All medical services are provided by Live Life Now Health Group, PA d/b/a Live Life Now Medical Group. All counseling and therapy services are provided by independent licensed practitioners including licensed clinical social workers (LCSW) and licensed mental health counselors (LMHC). Individuals should contact their physician or therapist with any questions about their treatment.

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How to Manage Alcohol Cravings: Helpful Tips & Tools

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If you’ve experienced alcohol cravings while navigating sobriety or moderation, guess what? You’re human. Alcohol cravings are a natural and even to-be-expected part of the alcohol recovery timeline, especially in the earlier days. My patients often ask me, “How do I stop alcohol cravings for good?” 

The reality is that the sobriety or moderation journey is often a non-linear one, and you may confront cravings at any point in your journey. However, the good news is, with the right support and online alcohol treatment, you can learn how to manage cravings, and ultimately reduce their frequency and intensity. Cravings are not a sign of weakness. You have agency, and with this resource, a wealth of craving management tools at your disposal. 

How to address alcohol cravings 101

Generally, a craving is defined as a subjective experience of wanting to use a drug. The experience is highly variable depending on numerous factors, including your mood, environment, where you are in the alcohol recovery timeline, and beyond. Cravings follow a period of abstinence from drinking alcohol, whether that’s a few hours or a few years. As a reminder, just because you experience a craving, it does not mean you’ve lost control or haven’t made meaningful progress. 

In fact, it’s an opportunity to exercise your control and show your progress. Cravings can last anywhere from a few seconds to even a few hours. It’s essential to keep in mind that cravings are temporary and that they will eventually go away.

It’s helpful to visualize cravings as the ebb and flow of the ocean waves. Sometimes the waves are big, and other times they are so small that you barely notice them. Riding out a craving can be like riding a wave. Check out some more information about ‘urge surfing’ to put this into practice.

While intense cravings can increase your risk of drinking, they do not have to lead to drinking. Through planning and practice, you can learn how to manage cravings more effectively. The management of cravings can be broken down into two parts: 

What you do before you start having cravings and what you do when you are having cravings.

Let’s dive in. 

Pre-cravings work: Decreasing the frequency and intensity of cravings

Engaging in your sobriety or moderation toolkit prior to having cravings is a really effective way to reduce the intensity of cravings. While craving management is useful, like treating any condition, prevention work can reduce future severity. Eliminating cravings altogether may not be realistic, but you can decrease the frequency and the intensity of cravings to be more manageable. The first tool for doing so? Understanding triggers. 

Although cravings often feel unpredictable, there are usually triggers that lead to them. Triggers are teachers, and play a key role in craving management. The next time you have a craving, take note of your mental and physical state.

  • Where are you? 
  • What time of the day is it? 
  • How do you feel? 
  • What are you doing?

As you continue to keep track of your cravings in a journal or document, you will begin to recognize patterns and be able to identify specific triggers. Triggers can be anything associated with drinking alcohol and can be categorized into internal and external triggers. 

Identify & address internal triggers

Common internal triggers include negative emotions (and sometimes even positive emotions), physical discomfort, boredom, and stress. Internal triggers can have a strong influence on your desire to drink. Frequent drivers of cravings are feelings of depression and anxiety. Those feelings are uncomfortable, and alcohol can provide immediate, short-lived relief. 

Your brain learns that behavior, and begins to crave alcohol whenever you are feeling depressed or anxious. However, drinking alcohol only masks these feelings and actually intensifies these negative emotions. It can be scary to identify depressive or anxious thoughts as a trigger, but it also provides a path towards healing. You can unlink depression and alcohol and anxiety and alcohol and treat both simultaneously.

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If you are dependent on alcohol, it’s possible that you will experience alcohol withdrawal symptoms when you significantly cut down alcohol consumption or stop drinking. You should consult your physician before quitting alcohol cold turkey or cutting down. Severe withdrawal symptoms include delirium tremens and hallucinations, which can be dangerous or life-threatening without medical supervision. If you believe you are experiencing acute withdrawal symptoms, you should contact your provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. 

