The purpose of this article is to shed light on the relationship between naltrexone and alcohol, including the concept of pharmacological extinction. I will also cover how to use naltrexone for alcohol addiction.
Awhile back, I wrote an article on The Sinclair Method, and it has generated a lot of positive discussion since then.
While that article gives an overview this same treatment option, we will now go deeper into the pharmacology of naltrexone, research studies, alternatives to naltrexone, and additional topics that I did not fully elucidate.
Overview of Naltrexone and Alcohol
Naltrexone hydrochloride is a medication that has been approved to treat opioid addiction for decades, and alcohol addiction since 1994. Naltrexone is the generic name for this drug, and brands include an oral pill called Revia and a long-acting shot called Vivitrol.
Naltrexone is a opioid antagonist, meaning that it plugs the same brain receptors as opiates and endorphins (the brain’s natural pleasure chemicals). Instead of producing pleasurable effects, naltrexone sits in the receptor site and simply blocks pleasure chemicals from entering.
Specifically, naltrexone plugs the mu-opioid beta-receptor. You can see how this works in the picture below, which portrays the action of the Vivitrol shot.
When alcohol is consumed, the brain releases endorphins, which are endogenous opioids that are also released in response to exercise, food, sex, and other pleasurable activities.
Naltrexone therefore prevents drinkers from feeling pleasure when they drink. When the oral pill version is consumed, it must be taken before every drinking session to be effective.
Naltrexone was approved for alcohol addiction in 1994 after studies demonstrated that it reduced the amount of alcohol consumed and the severity of relapses.
Importantly, naltrexone taken alone with abstinence shows only a small reduction in relapse rates. The mechanism through which naltrexone works requires naltrexone and alcohol to both be present, over the course of repeated episodes of drinking. This process is called pharmacological extinction.
In other articles, I’ve partially explained alcohol addiction as an attempt to maintain comfortable levels of GABA, which is the brain’s primary calming neurotransmitter.
Yet as any heavy drinker knows, the calming effect of alcohol is only half of the equation. The other half is the profound sense of pleasure, euphoria, and reward that our brains come to associate with drinking.
For alcoholics, nothing releases endorphins as intensely as large quantities of alcohol.
In the past few decades, scientists have concluded that alcohol’s effects are mediated at least partly through the brain’s internal opioid system. This system is closely connected to the dopamine system, which is responsible for learning, motivation, and sense of reward.
From an evolutionary perspective, this makes sense: We need to remember things in our environment that give us pleasure so that we can instinctually seek them out in the future. For those of us who are predisposed to alcohol addiction, our brains’ attempts to automate goal-seeking for our own survival ends up threatening our survival.
The progression of alcoholic drinking can therefore be seen as a learned behavior even though the drinker has no conscious control over it. This kind of subconscious learning is reinforced by a chain reaction of neurotransmitters beginning with endorphins, which eventually causes the brain to release dopamine at the very idea of drinking. For an alcoholic in withdrawal, a single thought can easily begin the process of getting ready to go obtain alcohol from a store or a bar.
Pharmacological extinction is the gradual reversal of drinking as a learned behavior. It is made possible by the repeated presence of both naltrexone and alcohol, allowing the drinker to stop feeling pleasure and euphoria from the act of drinking. Over time, the drinker’s internal opiate system and dopamine system rewire so that the thought of alcohol produces a state of indifference rather than craving.
In a sense, pharmacological extinction is the alcoholic equivalent of training Pavlov’s dogs to associate the bell with no food at all.
Pharmacological extinction requires that naltrexone and alcohol are taken together for as long as the person decides to drink. In other words, for people who use naltrexone for alcohol addiction, naltrexone should be taken before each drinking session for the rest of their lives.
If they simply stop taking it and continue to drink, endorphins will be released that rekindle their alcohol addiction all over again.
Over the past few decades, a lot of research has been done on naltrexone and alcohol. The use of naltrexone for alcohol disorders is well-established in the scientific literature:
- In a 6 month double-blind, placebo-controlled study with 118 alcoholics, naltrexone was associated with significantly fewer heavy drinking days than the placebo (source)
- A 1997 study found that when naltrexone was combined with therapy, only 35% relapsed, compared to the treatment industry standard of up to 90% relapse (source)
- Out of 14 clinical trials conducted through 2001, only two failed to demonstrate the efficacy of naltrexone for alcohol disorders (source)
- A 2014 meta-analysis found that naltrexone for alcohol disorders is effective at reducing heavy drinking and extinguishing cravings (source)
- People with a particular variant of a gene (A118G Asn40Asp, or asparagine-to-aspartate amino acid substitution at position 40) for the mu opioid receptor obtain a greater high from alcohol and more dopamine response. A study conducted on alcoholics with this genotype found more success using naltrexone for alcohol addiction (in the form of reduced return to heavy drinking) than with other genotypes. (source)
The last study points to a recurring theme on this site: Due to biochemical individuality, some treatment methods work better for some people than for others.
How To Use Naltrexone For Alcohol Addiction
The following information may be useful if you are considering taking naltrexone for alcohol addiction:
- Naltrexone is a generic drug, and the two main brand names are Revia and Depade.
- Revia comes in bottles of 30 or 100 tablets, 50 mg each, while Depade comes in bottles of 30 or 100, either 25, 50, or 100 mg each.
- Typical dosage of naltrexone for alcohol addiction is 25-50 mg per day, either once per day, in split doses, or just prior to drinking.
