When most people picture treatment for a drinking problem, they picture willpower, meetings, and maybe a stay somewhere. Medication rarely comes up. That is a gap, because the FDA has approved several medications for alcohol use disorder, and one of the most widely studied is naltrexone.
This article explains what naltrexone is, how it works on drinking, who tends to be a good fit, and what to know before starting. It is general information, not medical advice. Whether naltrexone or any other medication makes sense for you is a decision to make with a medical provider who knows your history.
A medication most people have never been offered
Medications for alcohol use disorder are used far less often than the research supports. A large review of outpatient alcohol treatment published in JAMA described them as considerably underused, even though several have solid evidence behind them.
Part of the reason is simple awareness. Many people, and some clinicians, still think of alcohol treatment as something you do only with counseling and support groups. Those matter, and they remain the foundation. But the National Institute on Alcohol Abuse and Alcoholism is clear that three medications, naltrexone, acamprosate, and disulfiram, are approved to help people stop or reduce drinking, that they are not addictive, and that they can be used alongside behavioral treatment.
How naltrexone works
Naltrexone blocks opioid receptors in the brain. That sounds unrelated to alcohol, but part of what makes drinking rewarding runs through that same system. When those receptors are blocked, alcohol tends to produce less of the pleasant, pulling feeling that makes one drink turn into five.
People describe the effect in different ways. Some say the craving is quieter. Some say they notice they can stop after one or two drinks in a way they could not before. Some find that drinking just feels less worth it. NIAAA summarizes it plainly: naltrexone can help people reduce heavy drinking.
What it does not do is make you sick if you drink. That is a different medication, disulfiram, which works by causing unpleasant reactions to alcohol. Naltrexone works on the reward side instead of the punishment side, which is one reason many people find it easier to stay on.
Daily tablet or monthly injection
Naltrexone comes in two forms. One is a tablet taken once a day. The other is an extended-release injection, given by a health care provider about once a month, which removes the need to remember a daily dose.
Each form has trade-offs, and SAMHSA’s clinical guide on medications for alcohol use disorder walks through them for prescribers: how quickly each can be started, how long someone may need to go without drinking beforehand, and what to watch for along the way. Which form fits, or whether a different medication fits better, depends on the person. At Athens Recovery, our medical team evaluates each client and helps them decide which therapies they are a candidate for.
What the research shows
Naltrexone is one of the most studied medications in addiction treatment. The same JAMA review pooled results from dozens of randomized trials and found that naltrexone was associated with fewer people returning to heavy drinking compared with placebo. Acamprosate also showed benefit, particularly for helping people who had already stopped drinking stay stopped.
It is worth being straight about the size of the effect. Naltrexone helps, but it is not a switch that turns a drinking problem off. It works best as one part of a treatment plan that includes counseling, support, and a real look at what drinking has been doing for you. That is also how the research was done: most trials paired medication with some form of psychosocial care.
Who tends to be a good fit
Naltrexone is often considered for people who:
- Experience strong cravings for alcohol
- Want to stop drinking, or want to significantly cut back as a first step
- Have tried to stop before and found the pull too strong
- Are in counseling or outpatient treatment and want an added layer of support
It is not right for everyone. The most important exception involves opioids.
An important safety note about opioids
Because naltrexone blocks opioid receptors, it cannot be combined with opioids of any kind, including prescription pain medication, heroin, fentanyl, and buprenorphine. Someone who still has opioids in their system and takes naltrexone can be thrown into sudden, severe withdrawal. That is why a medical provider will ask detailed questions about opioid use, and may test for it, before starting.
There is a second risk on the other end. While naltrexone is working, it blocks the effects of opioids. When someone stops taking it, their tolerance may be much lower than before. Using opioids at a previous amount after stopping naltrexone can lead to overdose. If opioids are any part of your history, tell your provider, even if it feels unrelated to your drinking.
Your provider will also review your liver health, other medications, and any upcoming surgeries or procedures where pain medication might be needed. Common side effects, as SAMHSA’s guide notes, can include nausea, headache, and dizziness, and they often ease with time.
Naltrexone is not a detox
This point matters enough to say on its own. Naltrexone does not treat alcohol withdrawal, and stopping heavy drinking suddenly can be dangerous. Alcohol withdrawal can cause seizures and, in severe cases, a life-threatening condition called delirium tremens. Symptoms can begin within hours of the last drink and may worsen over the next several days, which is why the timing and setting of stopping matter.
If you have been drinking heavily and daily, talk to a medical provider before you stop. Some people need a period of medically supervised alcohol detox first. Medication like naltrexone usually comes after withdrawal is safely behind you, as a way to help you stay on track.
How medication fits into outpatient treatment
At Athens Recovery, medication is part of a treatment plan, not a replacement for one. Clients work with our clinical team in our partial hospitalization program (ASAM Level 2.5, six hours a day, Monday through Friday) or our intensive outpatient program (ASAM Level 2.1, three hours per session), and our medical team manages any medication alongside that work.
Counseling gives you the tools. Medication, when it is a good fit, can quiet the noise enough to use them. For many people the combination is what finally makes change feel possible rather than exhausting.
Questions to bring to your first appointment
If you are wondering whether medication could help, a few questions are worth asking:
- Based on my drinking, do I need medical detox first?
- Am I a candidate for naltrexone, or would a different medication fit better?
- Do any of my current medications or health conditions rule anything out?
- How will we know if it is working, and how long would I take it?
You do not need to have answers before you call. That is what the evaluation is for.
Getting started
If drinking has started to cost more than it gives, you do not have to figure out the next step alone. Call (762) 728-7286 or reach out to our admissions team online. We will talk through what is going on, verify your insurance, and explain what an evaluation with our medical team looks like.
