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Should Naltrexone be a Part of Your Recovery Toolbox?

A woman with her hair up looking out a large window at a body of waterPhoto credit: Jad Limcaco via Unsplash

In the digital age, recovery options range far and wide. The traditional options like a 12-step program and rehab work for many people. For those who seek a different approach but still want the group setting, mutual-aid options like SMART Recovery exist. For those who want a holistic approach, there are completely online options like Tempest. Medication-assisted treatment (MAT)—using something like Naltrexone to quit drinking—is also an option for those who are working through alcohol use disorder (AUD) and/or substance use disorder.

Whichever method you decide to take, your recovery should fit your individual needs, regardless of society’s commentary. What works best for you is what matters, and that includes medication. Using something like Naltrexone, which is non-addictive and can help decrease cravings, is a harm reduction approach to quitting drinking.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as “the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

Nasrin Bashiri, MD, a board-certified child, adolescent, and adult psychiatrist with interest and experience in addiction medicine, emphasizes the fact that MAT should not be approached as a singular answer to recovery.

“It is important to know that MAT is one part of the treatment plan for alcohol use disorders,” she says. “Recovery groups and individual counseling and therapy are important steps toward recovery as well.”

Medication-assisted treatment, SAMHSA explains, “operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative and euphoric effects of the substance used.”

One such medication, Naltrexone, is an FDA-approved option. You might be wondering whether or not Naltrexone should be a part of your recovery plan. We’re taking a look at the history and use of Naltrexone and speaking with Dr. Nasrin Bashiri and Linda Johnson, LMFT, LAADC to help you determine whether or not Naltrexone should be a consideration for your recovery.

First, a Brief History of Naltrexone

Naltrexone isn’t a new medication. In fact, it has been around since the 1960s. It was first developed (synthesized) and patented in 1961 by two doctors at the Memorial Sloan Kettering Institute for Cancer Research: Dr. Jack Fischman and Dr. Mozez Lewenstein.

At the time, the theory, which was developed by Dr. Harold Blumberg of Endo Laboratories in Long Island, NY, was that the medication would prevent opioid overdose in an emergency situation. That theory proved to be true, and the FDA approved an intravenous version—meaning administered through the veins, typically in a controlled medical environment like a hospital—of Naltrexone to prevent opioid overdose in 1971. A quick injection form wasn’t approved until 2014. 

You might recognize the modern name NARCAN, the nasal spray form of a drug called Naloxone administered by EMTs and emergency physicians. Naloxone is considered the short-acting version of Naltrexone. Says the National Library of Medicine:

A comprehensive discussion of naltrexone should be understood within the context of naloxone, which is considered its short-acting version based on relative half-lives (three hours for naloxone, 13 hours for oral naltrexone). When first synthesized, naloxone was a novel medication as well as a cornerstone of research into the pharmacology of the opioid system. Naloxone successfully competes against opioids to bind to the “Mu” opioid receptor on neurons, completely blocking the opioid’s downstream effects. As a “Mu opioid receptor (MOR) antagonist,” it reverses the potentially deadly effects of opioid overdose.

The nasal spray was approved by the FDA in 2017. 

In a parallel timeline, the pill form of Naltrexone was also studied as a possible treatment for heroin addiction in 1974. It was approved by the FDA for the treatment of heroin addiction in 1984. 

It wasn’t until 1986 that Naltrexone was studied for the treatment of alcohol use disorder. At that time, a psychiatrist named Dr. Joseph Volpicelli conducted rat trials and found that Naltrexone might be a viable option for the treatment of alcohol use disorder. The results were so favorable that the study prompted a clinical trial, which also yielded favorable outcomes. That trial was then recreated in a larger study in 1992 by Yale, which then prompted FDA approval for the medication’s use specifically for alcohol use disorder.

How Naltrexone Works

When you drink, the alcohol goes straight to the bloodstream and the “feel good” chemicals like serotonin are released. Once those feel-good chemicals reach the receptors in the brain, it produces a euphoric feeling. This is one of the ways in which we become addicted to alcohol—our brains and bodies start to crave that feeling.