- For long term users of naltrexone for alcohol addiction, the drug only needs to be taken prior to drinking.
- Naltrexone has a low incidence of adverse effects that force people to stop using the drug; however, side effects can occur.
- Only take naltrexone under the supervision of a doctor.
Note: In severe cases as defined by high alcohol consumption, detoxification with medications may be necessary before introducing naltrexone for alcohol addiction and attempting to achieve pharmacological extinction. Usually, 3-7 days of abstinence are recommended before treatment with naltrexone. (source)
Before taking naltrexone for alcohol addiction, make sure to review the following:
While I did not experience pharmacological extinction, which would have involved continuing to drink while taking naltrexone, I did take naltrexone for some time after quitting alcohol in case I returned to drinking.
Naltrexone was prescribed to me by a doctor who simply told me that it was safe and might help me stay abstinent. A 2014 meta-analysis of 122 studies showed that naltrexone only helps 1 out of 12 people stay abstinent (i.e., without drinking while on naltrexone). (source)
This doctor did not mention anything about pharmacological extinction or The Sinclair Method. In retrospect, it’s clear to me that he would have been fired from his job at an abstinence-based clinic if he had seemed to promote a form of harm reduction.
In his defense, I think that he figured I would relapse just like the rest of his patients (or 90% of them), and that naltrexone might save my life. Since I defied the relapse statistics (thanks to my revelations about fitness and nutrition), I never gave naltrexone a chance to work.
I took naltrexone daily for several months, and then ultimately decided that I was less worried about returning to alcohol than I was about living a life that might be muted by the absence of endorphins. I wanted to be able to fully enjoy my workout highs.
This is not a criticism of the use of naltrexone for alcohol disorders – if I had known about pharmacological extinction years earlier, I would definitely have opted for this method!!
Since I did not experience pharmacological extinction for myself, the main takeaway from my experience with naltrexone has little to do with its effectiveness.
The takeaway instead is that experts who feel pressured to promote abstinence are sometimes reluctant to explain the relationship between naltrexone and alcohol – i.e., pharmacological extinction and the research supporting it.
Eventually, I realized that some of the most clinically effective treatment methods for alcohol disorders had been hid from me by a narrow-minded treatment establishment.
It was then that I resolved to try to help others learn about alcohol recovery methods that fit their particular needs.
Alternative Treatment Methods
Not everyone can obtain naltrexone, since it must be prescribed by a doctor. Fortunately, more doctors are becoming aware of the relationship between naltrexone and alcohol.
While naltrexone for alcohol addiction is a unique form of harm reduction, there are alternatives – including drugs that have been shown to be effective in controlling alcohol cravings when administered for long periods of time.
I will also briefly review some supplements and natural remedies that I REALLY wish I’d known about back when I was struggling with alcohol addiction.
Baclofen is a prescription drug that is structurally similar to GABA. Baclofen can be used to manage alcohol withdrawal symptoms, and it has also been used long-term by a growing number of people to achieve a state of indifference toward alcohol.
To learn more, check out my article on the interesting baclofen alcohol relationship.
Gabapentin is similar to baclofen in that it helps the brain produce more GABA. It is increasingly popular for alcohol withdrawal, and sometimes combined with baclofen for long-term extinguishing of alcohol cravings.
You can read more about gabapentin in my article on this treatment method.
Kratom is a plant that has been used for hundreds of years in Asia, and which contains compounds that are partial opioid agonists. An increasing number of people are successfully using kratom to get off of alcohol and manage cravings.
In my popular article about using kratom for alcohol withdrawal, I describe this method as the opposite of naltrexone.
I have made kratom tea on several occasions, with great results and no side effects. Of course, I take care and do not use kratom often. I promote the kratom from Top Extracts on this site because its kratom quality and customer service are second to none.
Phenibut is a legal supplement that is remarkably similar in structure to GABA. It is known to:
If you cannot obtain either gabapentin or baclofen, you can use phenibut to ease mild to moderate symptoms of alcohol withdrawal at home.
For a full description of how this might be done including dosage information, see my article on using phenibut for alcohol withdrawal.
Before I explain how Calm Support works, let me make one thing clear…
Nearly a year after I quit drinking, I finally understood that the majority of my post-acute withdrawal symptoms were caused by nutrient deficiencies caused by prolonged alcohol exposure.
I finally ended my post-acute withdrawal symptoms (including alcohol cravings) by doing a lot of research and spending a lot of money on herbs, vitamins, and minerals.
Calm Support is an ingenious collection of high quality nutrients and herbs that are very effective for alcohol withdrawal. These ingredients cost a lot of money when purchased separately. Many of my clients have been able to quit drinking using Calm Support along with external support and basic lifestyle improvements.
Naltrexone for alcohol addiction is a little-known but highly effective treatment that our medical establishment has all but hidden from patients.
While not everyone responds well to naltrexone, I believe that greater awareness of the relationship between naltrexone and alcohol can improve recovery odds for many people.
There is no one-size-fits-all approach for alcohol detox and recovery.
When I quit drinking, I had no idea what my alternatives for detox and recovery were. A doctor simply prescribed a course of benzodiazepines. I was not enlightened about other pharmacological options, nutrient repair, the hypoglycemic trap that so many recovering alcoholics fall into, or holistic strategies for improving my quality of life.
My goal in writing articles such as this one is to empower you to have a much better grasp on your situation, and your options, than I did when I quit drinking.
If you have any questions about naltrexone and alcohol, or pharmacological extinction, please leave them in the comment box below.