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 when drinking on naltrexone. 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.
Building self-esteem while changing your relationship with alcohol
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.
How effective is naltrexone?
Naltrexone is a highly effective tool for treating substance use disorders. While it can be effective on its own, research shows naltrexone is most effective when used in conjunction with cognitive behavioral therapy. That’s why Monument’s treatment plans include options for both medication-assisted treatment and psychotherapy. It’s also important to remember that naltrexone efficiency varies from patient to patient for a variety of not fully understood reasons. There is some scientific evidence that naltrexone is more effective for people with a certain endorphin receptor. Generally, studies show that naltrexone helps many people reduce their alcohol consumption and improve their health outcomes.
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.
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.
Are there risks associated with taking naltrexone?
While naltrexone is generally very well tolerated, no medication or supplement is entirely risk-free. However, most physicians agree that the benefits of naltrexone outweigh the potential side effects for most patients. For those that do experience side effects, the most common symptoms are headache and nausea. The severity of these side effects can vary for each individual. In most cases, symptoms can be managed by adjusting your dose with your physician. Some people find that their symptoms don’t minimize with time and dosage changes, and decide to explore other options with their physician.
It’s important to note that naltrexone doesn’t prevent any of the physical side effects and risks associated with alcohol consumption, such as decreased motor skills and critical thinking. If someone were to drink while taking naltrexone, they may not be as aware of their intoxication level due to the pleasure-blocking effect of naltrexone. In some cases this can lead to unhealthy consumption and risky behavior.
Ways to take naltrexone
Naltrexone’s duration of action is approximately 24 hours. Therefore, with consistent adherence, you’ll have a therapeutic dose throughout the day. To integrate taking naltrexone into your daily routine, your physician will encourage you to take your naltrexone pill at a time most convenient for you so that you don’t forget a dose. Some physician prescribe naltrexone as part of The Sinclair Method, however this method is not used at Monument.
Although the vast majority of patients who receive naltrexone treatment for alcohol use disorder take naltrexone pills, there is an alternative for those who would prefer not to take oral naltrexone. Individuals can also receive monthly intramuscular injections of naltrexone. Naltrexone injections require monthly in-person visits to a medical provider, and can also cause swelling and bruising upon injection.
How to get started taking naltrexone
The first step to start taking naltrexone is to have a conversation with a healthcare provider. At Monument, you can speak with a licensed physician experienced in prescribing naltrexone. Together you’ll discuss your medical history and drinking habits and determine if naltrexone is safe and appropriate for you. Pending a prescription, your medication will be conveniently sent directly to your home, or local pharmacy if preferred.
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 care you deserve.
Sources:
- Addiction, 99(7), 811-828. “Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review, https://pubmed.ncbi.nlm.nih.gov/15200577/” Accessed May, 5. 2021.
- Cochrane Database of Systematic Reviews. “Opioid antagonists for alcohol dependence, https://pubmed.ncbi.nlm.nih.gov/21154349/.” Accessed May, 5. 2021.
- University of Helsinki. “Predictors of Alcohol Treatment Outcome: Prognostic factors in cognitive behavioral therapy for problem drinking including Targeted Use of Naltrexone, https://helda.helsinki.fi/bitstream/handle/10138/42852/vuoristo-myllys_dissertation.pdf;sequence=1.” Accessed May, 5. 2021.
- Science Daily. “Certain populations may benefit most from alcohol-dependence treatment naltrexone, https://www.sciencedaily.com/releases/2011/03/110315163203.htm. Accessed June 7, 2022.
- Family Physicians Inquiries Network Inc. “Is naltrexone an effective treatment for adults with alcohol use disorder?, https://journals.lww.com/ebp/Citation/2021/07000/Is_naltrexone_an_effective_treatment_for_adults.34.aspx.” Accessed on June 6, 2022.
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
About the Author
Monument is an online platform dedicated to helping individuals cut back or quit drinking alcohol through evidence-based treatment and compassionate care. We connect our members to an anonymous community, therapist-moderated support groups, and a comprehensive collection of resources to provide the support and information they deserve. For those seeking medical treatment, Monument introduces members to licensed physicians and specialized therapists who work together to develop personalized treatment plans tailored to each individual's unique goals.
Our services are not only research-based but also affordable and accessible, ensuring that a healthy relationship with alcohol is attainable and celebrated by all. Monument is proud to be contracted with major health care payers such as UnitedHealthcare, Aetna, and Cigna, making our services in-network and available to a wide range of individuals seeking support.
Monument's clinical operations are overseen by a well-experienced medical team comprising leading experts in the field of addiction medicine. Our medical team is led by Dr. Abe Malkin, MD MBA who's team has an extensive background in treating alcohol use disorder (AUD) and are dedicated to providing the highest quality care.
At Monument, we understand that each individual's journey with alcohol is unique. That's why we offer a holistic approach to treatment that includes.
FDA-Approved Medications: Prescribed by our licensed physicians, these medications help reduce cravings and support sobriety or moderation. We only prescribe effective, non-controlled medications.
Specialized Therapy: Our therapists are experts in addiction treatment and provide personalized counseling to address the underlying causes of unhealthy drinking behaviors.
Support Groups: Led by professional therapists, our support groups offer a safe space for members to share their experiences, gain insights, and build a supportive community.
Resources and Tools: We provide access to a wealth of resources, including articles, webinars, and self-assessment tools to help members stay informed and motivated on their journey.