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Naltrexone received food and drug administration approval in 2006. Many people are familiar with the drug as a medication prescribed to individuals as part of medically assisted therapy in addiction treatment programs addressing opioid detox and addiction. Many people do not realize is that Naltrexone has been used to effectively treat alcohol addiction for more than 20 years.
When first approved, Naltrexone was solely used to address and manage symptoms of opioid detox and withdrawal. Today, it is a common part of comprehensive alcohol addiction treatment programs as well. It is important to remember that Naltrexone is not a "cure" for addiction and its use is only effective as part of a treatment plan that addresses all aspects of detox, treatment, and aftercare. Before Naltrexone can be introduced as part of a treatment plan, you must complete detox. It cannot be introduced into your system if you are still physically dependent on alcohol. If you take Naltrexone while still under the influence of alcohol, it can lead to powerful side effects that can be difficult to manage.
Naltrexone is a drug prescribed by members of the treatment team at an alcohol rehab. Generally used as part of a medication-assisted therapy program, Naltrexone should only be prescribed after the detox process is complete. Because detoxing from alcohol addiction can be difficult and sometimes leads to dangerous and potentially life-threatening withdrawal symptoms, detox should occur under medical supervision in an alcohol rehab where providers are skilled in medically assisted alcohol detox.
Naltrexone works in the brain to reduce dependency on alcohol5. Like other drugs used to help manage symptoms of withdrawal, Naltrexone blocks the effects of specific receptors in the brain. These receptors, called opioid receptors (even when talking about alcohol addiction), are specific locations on the brain where chemical components of alcohol or drugs attach. Naltrexone belongs to a class of medications called opioid agonists. These drugs work to block the effects of alcohol in the brain. When used as directed, it can help limit many of the challenges associated with overcoming alcohol addiction.
Naltrexone can be administered in several forms4. The tablet form is most frequently used in the addiction treatment environment. However, many treatment centers (both inpatient and outpatient) prescribe the injectable form of Naltrexone (sold under the brand name Vivitrol), which is administered once per month. For some patients, this is preferable over daily tablets, which can be forgotten. Another form of Naltrexone growing in popularity in the treatment setting is Naltrexone implants. The implant slowly releases Naltrexone over an eight-week period. Because this option doesn't require daily or weekly monitoring, it is convenient for those who are actively participating in a treatment program (especially outpatient programs) or for those who struggle with medication self-management.
When you drink alcohol, it binds to specific receptors in the brain that are responsible for feelings of pleasure, euphoria, and joy. Naltrexone works within the brain to block the receptors alcohol attaches to, effectively eliminating the ability of alcohol to produce desirable effects. Also, alcohol is a depressant which means when you consume alcohol, it produces feelings of relaxation. This occurs because alcohol encourages the brain to release chemicals called endorphins. Endorphins are responsible for producing the "feel-good emotions" people desire when they drink. These higher endorphin levels are in the brain, the better you feel. These desirable feelings and emotions are why people turn to alcohol to dull pain, calm heightened emotions and to relax and reduce stress. Using alcohol to "feel better" quickly leads to a cycle of tolerance, dependency, and eventually addiction.
Naltrexone is generally provided early in the recovery process, shortly or immediately after detox ends. When you take Naltrexone, the receptor sites in the brain are blocked. This means consuming alcohol no longer encourages increased endorphin production or release. Without increased endorphins, you cannot achieve the "high" alcohol customarily produced. This provides a range of benefits, including reduced cravings and the ability to focus on addiction treatment without the desire to drink alcohol.
Another significant benefit to Naltrexone, a part of an alcohol treatment program, is that, unlike some other drugs used in medically assisted treatment (MAT) programs, Naltrexone is non-habit forming (non-addictive) and non-narcotic. Fortunately, this means those who take Naltrexone as part of a medically supported addiction treatment program can do o without developing a dependency on the medication or other addictive behaviors. This is a significant benefit over some other medicines, which can lead to dependence, addiction, and the concern of "swapping one addiction for another" in the effort to get and stay sober.
Naltrexone is also beneficial as part of an alcohol addiction relapse prevention plan. Again, Naltrexone works by blocking opioid receptors in the brain; even if you relapse and consume alcohol, you will not achieve the same relaxed or euphoric state you desire and experienced with alcohol consumption prior to completing an alcohol addiction treatment program. With continued Naltrexone therapy, your brain will eventually stop associating alcohol with pleasurable feelings and emotions.
Although highly beneficial when used as directed, Naltrexone may not be appropriate or beneficial for everyone1. There are some instances where Naltrexone may lead to worsening side effects, new or worsening addiction symptoms. Additionally, there are circumstances where some individuals, regardless of their desire to get sober from alcohol addiction, should avoid taking Naltrexone altogether. In these situations, your addiction treatment team at an inpatient alcohol rehab will help you determine the best combination of therapy and medication to meet your specific treatment needs and goals.
It is vital to mention that Naltrexone should only be used if you have entirely detoxed from alcohol, and you should not continue to drink while using it. Also, Naltrexone is an opioid agonist, meaning it blocks the effects of opioid drugs. If you currently take an opioid medication for chronic pain management or you are addicted to an opioid drug, Naltrexone may not be beneficial as part of your treatment plan.
