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January 31, 2024

How Does Naltrexone Work for Alcohol?


Alcohol Use Disorder (AUD) is a widespread and challenging public health issue that affects millions of people worldwide. The 2021 National Survey on Drug Use and Health (NSDUH) found that 29.5 million people ages 12 and older had AUD in the previous year. Various treatment options exist to help those with AUD, and one medication that has gained attention for its effectiveness is naltrexone.

According to The American Journal of Psychiatry, naltrexone has been shown to improve numerous drinking outcomes, including a return to any drinking and a return to heavy drinking. Naltrexone is thought to help with craving and alcohol-related euphoria. This could be especially beneficial when dealing with binge drinking, which occurs among one-fifth of adults in the United States. Binge drinking is very detrimental to someone’s health, contributing to half of the annual deaths from alcohol. More than 140,000 deaths each year are attributed to alcohol.

What is Naltrexone?

Naltrexone is an opioid receptor antagonist that is particularly useful in reducing alcohol consumption and promoting abstinence. Naltrexone’s use in treating alcohol dependence is rooted in its original approval for opioid addiction. Developed in the early 1960s, naltrexone was primarily utilized to help individuals overcome opioid dependence by blocking the effects of opioids in the brain. However, researchers soon observed its potential for addressing alcohol-related issues.

Naltrexone can be administered in a pill form or an injection. The pill can be taken daily for AUD, but the extended-release injectable is used more often for the treatment of OUD. It is not recommended for anyone under 18 or with other health conditions. It should be used in conjunction with other behavioral health therapies as part of a comprehensive plan to treat the person’s AUD.

Naltrexone & Alcohol Use Disorder

Naltrexone acts as a competitive antagonist at the mu, kappa, and delta opioid receptors in the brain. These receptors are crucial components of the endogenous opioid system, which plays a role in the rewarding effects of alcohol. By blocking these receptors, naltrexone disrupts the reinforcing properties of alcohol, making it less appealing and reducing the likelihood of relapse.

Alcohol consumption triggers the release of endorphins, the body’s natural opioids, leading to pleasurable sensations. Naltrexone’s antagonistic effect dampens this pleasure response, making the experience of drinking less rewarding. This reduction in reinforcement diminishes the craving for alcohol, which is a key factor in the cycle of addiction.

Over time, individuals with AUD develop conditioned responses to alcohol-related cues. These cues, such as the sight of a bottle or the smell of alcohol, become associated with the rewarding effects of drinking. Naltrexone aids in extinguishing these conditioned responses by:

  • Disrupting the link between the cues and the pleasurable effects of alcohol
  • reducing the likelihood of relapse triggered by environmental stimuli.

Beyond its impact on the opioid system, naltrexone influences other neurotransmitter systems implicated in addiction. It has been suggested that naltrexone may alter the activity of the mesolimbic dopamine system, which is heavily involved in the reinforcing effects of alcohol. By modulating dopamine release, naltrexone contributes to a blunted response to alcohol, further reducing its attractiveness.

Is Naltrexone Safe and Effective?

Naltrexone is generally considered safe and effective when used as prescribed under medical supervision. Naltrexone’s safety profile is well-established, but like any medication, it can have side effects. Common side effects include:

  • Nausea
  • Headache
  • Dizziness
  • Fatigue

Effectiveness varies among individuals, but studies have shown that when combined with counseling or therapy, naltrexone can significantly reduce alcohol cravings and the risk of relapse in individuals with alcohol use disorder (AUD). It's not a standalone solution and works best as part of a comprehensive treatment plan.

As with any medication, it's essential to discuss individual health conditions and potential interactions with a healthcare professional before starting naltrexone.

Naltrexone is often most effective when used as part of a comprehensive treatment plan that includes psychosocial interventions such as counseling and support groups. Combining medication with behavioral therapies addresses both the physiological and psychological aspects of alcohol dependence, increasing the likelihood of sustained recovery.

How Does Naltrexone Compare With Other Intervention Methods?

Naltrexone is one of several interventions used to address alcohol use disorder (AUD). Its effectiveness and comparison with other methods depend on various factors, including individual preferences, the severity of the disorder, and any co-occurring conditions. Here's a comparison with some other intervention methods:

  • Behavioral Therapy: Therapies like Cognitive Behavioral Therapy (CBT) or Motivational Enhancement Therapy (MET) address the psychological aspects of addiction. They help individuals identify and change behaviors related to alcohol use. Naltrexone can complement these therapies by reducing alcohol cravings, making it easier for individuals to engage and benefit from counseling.
  • Acamprosate: Another medication used for AUD, acamprosate, works differently from naltrexone. Acamprosate helps stabilize brain chemistry post-detox, reducing symptoms of protracted withdrawal. It may be used alongside naltrexone or independently, depending on individual needs.
  • Disulfiram: Unlike naltrexone, disulfiram (Antabuse) doesn't directly impact cravings but creates an unpleasant reaction when alcohol is consumed. This discourages drinking by causing severe discomfort (such as nausea and vomiting) when alcohol is ingested. However, its effectiveness relies on consistent adherence and avoidance of alcohol.
  • Support Groups: Programs like Alcoholics Anonymous (AA) provide peer support, encouragement, and a structured approach to recovery. They don't involve medications but can be used in conjunction with naltrexone or other medications as part of a comprehensive treatment plan.

These methods often involve a personalized approach, considering the individual's response to treatment, preferences, and existing health conditions. Usually, a combination of approaches yields the most effective results.

Don’t Shy Away From Medication Assisted Treatment

Naltrexone is a valuable tool in the treatment of Alcohol Use Disorder, offering a pharmacological approach to address the neurobiological aspects of addiction. By disrupting the reinforcing effects of alcohol, reducing craving, and extinguishing conditioned responses, naltrexone contributes to a comprehensive strategy for managing AUD. Continued research and a personalized treatment approach are essential for maximizing the benefits of naltrexone and improving outcomes for individuals struggling with alcohol dependence.

At Meta, our clients deserve an addiction recovery experience that puts their needs first. That’s why we involve each client in the addiction recovery process through personalized addiction treatment plans, resources, and more. Contact us today to learn how we equip our clients with the knowledge and support they need for long-term recovery.