Naltrexone For Alcohol Use Disorder

Naltrexone And Alcohol Use Disorder

Naltrexone is a medication approved by the FDA to treat alcohol use disorder. Alcohol use disorder (AUD), commonly known as alcoholism, is a medical condition that is characterized by the inability to cut down on alcohol despite its harmful effects on daily life, including professional and personal impacts.

AUD is one of the most severe health conditions in the United States, with approximately 80,000 annual deaths attributed to alcohol use. Studies have shown that in 2023, of the estimated 28.9 million people 12 years of age and older in the U.S. with AUD, 2% received alcohol treatment medication, including naltrexone, in the past year.

Naltrexone is a beneficial treatment option for AUD that is available in both pill and injectable form. The oral form of naltrexone has been approved for AUD for almost 30 years, and the long-acting injectable formulation has been around since 2006.

Naltrexone for AUD is marketed under the following brand names:

• ReVia (oral tablet): given 50mg once daily
• Depade (oral tablet): given 50 mg once daily
• Vivitrol (extended-release injectable): given 380 mg intramuscularly once a month

How Does Naltrexone Work?

Naltrexone works as an opioid receptor antagonist, primarily blocking the mu opioid receptors in the brain. These opioid receptors are responsible for inducing a euphoric high when opioids such as heroin or prescription opioids are taken. They also help in producing a euphoric high when endogenous opioids, also known as endorphins, are released. Stimulation of the μ opioid receptor contributes to the rewarding effects of alcohol, and therefore, consuming alcohol also releases endorphins. Using naltrexone to block this effect at the mu opioid receptor can help treat alcohol use disorder.

Naltrexone also works on the hypothalamic pituitary axis (HPA) in the brain, which plays a key role in hormonal and stress regulation, and research suggests that alcohol plays a role in this stress circuit. However, the exact mechanism of how alcohol affects the HPA and, therefore, how naltrexone works on the HPA to treat AUD is unknown.

Does Naltrexone Reduce Alcohol Consumption?

Naltrexone does reduce alcohol consumption in many ways. It is known to reduce the frequency of drinking, the number of drinks consumed, and binge drinking episodes. A study published in the American Journal of Psychiatry found that people who took naltrexone during periods of perceived high-risk alcohol drinking showed a reduction in overall alcohol consumption.

With each dose of naltrexone, the goal is for the cravings and urges to lessen, leading to less alcohol consumed each time. This leads to eventually reducing the amount or even eliminating drinking, if that is what the person desires. This is known as the elimination method, where a behavior is slowly reduced due to a reduction in cravings and urges.

How Well Does Naltrexone Work To Reduce Drinking?

Naltrexone is 78% effective when treating AUD using the Sinclair method. The Sinclair method is an evidence-based treatment approach to treat AUD using naltrexone as needed before drinking.

While abstinence is typically the ultimate goal in addiction treatment, the Sinclair method is focused on reducing alcohol consumption by slowly extinguishing cravings and urges over time. Naltrexone is taken one hour before consuming alcohol, and during this time, the endogenous opioid receptors are fully blocked, and the typical “tipsy” euphoric feeling after consuming one drink is eliminated; therefore, the person usually does not desire to have a second or a third drink. If the person is committed to taking naltrexone every time they crave an alcoholic drink, this method works well to reduce drinking.

Since alcohol no longer produces the dopamine euphoria that was once desired, people are encouraged to find healthier outlets to experience natural dopamine euphoria in the body. Activities like listening to music or exercising are healthy ways to produce dopamine and are strongly encouraged. Over time, the goal is to replace drinking alcohol with these dopamine-induced activities.

Overall, naltrexone is a medication with minimal side effects and considerable flexibility in terms of use, allowing for optimal benefit in ways that work best for each individual. People can take it daily, as a monthly injection, or as a targeted, as-needed medication for when they feel the urge to drink.

What If I Drink While Taking Naltrexone?

Consuming alcohol while on naltrexone is not contraindicated and is a normal part of the Sinclair method. The Sinclair method teaches people to take naltrexone one hour before consuming alcohol because this timeframe is when naltrexone is at its highest concentration in the blood, and therefore, when alcohol is present, the euphoric effects from alcohol are blocked. The person does not experience the desired alcohol pleasurable state.

The effects of naltrexone can wear off after several hours, and if people continue to drink after these several hours, the naltrexone time frame can wear off, leading to the euphoric alcohol buzz. To prevent this, some experts recommend taking another dose of naltrexone or using the injectable form so the concentration doesn’t dip over time, just in case more alcohol is consumed than planned.

It is important to note that naltrexone does not induce alcohol withdrawal effects. Still, it can impair coordination, and so it is extra important not to drive while taking naltrexone, especially while drinking, because it can worsen the effects of impaired driving.

Where Can I Get Naltrexone?

Naltrexone is available by prescription from any licensed medical provider, such as a physician, nurse practitioner, or physician assistant. Telehealth providers can prescribe naltrexone as well, so if time, transportation, or going into a clinical office is a barrier to seeking treatment for alcohol use disorder, telehealth is a reputable and accessible option.

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Seeking Treatment For Alcohol Use Disorder

The severity of the addiction and required level of care typically determine the type of alcohol addiction treatment recommended. From inpatient rehab and outpatient programs to support groups, many modalities exist to help you get the support you need.

Naltrexone is a critical part of many alcoholism treatment programs. If you or a loved one is interested in learning more about naltrexone to help overcome alcohol addiction, help is available. Contact a treatment provider to explore your rehab options and begin your recovery journey today.