Identify & avoid external triggers

External triggers can include people, places, and things that you associate with alcohol. Our brain loves efficiency, and aims to make our behaviors more automatic by grouping things together. When you drink alcohol and artificially increase the dopamine levels in your brain, your brain tries to remember everything associated with that temporary pleasure to repeat the behavior. For example, you might come to associate certain activities, friends, and venues with drinking.

Typically it’s easier to control external triggers than internal triggers, and the most effective action to take is to avoid these external triggers as much as possible. If you have alcohol in your home, get rid of it or put it away in a place where it’s very inconvenient for you to reach. 

If you are conditioned to drink while watching TV from your favorite couch, rearrange them. The goal is to weaken the brain’s connection between the triggers and alcohol consumption. This process can include trial and error, and that’s part of the process. You can also join Monument’s online alcohol support groups to hear what’s worked for other members. 

During a craving: Tools for managing alcohol cravings

Even with your best efforts, both mild and intense alcohol cravings can still occur. It does not mean you did anything wrong or failed in any capacity. In fact, in the early phases of your recovery, you are expected to have cravings. Remember that cravings are temporary, and even if it doesn’t feel like it in a given moment, they will eventually pass. Identifying an alcohol craving early on presents more opportunity to manage it, and prevents escalation. Having the right tools at hand is the key to successfully managing cravings. Here are tips I share with my patients. 

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Be mindful.

The very first step in managing an alcohol craving is recognizing it. Be curious about the experience. How strong is it? Do you feel it in your body? How does it feel? Where is it located? Be kind to the sensation of cravings—your perspective and attitude toward cravings influence how you manage them.  

Many people’s instinct is to feel bad when they have cravings. If you start creating negative associations with cravings, you will experience more negative emotions, which could further trigger you to drink. Understand that cravings are natural, and as described before, present an opportunity for you to put your skills into practice. 

Do not just rely on your willpower. 

One of the most common mistakes people make when managing cravings is relying too much on ‘willpower.’ Many psychologists define willpower as the ability to delay gratification, resisting short-term temptations in order to meet long-term goals. Using your willpower can be one of the tools in your toolkit, but it shouldn’t be the only one. 

Willpower is a finite resource that is often unpredictable and varies throughout the day. Additionally, relying on your willpower to resist cravings can take up a lot of effort and energy. When you’re tired at the end of your stressful day and have very little willpower left, you are in a very vulnerable situation, especially if you don’t have other strategies.

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Remember the “Five Ds”

The “Five Ds”  are more popularly known in the management of nicotine cravings, but are just as helpful in managing alcohol cravings. 

  • Delay: If you are working on moderating your drinking (instead of abstaining altogether), try extending the time between when you experience a craving and when you have a drink. If you wait long enough, your craving may just disappear, and you might not feel the need to drink. 
  • Distract: Do something else. Keep yourself busy. Occupy your mind with a hobby, TV show, or meditation. If you’re able to, doing physical activity is a great way to distract yourself and release tension. Get up, and go outside. Take a walk. Lean on alcohol-free activities that bring you joy. 
  • Drink water: You may be thirsty when you are craving alcohol. Drink plenty of water throughout the day to avoid thirst becoming your trigger. 
  • Deep breathing: Take a deep breath in and exhale slowly and fully. Activate your parasympathetic system in order to relax.  
  • Discuss: Reach out to other people who understand what you’re going through. Post in the Monument Community at any time or attend one of the many alcohol support groups. You are not alone in this. 

Evidence-based tools: Medication to reduce cravings and therapy 

In addition to the behavioral tools like the 5 Ds, there are also evidence-based tools that can be extremely effective in craving management. One of those is medication to stop drinking. There are three FDA-approved medications to treat alcohol use disorder: naltrexone, acamprosate, and disulfiram. Two of these medications, naltrexone, and acamprosate, are shown to help with cravings. 