Naltrexone can also lead to effects on your liver. If you already have a diagnosed liver condition such as hepatitis or hepatic failure, your addiction treatment specialist may choose an alternate treatment option as Naltrexone use may worsen your existing liver condition.
Because addiction affects people of all ages, it is possible for someone under the age of eighteen to struggle with alcohol addiction. In fact, the 2019 National Survey on Drug Use and Health found that nearly 10% of adolescents and teens between ages 13 and 17 struggle with alcohol abuse and misuse, and as many as 12% of individuals ages 12 to 20 meet the diagnostic criteria for an alcohol use disorder. Unfortunately, Naltrexone is not suggested for anyone under the age of eighteen as research around its safety and efficacy for this age group has not been widely researched.
Because Naltrexone can react negatively with other medications, including prescription medications, over-the-counter medications, holistic remedies, and herbal treatments, it is essential to discuss any medication you currently use with your addiction treatment team. They will work with you to determine who Naltrexone fits into your treatment program to ensure your continued medical health and safety.
Naltrexone is available by prescription only. In both inpatient and outpatient treatment environments, Naltrexone is used as part of a medication-assisted treatment (MAT) program. MAT programs combine the use of medications like Naltrexone with behavioral therapies like cognitive-behavioral therapy to provide a holistic and well-rounded treatment approach. In the inpatient environment, Naltrexone is prescribed by medically trained treatment professionals who understand how Naltrexone works and how it can help you achieve your treatment goals. Naltrexone would not be introduced into your treatment program at an inpatient alcohol rehab until you have completed detox and no longer struggle with the challenging symptoms of alcohol withdrawal, such as cravings and other uncomfortable symptoms. For the use of Naltrexone to be safe, it is essential to be completely free from alcohol in your body.
Naltrexone may also be used in a medically assisted treatment program as part of an outpatient alcohol rehab. There are positives and negatives to the outpatient alcohol rehab approach. The most notable positive is the ability to seek help to overcome addiction while remaining at home. Unfortunately, there are complications to Naltrexone use in the outpatient setting. Naltrexone requires strict adherence to prescribing instructions. It also requires patients to entirely abstain from all other narcotic drugs and alcohol while using Naltrexone. If you use Naltrexone and take a large amount of opioid drugs or drink to excess to overcome the opioid blocking effects of Naltrexone, you are at a significant risk for overdose and death.
Additionally, the inpatient treatment environment is ideal for a medically assisted treatment program. When someone receives Naltrexone in the inpatient setting, it ensures the individual receives the appropriate dose on the correct schedule. Having a member of a highly skilled treatment team provide medications daily reduces the need to focus on self-administration of medication so you can focus all of your attention on overcoming alcohol addiction and maintaining lasting sobriety.
There are currently three medications widely used to help address symptoms of alcohol addiction2. These include Naltrexone, disulfiram, and acamprosate.
Disulfiram 3(Antabuse) has been used as part of alcohol addiction treatment programs for more than forty years. Unfortunately, the evidence for its effectiveness when compared to Naltrexone is limited. When you drink alcohol after taking disulfiram, it produces unpleasant and potentially dangerous effects. Disulfiram works within the body to inhibit the effect of alcohol while producing an acute sensitivity to it. Drinking alcohol while using disulfiram immediately produces many of the effects experienced when you have a hangover. However, other significant and life-threatening consequences, including heart attack, convulsions, and death, can also occur in individuals who experience severe reactions to the combination of alcohol and disulfiram. It is considered a second-line treatment behind Naltrexone; however, if Naltrexone is not safe or beneficial for your treatment needs, disulfiram may be an effective treatment option. Additionally, disulfiram does not reduce alcohol cravings leading to poor treatment compliance.
Acamprosate (Campral) has been used in Europe since 1989 for the treatment of alcohol dependency. In 2004, it became the third alcohol addiction treatment drug to receive approval from the U.S Food and Drug Administration. Acamprosate is believed to reduce positive reinforcement of alcohol use by reducing the positive effects of alcohol on the body. Additionally, it helps reduce the severity and intensity of withdrawal cravings. However, unlike other drugs approved for alcohol addiction treatment, the exact mechanism (how it works) of these actions is unknown. Like Naltrexone, Acamprosate has no potential for abuse or dependence; however, there is an increased rate of risk for self-harm, suicidal ideation, suicidal attempts, and completed suicide. Also, like Naltrexone, acamprosate is indicated for use as part of a comprehensive treatment program and is not indicated as a standalone treatment for alcohol addiction.
Deciding to seek help for alcohol addiction is a challenging but potentially life-saving decision. It is vital to do your research as not all addiction treatment centers are the same. While each program strives to provide safe and effective alcohol addiction treatment, not all provide comprehensive medically assisted detox or medication-assisted therapies. It is vital to select a rehab that specifically addresses your treatment needs while considering your overall physical, psychological, and spiritual health.
Because there are so many treatment centers in the United States, choosing a rehab where you feel safe and supported and comfortable is vital to ensuring you can complete the ensure duration of your program.