More than 14 million US adults have alcohol use disorder — the medical term for alcoholism — a health condition that causes people to keep drinking even when it negatively affects their lives, according to the National Institute on Alcohol Abuse and Alcoholism. Even if a person wants to part ways with alcohol, it’s one of the hardest habits to break because excessive use can cause people to physically crave it.
Luckily, there are multiple, evidence-backed ways to help people manage unhealthy drinking habits, including 12-step programs, such as Alcohol Anonymous, cognitive behavioral therapy, and in-patient and out-patient rehab programs, where people detox from alcohol and learn coping mechanisms to stay sober.
Sometimes, doctors also prescribe medication for alcohol use, either in addition to or instead of other therapies. In the 1980s, researchers first began studying a drug called Naltrexone, as a way to reduce alcohol cravings. After the FDA approved it to treat AUD in 1994, it’s now one of the most common medications doctors use for the condition.
Naltrexone works by blocking opioid receptors in the brain. This lessens alcohol’s effects — sedation and euphoria — and, over time, reduces people’s cravings for it. Some people take Naltrexone to help them stay sober. Others want to curb binge-drinking or other problematic drinking behaviors. Studies show that Naltrexone and similar drugs can support both goals, by preventing relapses as well as helping people cut down on how much, and how often, they drink.
But what’s it actually like to take Naltrexone? How well do people who try “medication-assisted” treatment for alcohol use disorder feel it works? Here are five first-hand accounts from people who’ve done it.
“It’s as if the addiction has been erased from my brain.”
Katie, 34, Monterey, California
Katie had tried to quit drinking dozens of times. She’d been to AA, read self-help books, cleansed and revamped her diet, and embraced meditation. Nothing worked, and whenever she wasn’t drinking, unrelenting cravings made her life miserable. “Even though I would be sober on the outside,” she says, “on the inside I was having a battle in my mind, forcing myself to not give in to the craving, and avoiding people, places and things that would trigger my urge to drink.”
In 2017, she learned about the Sinclair Method, which entails taking Naltrexone before having a drink to block the “buzz.” This makes it easier to wean yourself off alcohol because you gradually stop associating it with pleasure.
To Katie’s surprise, no local doctors endorsed Naltrexone; they all recommended AA or detox and said they’d only consider prescribing medication if she quit drinking first. Eventually, she found a not-quite-local doctor who used the Sinclair Method and saw patients virtually. Her first appointment ended with a prescription. “My life was changed,” she says.
Within a week of starting medication, her relationship with alcohol was different. She couldn’t finish two glasses of wine, let alone her usual bottle. She drank less and less over time — without any white-knuckling. After nine months, she was down to about one glass of wine a month, which she describes as a miracle. Now, after three years of full sobriety — and no Naltrexone — Katie doesn’t even feel like drinking at all. “It’s as if the addiction has been erased from my brain.”
“I’ll stay on Naltrexone forever if it keeps working like it is.”
Kyle, 33, Utah
After going to rehab for alcohol use at 22, Kyle stayed sober for about three and a half years. Then, one winter night, he and his partner decided he should try drinking again, to see if he could handle it. He couldn’t — within a few months, he was drinking day and night.
He did a second stint in rehab two years later, and then stayed sober for a year before falling off the wagon again. Desperate to get his life together once and for all, he asked his primary care provider for two medications he’d researched on his own: Naltrexone and Antabuse, a prescription drug that makes you sick (nausea, vomiting, severe headaches) if you drink. Now, Kyle is totally sober. “It’s been more than two years, and I’ll stay on Naltrexone forever if it keeps working like it is,” he says.
For the first 18 months of his sobriety, Kyle saw his PCP, who happens to be an addiction treatment expert, for monthly Naltrexone shots. (The injectable form of the drug is called Vivitrol.) His doctor wanted to administer the medication herself to make sure Kyle didn’t skip a dose. Once she felt confident in his commitment to sobriety, she prescribed Naltrexone pills instead, which he takes nightly. He has no plans to drink again, and he doesn’t expect to need additional support from inpatient treatment or therapy. The two medications have eliminated his urge to drink entirely.
“My family and friends have noticed a complete difference in my attitude and physical status.”
Jesse, 41, Detroit
Jesse noticed his drinking was getting out of hand about three years ago. He began missing work more frequently, and his colleague started making comments about smelling alcohol. “The final straw was when I went out for my birthday and didn’t know how I got home,” he says.
He went to rehab, but only managed to stay sober for a few months. Soon afterwards, he asked his PCP for Naltrexone and got a prescription easily. As long as he’s diligent in taking it, Jesse says he doesn’t crave alcohol anymore. But he takes Antabuse too, just in case.
In addition to taking medication, Jesse attends an addiction support group called SMART Recovery. After getting a ticket for driving while intoxicated, he also uses Soberlink, a digital breathalyzer that automatically notifies the local courthouse if he drinks.
“My family and friends have noticed a complete difference in my attitude and physical status,” he says. “I lost 50 pounds, I don’t feel depressed, and my anxiety is almost completely gone.”
“If I take a Naltrexone, there’s no desire to have more than a drink or two. If I slip and ‘wing it’, I can get in trouble.”
Will, 51, Salt Lake City
In the back of his mind, Will had known for a few years he had a drinking problem. But he didn’t take any steps to address it until he learned about medications prescribed for alcohol use disorder. Even then, he didn’t set out to quit drinking. He just wanted to scale back to prevent alcohol from negatively affecting his life.
Equipped with literature, Will hoped to convince his PCP that the Sinclair Method was a viable treatment approach. His doctor consulted a colleague who was familiar with it and then prescribed Will a short supply of Naltrexone. Now, his doctor is totally on board with Will taking Naltrexone indefinitely.
Naltrexone helps, Will says, but he has to make sure he takes it properly. “If I’m good and always take a Naltrexone before drinking, there’s no desire to have more than a drink or two,” he says. “If I slip and ‘wing it’, I can get in trouble.”
Generally, he limits his drinking to weekends and holidays, and maybe once or twice during the week — far less than his former everyday drinking habits. On weekends, he may occasionally drink a little heavier. “However, since that’s only sporadically, it generally feels pretty bad the next day and serves as a good reminder to get back to the plan.”
Will prefers the Sinclair Method because it gives him more flexibility than some of the 12-step programs, which track progress by counting sober days. In following the Sinclair Method, he can view any missteps with alcohol as setbacks within a big picture, rather than failures. “You learn your lesson, change your behavior, and do no better next time,” he says.
“I recommend it in early recovery because your thoughts are not consumed with urges and you can start to envision a life of sobriety.”
Rachel, 29, New York City
Rachel first learned about Vivitrol injections from a psychiatrist and substance abuse counselor at an intensive outpatient program she attended for alcohol use disorder. During the early stages of her recovery, Rachel was still able to drink if she wanted to — but she wouldn’t get a buzz, as she quickly learned.
She’s been totally sober for more than two years and she no longer needs to take Vivitrol to avoid drinking. The key was abstaining long enough to stop craving alcohol, which the medication made possible. “I definitely recommend it for those in early recovery because your thoughts are not consumed with the urges that you may be experiencing and you can start to envision a life of sobriety,” she says.
Now, as a certified recovery peer advocate and addiction recovery coach, Rachel helps other people get sober: “I am now living life to the fullest and am able to show up for people and be the reliable and caring person that I was prior to active addiction.”