Naltrexone helps reduce cravings by blocking opioid receptors in the brain. You can read more about naltrexone benefits to learn more, and if you think medication could be right for you, you can work with a physician on the Monument platform to discuss your options. It’s important to remember that while medications like naltrexone are a great tool, there is no ‘miracle drug’ to completely stop cravings. 

Another great research-supported tool is online alcohol therapy. Working with a therapist to form new, healthier associations and coping mechanisms is an excellent option for anyone looking to change their relationship with alcohol. They can help you address internal and external triggers, practice mindfulness, build coping skills, and much more. 

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Now what? The long-term craving timeline 

If you’ve put all of the above tools into practice, you might be wondering, ‘how long until I stop experiencing cravings?’ As with most stages of the alcohol recovery timeline, the answer is unique to you. That said, as you remove triggers and develop new coping techniques, you should experience fewer and less intense alcohol cravings

The cravings may be so mild that you don’t even recognize them as cravings. It’s also important to note that your brain never entirely forgets its positive associations with alcohol, especially when confronted with stress and negative feelings. For that reason, it’s important to keep your tools fresh in your mind, and continue to engage in your sobriety or moderation toolkit as long as it’s serving you. You are more powerful than your cravings, and have all the tools at your disposal. 

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Naltrexone Benefits: Does Naltrexone Work?

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Naltrexone is approved by the FDA for the treatment of opioid dependence and alcohol use disorder, among other conditions. In the context of this article, I’ll specifically be discussing alcohol use disorder, and how naltrexone helps people who want to stop drinking, cut down on drinking, or only drink on special occasions. While medication to stop drinking was once lesser-known, it’s now instrumental in many recovery journeys. As a physician at Monument, I get to see the transformative qualities of this treatment every day.

What are the benefits of naltrexone?

Naltrexone is an opioid antagonist that is commonly used for those looking to reduce alcohol consumption or achieve sobriety. What it does is reduce cravings for alcohol and the likelihood of unhealthy drinking. When you drink alcohol, your brain produces “feel-good chemicals” called endorphins. For endorphins to give you the pleasurable effects of alcohol, they need to bind to the endorphin receptors that are responsible for feelings of euphoria in your brain. 

Naltrexone works by blocking these receptors so that you get less pleasure from drinking alcohol. Blocking these receptors also indirectly decreases the release of dopamine, a pleasure neurotransmitter. As you continue to take naltrexone, your brain will no longer associate alcohol with pleasure, and you will have less desire to drink. 

Naltrexone therapy is especially helpful for a patient in the beginning phase of recovery when you have intense cravings for alcohol. Fighting against cravings all day takes up a lot of energy and can make you both mentally and physically tired. By having fewer and less intense cravings, you get more headspace to work on other aspects of recovery, such as processing emotions and developing coping mechanisms in alcohol therapy

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One of the most important naltrexone benefits is that it’s not habit-forming (or ‘addictive’). Naltrexone is generally well-tolerated, with very few interactions with other medications. You can read more about potential side effects in this Naltrexone 101 overview, and discuss in detail with your physician in the context of your own medical history and goals.

Does naltrexone actually work?

The FDA approved naltrexone in 1994 for alcohol dependence, and since then, many studies and clinical trials have supported its effectiveness. A meta-analysis of 19 studies with a total of 3205 participants showed that naltrexone reduced the likelihood of relapse by 38%.¹ Another meta-analysis of 50 randomized clinical trials with 7793 participants concluded that naltrexone was effective at reducing the amount and frequency of drinking.² 

It’s important to note that naltrexone is not a ‘miracle drug’ that will completely take away a patient’s desire to drink. (There is no such thing!) Though it’s not a miracle drug, for some people, it works so well for them that they immediately change their relationship with alcohol. 

