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Naltrexone for Alcohol Abuse Treatment: Everything You Need To Know

By Manjari Bansal, Jen Venegas
Naltrexone is a medication used to treat alcoholism, also known as alcohol use disorder. Read on to learn what this drug is and how it works.

Many therapies addressing alcohol use disorder are available today, although most require a comprehensive care plan for the patient. One therapeutic choice is naltrexone, a drug that can be used as a part of a medication assisted treatment plan for alcohol use disorder. Read on to learn more about naltrexone and its potential role in soothing alcohol cravings.

What is Naltrexone?

Naltrexone is a medication that can be used to treat both opioid use disorder and alcohol use disorder. According to the Substance Abuse and Mental Health Services Administration, naltrexone is prescribed as part of a medication-assisted treatment program for substance use disorder. 

Using Naltrexone for Alcohol Dependence

Patients may take the drug in pill form or as an extended-release intramuscular injection—although risk assessment must occur before a patient is prescribed naltrexone injections. 

Naltrexone has been approved by the U.S. Food and Drug Administration as an option for medication assisted treatment. “It is relatively pure and long-lasting and can be prescribed by any practitioner licensed to prescribe medications,” Nzinga Harrison, MD, tells WebMD Connect to Care. 

“However, it is crucial to remember that naltrexone is not a complete cure for alcohol use disorder or opioid use disorder. Instead, it’s simply a single component in a comprehensive treatment plan that includes counseling, behavioral therapies, and aftercare programs,” Harrison explains.

How Does Naltrexone Work for Alcohol?

 

Naltrexone reduces alcohol cravings by lessening the bodily reactions that occur due to alcohol misuse. “Naltrexone functions by blocking the endorphin receptors in the body to suppress the effects of drinking. This function reduces alcohol cravings and helps individuals in recovery gradually reduce their alcohol intake,” Harrison explains. 

Although your alcohol use disorder treatment plan should be tailored to your specific needs, naltrexone is often taken in pill form daily, for approximately three to four months, during medication assisted treatment. 

Patients typically complete physician-assisted detox prior to beginning naltrexone. To help prevent strong side effects of alcohol withdrawal,  such as nausea and vomiting, practitioners wait until after the alcohol detox process before administering naltrexone, according to the Substance Abuse and Mental Health Services Administration. 

Naltrexone is non-addictive and not an opioid, making it a safe medication for an alcohol abuse treatment plan.

How Long Does Naltrexone Block Alcohol?

“Naltrexone is a medication commonly used to help people abstain from drinking alcohol,” Clare Waismann, RAS, SUDCC, Founder and Director of Waismann Method Opioid Treatment Center and Domus Retreat in California, tells WebMD Connect to Care. “Although it does not directly block the effects of alcohol, it has been shown to reduce cravings and pleasure from drinking for around 24 hours. 

“Naltrexone works by blocking dopamine release, which indirectly limits the release of dopamine after alcohol consumption. This makes drinking less pleasurable and reduces the likelihood of continuing to drink once you have started. Over time, as you take Naltrexone, the brain's association between alcohol and pleasure weakens, decreasing alcohol cravings. Therefore, Naltrexone can be an effective tool in helping you abstain from drinking. There is no magic cure for alcoholism, but medications like Naltrexone can help manage cravings and reduce pleasure from drinking,” Waismann explains.

“Naltrexone is available in a pill form that is taken daily, or as an extended-release intramuscular injectable that is administered every 30 days,” Aaron Sternlicht, LMHC, CASAC, a therapist and co-founder of Family Addiction Specialist in New York, tells WebMD Connect to Care. “Naltrexone implants are also available that last for approximately 8 weeks.”

“The half-life [of Naltrexone] is up to 12 hours,” Hassaan Tohid MBBS, SUDCC, CCATP, Board Certified Addiction Counselor, and Founder of California Institute of Behavioral Neurosciences and Psychology, tells WebMD Connect to Care. “The drug is eliminated from the system in 12 (usually 4-13 hours) or a maximum of 24 hours. This doesn’t mean the full dose is eliminated but as the name suggests, it is the half of the dose that is eliminated.” 

“Usually, the younger you are, the faster naltrexone is eliminated from the body. A patient’s overall health also is a factor that determines how long naltrexone remains in the system. The healthier and younger you are, the faster it is eliminated,” Tohid adds.

What Happens if you Drink Alcohol While Taking Naltrexone?

Unlike other medicines (eg. Disulfiram), Naltrexone does not make you feel sick if you consume alcohol while taking it, States the American Academy of Family Physicians. 

