Naltrexone for Alcohol Use Disorder: How It Works and Who It Helps

Naltrexone for alcohol use disorder is an FDA-approved, nonaddictive medication that blocks opioid receptors in the brain. As a result, drinking feels less rewarding and cravings tend to ease. It comes as a daily pill or a monthly injection (Vivitrol). It can help people cut back on heavy drinking or stay sober, especially alongside counseling.

Maybe you have tried to cut back on your own. Willpower alone keeps running out by Thursday night. That is common, and it says nothing about your character. Alcohol use disorder changes how the brain responds to reward and stress, so medication is one reasonable tool among several. This guide explains how naltrexone for alcohol works, who tends to benefit, and who should not take it.

What Is Naltrexone for Alcohol, and Is It FDA-Approved?

Yes. The FDA approved oral naltrexone for alcohol dependence in 1994. That came a decade after its first approval, for opioid use disorder. In 2006, the FDA approved an extended-release injectable version, sold as Vivitrol, for the same purpose. The brand name for the tablet was originally ReVia, although most people today receive the generic.

Naltrexone is one of three medications the FDA has approved for alcohol use disorder (AUD). The other two are acamprosate and disulfiram. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), all three are nonaddictive. In addition, they can be used alone or combined with other forms of treatment. A primary care provider can prescribe them, as can a psychiatrist or addiction medicine specialist.

The American Psychiatric Association weighed in with a 2018 practice guideline. It recommends offering naltrexone or acamprosate to adults with moderate to severe AUD who want to drink less or stop. The guideline also describes those two as the medications best supported by clinical evidence.

How Does Naltrexone Work?

Alcohol triggers the release of the body’s own opioids, called endorphins. Those endorphins act on opioid receptors, which in turn release dopamine in the brain’s reward system. That chain is part of why the first drink feels good and why the next one is easy to reach for.

Naltrexone is an opioid receptor antagonist, meaning it sits on those receptors and blocks them. Consequently, drinking delivers less of a reward. SAMHSA’s prescriber guide (TIP 49) puts it simply: naltrexone reduces both the rewarding effects of alcohol and the craving for it. Many people say drinking simply feels less “worth it.” That can make stopping at one or two drinks more realistic.

Here is a point that surprises people: taking naltrexone for alcohol does not make you sick if you drink. That sets it apart from disulfiram (Antabuse), which causes flushing, nausea, and a racing heart when combined with alcohol. Naltrexone also does not treat withdrawal. Someone who is physically dependent on alcohol may need medically supervised withdrawal first, since stopping suddenly can be dangerous. Our alcohol withdrawal timeline explains what to expect.

Naltrexone Pill vs. Vivitrol Injection

Both forms contain the same medication. The difference is how it gets into your body and how long it lasts.

• Oral naltrexone: the typical dose listed on the FDA label is one 50 mg tablet per day. It is inexpensive as a generic. However, it only works on the days you take it.
• Extended-release injectable naltrexone (Vivitrol): the FDA label lists 380 mg given as an injection into the buttock muscle every 4 weeks by a health care professional. Because it lasts a month, missed pills stop being a problem.

For some people, the monthly shot removes a daily decision point. Others prefer the flexibility of a pill. Your prescriber decides the form and the dose based on your health history. Treat these label doses as background, not instructions.

Who Does Naltrexone for Alcohol Help?

Naltrexone is generally considered for adults with moderate to severe alcohol use disorder. Unlike some treatments, it does not require a goal of lifelong abstinence. It may fit someone who:

• Wants to reduce heavy drinking days, even if they are not ready to quit completely
• Has stopped drinking and wants support against strong cravings
• Keeps returning to drinking after periods of sobriety
• Functions well at work but drinks more than intended most evenings, a pattern we describe in our post on the high-functioning alcoholic
• Is not taking, and does not expect to need, opioid medications

What the Research Shows

The evidence base is large. A 2010 Cochrane review pooled 50 randomized trials with 7,793 participants. Naltrexone reduced the risk of heavy drinking to 83% of the risk seen with placebo. It also decreased drinking days by about 4%. Most studies lasted about three months.

Similarly, a 2014 federal review for the Agency for Healthcare Research and Quality (AHRQ) looked at oral naltrexone for alcohol. It found the 50 mg dose helped prevent a return to heavy drinking. The authors estimated that 12 people would need treatment for one person to avoid returning to heavy drinking. For the injectable form, evidence was weaker. Still, that review found a reduction in heavy drinking days.

In plain terms, naltrexone helps many people but not everyone. Nobody can promise a result. Even so, the benefits tend to be stronger when medication comes with counseling.

What Is the Sinclair Method?

You may see naltrexone discussed online in connection with the Sinclair Method. With this approach, a person takes naltrexone about an hour before drinking, rather than every day. Researcher John David Sinclair proposed the idea. Drinking while the reward pathway is blocked, he argued, gradually weakens the learned urge to drink.

This targeted use is debated. Some trials have studied as-needed dosing. Still, the FDA label describes daily use, and research on targeted dosing is smaller than for daily dosing. If the approach interests you, raise it with a prescriber. Don’t change how you take the medication on your own.

Who Should Not Take Naltrexone?