However, for most people, naltrexone reduces the pleasure of and cravings for alcohol to a certain degree and is best supported by other tools to control or stop drinking such as alcohol support groups and alcohol therapy. Alcohol use disorder is a biopsychosocial condition, which means it’s influenced by biological, psychological, and socio-environmental factors. Tools like online therapy and treatment can be especially effective in addressing the social and psychological influences, and managing co-occurring conditions such as anxiety or depression. 

As soon as I started taking it, the medicine helped me quit my bottle of wine a night habit. That gave me a chance, through therapy, to build a toolset that would allow me to reintroduce alcohol on my terms and in quantities that weren't so self-destructive.

 What factors may affect naltrexone’s effectiveness?

While naltrexone treatment is well tolerated and effective for many people, as with all components of the recovery journey, your experience will be unique to you. At Monument, you’re connected to a Care Team to personalize your online alcohol treatment plan in a way that will be most effective for you. Here are several factors to be aware of as you discuss medication to stop drinking with your physician. 

Genetics

Research suggests that people with a certain type of endorphin receptor gene respond better to naltrexone therapy.³ While this is random based on your own genetics, it can play a small role in its effectiveness.

Dosage

If they deem it safe and appropriate, your physician will prescribe oral naltrexone in accordance with the FDA recommended daily dose of 50 mg. As with many other medications, if you and your physician agree a different dosage may better suit your needs and goals, your physician will work with you to prescribe the optimal dosage for you.   

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Timing & adherence

Naltrexone’s duration of action is approximately 24 hours. Therefore, with consistent adherence, you will have a therapeutic dose throughout the day. To integrate taking naltrexone into your daily routine, your physician will encourage you to take your oral naltrexone tablet at a time most convenient for your schedule. With consistent adherence, time of day doesn’t play a significant role in medication effectiveness. However, like with many other medications, the best results will come with consistency.  

Co-occurring conditions

While naltrexone treatment can help you have less urge to drink, it’s important to simultaneously treat the underlying causes of heavy drinking. As referenced previously, mental health conditions like depression and anxiety are commonly experienced alongside alcohol use disorder. The alcohol recovery timeline is often non-linear and can bring about uncomfortable mental, physical, and emotional changes. These challenges and more can be worked through in specialized alcohol therapy. It’s important to remember that growth happens through discomfort and that these changes are most likely an indication of recovery, healing, and progress. 

Is naltrexone right for me?

Multiple factors need to be considered before starting naltrexone, all of which should be discussed with a licensed physician via a Monument treatment plan or elsewhere. First, if you believe you are experiencing acute withdrawal symptoms, you should contact your provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. Quitting cold turkey can be life-threatening, and proper withdrawal management is critical for your safety. 

Moreover, naltrexone can cause side effects that could make the withdrawal symptoms worse. A physician will review your medical history and determine whether it’s safe and recommended for you to take naltrexone.

As mentioned, naltrexone is generally well tolerated. Like any medication, there are some potential side effects, the most common being headache and nausea. It’s recommended to connect with your physician about managing side effects, which can subside after a few weeks. Everybody is different, and your physician can help you weigh the side effects and benefits.

Alcohol use disorder is a medical condition and can be treated with science-backed solutions. For most people who have an unhealthy relationship with alcohol, naltrexone can be an incredibly effective tool for building healthier habits and unlocking the benefits that come with sobriety or moderation. Interested in seeing if naltrexone is right for you? Sign up for an online treatment plan to get the personalized, evidence-based care you deserve.   

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Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

¹Carmen, B., Angeles, M., Ana, M., & María, A. J. (2004). Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction, 99(7), 811-828.

²Rösner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD001867. DOI: 10.1002/14651858.CD001867.pub3

³Vuoristo-Myllys, S. (2014). Predictors of Alcohol Treatment Outcome: Prognostic factors in cognitive behavioral therapy for problem drinking including Targeted Use of Naltrexone.

Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use for a patient with active liver disease must be carefully considered in light of its hepatotoxic effects. 

In the treatment of alcohol dependence, adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness, and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list