“Naltrexone blocks the euphoric effects and feelings of intoxication from alcohol when you drink it,” James Pratty, MD, a Psychiatrist and Medical Director at Behavioral Health for Brand New Day, tells WebMD Connect to Care. “This allows people with alcohol use disorder to lessen their drinking behaviors enough to stay in treatment, avoid relapses, and take their medication. Naltrexone will not prevent impairment while drinking alcohol.”

However, “every individual will react differently to side-effects if they drink alcohol while taking naltrexone,” Sternlicht says. “Some individuals may not experience any adverse reactions, while others may experience symptoms such as nausea, vomiting, headaches, stomach cramps, or headaches.”

“Moreover, one thing to remember is that naltrexone does block the intoxication feeling, it does not block the reduced coordination, slow reflexes, and bad judgment caused by alcohol,” Tohid says. “Therefore, you still cannot drive while taking naltrexone and alcohol at the same time (although you don’t feel drunk yet you cannot drive).”

How Long Should I Take Naltrexone for Alcohol?

“The duration of naltrexone treatment for alcohol dependence is typically 3-6 months, although some people may need to stay on the medication for longer,” Waismann says. “This decision is made on a case-by-case basis as every patient should be treated as an individual with their own unique health needs.”

The usual starting dose of naltrexone is 25 mg per day, with an increase to 50 mg per day in a week’s time,” Tohid says. “Daily oral intake of naltrexone lasts for 3 to 4 months. If the patient achieves the goal of abstinence, then the treatment can be discontinued. Then the patient is monitored for 4-6 months. If the patient starts drinking again, naltrexone is restarted. If the heavy drinking continues during the first few months, the long-term naltrexone treatment begins.”

“If  Naltrexone is helping control cravings, most people will take naltrexone for a minimum of a year,” Mark Jaffe, MD, Psychiatrist at Westwind Recovery Los Angeles, tells WebMD Connect to Care. “During that period of time, most persons can find a good support network, get their psych meds stabilized, get into good psychotherapy, find good group meetings to attend, and learn how to cope and enjoy life without alcohol.”

Waismann notes that several factors could influence the timeline for Naltrexone therapy and the dosage, including:

  • patient's age
  • health status
  • severity of addiction
  • history of relapse
  • liver condition
  • mental health status
  • polysubstance use, and response to Naltrexone treatment. 

“Some patients may only need a brief course of Naltrexone, while others may require long-term treatment. The best way to determine an appropriate timeline and dosage is to work with a board-certified addiction doctor who can create a personalized treatment plan based on your unique needs. During treatment, you will receive regular check-ups with your healthcare provider to ensure that the medication is working and that you are remaining abstinent from alcohol,” Waismann explains.

What is the Success Rate of Naltrexone?

“There is no one-size-fits-all answer to this question, as the success rate of Naltrexone for AUD [Alcohol Use Disorder] will vary depending on the individual,” Waismann says. “However, multiple studies have shown that Naltrexone reduced the likelihood of relapse by approximately 38% to 50% when used to treat alcohol dependence.” 

Although Naltrexone has a lengthy history of success treating alcoholism, it is not sufficient when taken alone,” Pratty says. “Naltrexone is most effective when taken in concert with other forms of treatment, including other medications, therapy, counseling, and 12-step programs. One area where Naltrexone has proven especially useful is in the treatment of alcoholics who have relapsed. Some studies support that short-term treatment with naltrexone decreases the chance of alcohol relapses by 36% and reduces the chance of returning to drinking by13%.”


“Treatment plans that involve Naltrexone are typically most successful when implemented under the care of a medical professional such as a doctor or psychiatrist who can monitor progress and make changes as necessary. If you or someone you know is struggling with AUD, consider discussing the possibility of incorporating Naltrexone into their treatment plan,” Waismann adds.

What are the Side Effects of Naltrexone?

“Naltrexone is a prescription medication commonly used to treat alcohol and opioid dependence,” Waismann says. “While it is typically well-tolerated, there are possible side effects that can occur with nausea and headache being the most common.” 

Waismann notes other possible side effects may include:

  • Dizziness 
  • Drowsiness 
  • Insomnia 
  • Lethargy 
  • Restlessness 
  • Anxiety 
  • Agitation 
  • Irritability 
  • Mood swings 
  • Muscle aches 
  • Joint pain 
  • Decreased appetite 
  • Weight loss 
  • Diarrhea 
  • Constipation 
  • Skin rash 

If you experience any side effects while using Naltrexone, contact your physician. They may be able to adjust your dosage or recommend a different treatment plan.”

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