“Naltrexone decreases the craving of drinking alcohol by blocking the euphoric effect of alcohol and is therefore helpful to decrease alcohol consumption,” says Dr. Bashiri.

This, in turn, deters people from drinking. After all, if you’re not experiencing the desired effect, then drinking likely seems less enticing overall. 

How Naltrexone Helps People with AUD

As stated above, the use of Naltrexone blocks the euphoric feelings produced by alcohol, so right off the bat, the alluring nature of alcohol might be relieved for someone. 

Additionally, the use of Naltrexone, in conjunction with proper mental healthcare and support, could improve quality of life for some. Dr. Bashiri has seen such improvement in her practice.

“It has helped them to stay away from alcohol and maintain their sobriety and improve their functioning and fulfilling their jobs and obligations.”

Johnson, who works with patients in her private practice who want to address AUD, also reports seeing positive results from Naltrexone use when it is accompanied by therapy and a recovery group.

“I’ve had clients benefit from the use of Naltrexone when other interventions were unsuccessful due to persistent, intense cravings for alcohol,” she says. “For most clients, Naltrexone significantly reduced the cravings for alcohol and blunted the ‘high’ from alcohol when a client did drink again.”

Johnson also reports that Naltrexone can be quite beneficial for those recovering from AUD who also have a history of trauma.

“A client may present to therapy with alcohol or other drug use as a primary concern, but often therapists discover that the substance misuse began as a ‘solution’ to emotional suffering, traumatic memories, mental health issues, or other stressful experiences,” she explains.

Johnson notes that when dealing with trauma, patients tend to use alcohol to numb the mental health issues that result from the experiences. Anxiety, depression, and PTSD are some of the common mental health issues that result from trauma, according to the U.S. Department of Health and Human Services’ Office on Women’s Health. Cutting back on alcohol, Johnson continues, sometimes means that these masked mental health issues resurface and are oftentimes heightened, which can be difficult to work through.

“These symptoms can trigger cravings for alcohol and place the client at risk for resuming old patterns of drinking,” Johnson says. “Non-addictive psychotropic medicines like Naltrexone are particularly useful during these times to help reduce these symptoms during treatment for alcohol misuse.”

Who is a Candidate for Naltrexone?

Put simply, Bashiri says, “Anyone above age 18 who has diagnostic criteria for alcohol use or opioid use disorder is a good candidate for Naltrexone.”

That said, there are some important things to consider. 

Withdrawal

If you are still using alcohol or opioids—even if it’s a prescription—you want to be upfront with your provider about your use.

“Since Naltrexone is an opioid blocking agent and it would make them go through withdrawal if they have opioids in their body,” Bashiri says.

If you use alcohol heavily and have become dependent on it, the use of Naltrexone before you’ve been properly detoxed from alcohol can cause withdrawal symptoms as well. 

Your Recovery Approach

As stated by Bashiri and Johnson, and in most literature about Naltrexone, the medication only works if you’re approaching recovery from a holistic perspective. Therapy, consistent contact with your provider, and a recovery program of some sort make the medication more effective. Naltrexone’s purpose is to aid your recovery process. 

Medication is Not a Cure

If you’re hoping Naltrexone or any other medication used to help treat addiction will cure you of your alcohol use, it might not be the right time to try it. Medication might help you through, but it is not a cure. Naltrexone in particular is only meant to be used for a short period of time. 

“(Naltrexone) isn’t intended to be taken for more than a few months, so it’s important that anyone using the medication also engage in addiction treatment programming like medical detoxification, peer support groups or group therapy, individual therapy, family therapy, and other healing practices,” Johnson says.

So, is Naltrexone Right for Your Recovery?

The reality is that there is no catch-all answer to this question. If your cravings are too intense and you can’t find relief, or if you’ve tried all other methods of recovery and find that you’re still having trouble staying away from alcohol—even though you want to quit drinking—then it is possible Naltrexone can help.

If you’re considering Naltrexone as part of your recovery toolbox, your provider can work with you to help you determine if MAT is right for you. Whatever you decide, what’s most important is that your choice makes sense for you. The purpose of any recovery tool is to help you through the process of getting sober. Your recovery process should be what you need.

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