How Naltrexone May Help Reduce Alcohol Use
Even with the best of intentions, reducing or quitting alcohol use might seem nearly impossible. That’s because alcohol use over time can cause chemical and neurobiological changes in your brain that make you crave it.
Quitting or reducing alcohol consumption doesn’t have to be a matter of sheer willpower. A rollercoaster of relapsing doesn’t make you a failure. There are medical treatments available that can make reducing alcohol use more achievable — even without complete abstinence.
Naltrexone is an FDA-approved standard of care treatment to help patients curb alcohol cravings and decrease the brain’s reward response to the substance. “Naltrexone is an effective and well-tolerated medication that can be part of a recovery plan,” says Dhruti Patel, M.D., a psychiatrist at the University of Miami Health System, who also works at the inpatient detoxication unit at Jackson Behavioral Health Hospital.
“You can have willingness and motivation to quit, but there is some assistance that your brain may need in the early stages of recovery,” she says.
Abstinence isn’t the answer for everyone
Abstinence, as promoted by Alcoholics Anonymous, has become a cultural norm for alcohol addiction. And while that works for some people, it can be impossible for others.
Drinking alcohol over time causes chemical and neurological changes in the brain, making it difficult to simply stop. “Culturally speaking, everyone has that notion of being able to stop drinking on their own as if it’s under their control,” says Dr. Patel.
How naltrexone works to reduce alcohol consumption
Naltrexone works by reducing the cravings and pleasurable effects of drinking. Patients who take the medication for at least 12 weeks often report drinking less and regaining control. “A big shift we’re seeing in treatment for alcohol use disorders is that we’re not expecting people to quit entirely, but instead find a way to manage their alcohol use,” says Dr. Patel.
Naltrexone makes this much easier for patients by reducing cravings in the brain’s reward pathway. It’s a generally well-tolerated medication with no long-term side effects and no withdrawal symptoms when stopping use. “It’s a very safe medication to use, and what people notice over time is that after they’ve built up this dependence and tolerance to alcohol, the medication naltrexone allows patients not to feel as many cravings,” says Dr. Patel.
For example, someone who drinks 8-10 drinks a day can cut back to one or two drinks daily with the help of the medication. “It’s been shown to be very powerful in cutting down binge drinking episodes, and eventually, we can guide the patient to reducing, if not stopping, their drinking completely,” says Dr. Patel.
The standard dose is once a day, and there’s no need to increase or decrease the dose. It also comes in a monthly injection form.
For some, naltrexone becomes part of a long-term recovery strategy, while others may transition off the medication after they’ve developed other coping skills and routines.
Flexibility in treatment goals
Unlike the pressure some can feel in traditional abstinence-only approaches, naltrexone allows for flexibility in recovery. Relapse is part of the typical recovery process. “Part of recovery with any substance and alcohol use disorder is that it’s like a roller coaster. There will be ups and downs in the process,” says Dr. Patel.
This flexibility is particularly important given the cultural pressures around alcohol. “Alcohol is everywhere — in grocery stores, gas stations and advertisements. That accessibility creates additional challenges for patients trying to reduce their use,” says Dr. Patel.
Is naltrexone right for you?
You may be a good candidate for naltrexone if you notice an escalation in your alcohol use that’s affecting your ability to function. “This may be the case if you have tried to cut back and are having a hard time doing so on your own,” says Dr. Patel.
Although naltrexone is safe for most people, consult with a physician first. Psychiatrists, primary care physicians and addiction specialists all take an active role in treating alcohol use disorder.
Patients with active liver disease or certain lab abnormalities may need alternative treatments. “Your doctor will likely order blood work to ensure you’re a good candidate and discuss other FDA-approved options or off-label treatments if necessary,” says Dr. Patel.
Naltrexone is most effective for patients when taken together with behavioral treatment from a support group or a therapist. “The ones who do better on naltrexone are those patients who implement behavioral modification on top of the medication,” says Dr. Patel.
For those who are eligible, naltrexone can offer hope. By reducing cravings, the medication can provide the brain with the support it needs during early recovery, making environmental and behavioral changes more manageable.
Wendy Margolin is a contributor for UHealth’s news service.
Tags: Alcohol harm reduction, Alcohol use disorder (AUD), Dr. Dhruti Patel, Medication-assisted treatment (MAT), Relapse prevention