Naltrexone is not safe for everyone. According to the FDA labels and SAMHSA guidance, people should not take it if they:

• Currently use opioids, including prescription pain medications such as oxycodone or hydrocodone
• Take buprenorphine or methadone for opioid use disorder
• Are in opioid withdrawal
• Have acute hepatitis or liver failure

Because naltrexone blocks opioid receptors, taking it with opioids still in your system can cause sudden, severe withdrawal. For that reason, the Vivitrol label calls for an opioid-free period of at least 7 to 10 days before starting. Prescribers may also use a urine drug screen or a naloxone challenge to confirm it is safe.

Naltrexone also blocks opioid pain relief. So tell every provider you see, including your dentist and any surgeon, that you take it. With the monthly injection, the blocking effect can last for weeks.

Liver Monitoring and Side Effects

Naltrexone labels warn about liver injury, and cases of hepatitis have been reported. According to SAMHSA’s TIP 49, the risk is mainly linked to doses far higher than those used for AUD. Even so, prescribers commonly check liver function before starting and during treatment. Meanwhile, heavy drinking itself strains the liver, which is one more reason to get regular checkups.

The most common side effects are nausea, headache, dizziness, fatigue, and nervousness. Some people also report anxiety, stomach pain, or loss of appetite. For Vivitrol, injection-site reactions such as pain, tenderness, or hardness are common. The label notes that some severe reactions have required surgery. The Vivitrol label also advises watching for depression or suicidal thoughts. If you notice mood changes, contact your prescriber, and call or text 988 if you are in crisis.

How Does Naltrexone Compare to Other Alcohol Medications?

Acamprosate (once sold as Campral) is thought to calm the brain’s glutamate system. That may ease the restlessness and discomfort that can follow quitting. It does not pass through the liver, which makes it an option for some people with liver disease. Disulfiram works in the opposite way from naltrexone. It makes drinking physically unpleasant, so it only fits people committed to not drinking at all.

Why Naltrexone Works Best With Therapy

Medication can quiet cravings. It cannot, however, teach someone how to handle a hard day at work, a family conflict, or the 6 p.m. habit loop. The Vivitrol label itself states it should be part of a management program that includes psychosocial support. Likewise, SAMHSA notes that these medications help people reduce drinking and achieve abstinence when used with counseling.

At Rockland Recovery Group, alcohol addiction treatment combines individual therapy, group work, and relapse prevention at our Braintree location. Rockland Recovery Group does not prescribe naltrexone itself. Instead, we coordinate access to naltrexone through partner prescribers, so medication and therapy can move forward together. You can read more about how this fits into our medication-assisted treatment services.

Many people pair medication with an intensive outpatient program, which typically runs 9 to 15 hours per week and leaves room for work. Some people need medical supervision to stop drinking safely. In that case, our team arranges detox placement at an accredited partner facility, then welcomes you back into outpatient care.

Does Insurance Cover Naltrexone for Alcohol?

Most commercial health plans cover naltrexone for alcohol use disorder. Generic tablets usually fall under your pharmacy benefit, and copays are often low. Vivitrol, on the other hand, may be billed under your medical benefit or a specialty pharmacy. Some plans also require prior authorization. Coverage details vary, so call the number on your insurance card to confirm.

Rockland Recovery Group works with commercial plans such as Blue Cross Blue Shield, Aetna, Cigna, Optum, and Tufts. To learn more, see does insurance cover rehab and our guide to Blue Cross Blue Shield rehab coverage in Massachusetts. We do not accept MassHealth or Medicare. If you have either, the Massachusetts Substance Use Helpline at 800-327-5050 can connect you with programs that do.

Deciding to try naltrexone for alcohol is a practical step, and it deserves a real conversation with a clinician. When you are ready, our admissions team can explain therapy options and how medication-assisted treatment works at Rockland Recovery Group.

Sources

Clinical information in this article comes from the sources below and is reviewed under our editorial standards.

1. Substance Abuse and Mental Health Services Administration. TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice. Chapter 3: Oral Naltrexone. www.ncbi.nlm.nih.gov
2. Substance Abuse and Mental Health Services Administration. TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice. Chapter 5: Extended-Release Injectable Naltrexone. www.ncbi.nlm.nih.gov
3. U.S. Food and Drug Administration. Vivitrol (naltrexone for extended-release injectable suspension) prescribing information. www.accessdata.fda.gov
4. StatPearls. Naltrexone. National Library of Medicine. www.ncbi.nlm.nih.gov
5. Substance Abuse and Mental Health Services Administration. Prescribing Pharmacotherapies for Patients With Alcohol Use Disorder (Advisory). library.samhsa.gov
6. National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help. www.niaaa.nih.gov
7. American Psychiatric Association. Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder, 2018. psychiatryonline.org
8. Rösner S, Hackl-Herrwerth A, Leucht S, et al. Opioid antagonists for alcohol dependence. Cochrane Database of Systematic Reviews, 2010. www.cochrane.org
9. Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings. Agency for Healthcare Research and Quality, 2014. www.ncbi.nlm.nih.gov

This article is for information and does not replace advice from a licensed clinician. If someone is unresponsive, breathing slowly, or has blue lips after using opioids, give naloxone if you have it and call 911. The Massachusetts Good Samaritan law protects people who call for help during an overdose. For a mental health crisis, call or text 988.