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For individuals navigating the path to recovery from alcohol use disorder (AUD), managing the daily, often overwhelming, urge to drink can be the single greatest challenge. It is a courageous step to seek help, and today, there are more evidence-based tools than ever to support your journey. One of the most effective and well-established of these tools is naltrexone for alcohol abuse. This non-addictive medication can be a critical component in breaking the cycle of dependence, quieting cravings, and empowering you to focus on the deeper work of healing.

At Empower Health Group, our philosophy is built on the truth that recovery is not one-size-fits-all. We believe in using every proven medical and therapeutic tool to create a personalized, compassionate, and effective plan for every person who walks through our doors. This whole-person approach is the cornerstone of our Empower facilities, which can be found from New England to Florida to the West Coast, providing a new beginning for individuals and families.

What Is Naltrexone, and How Can It Support Recovery?

Naltrexone is an FDA-approved medication used to treat both alcohol use disorder (AUD) and opioid use disorder (OUD).¹ First approved in 1994 for the treatment of alcohol dependence, it has become a cornerstone of modern addiction medicine.

It is important to understand what naltrexone is, as well as what it is not. It is an opioid antagonist, meaning it blocks the effects of opioids at their receptor sites in the brain. 

But what is naltrexone not?

• It is not an opioid itself.
• It is not a replacement therapy like methadone.
• It is not addictive.
• It does not create a high or any feeling of euphoria.
• It does not produce physical dependence.

Naltrexone is available in two primary forms:

1. Oral naltrexone (ReVia): A pill that is typically taken once per day.
2. Extended-release naltrexone (Vivitrol): An intramuscular injection that is administered by a healthcare professional once every 30 days.

Naltrexone is not the same as disulfiram (Antabuse), another medication used for AUD. Disulfiram works by causing a severe, unpleasant physical reaction (like nausea and vomiting) if a person drinks alcohol. Naltrexone, by contrast, works on a neurobiological level to reduce the desire to drink in the first place. This approach is a key part of our addiction treatment philosophy.

How Does Naltrexone Work for Alcohol?

To understand how naltrexone works, it helps to first understand what alcohol does to the brain. When a person drinks alcohol, it triggers the release of endorphins, which are the body’s natural opioids. These endorphins bind to opioid receptors in the brain, a process that in turn causes a large release of dopamine, which is known as the feel-good neurotransmitter. This dopamine rush creates the feeling of pleasure, reward, and euphoria associated with drinking.

This reward pathway is what reinforces the behavior. Over time, the brain learns to associate alcohol with this powerful reward, which leads to cravings and the compulsive use characteristic of addiction.

Naltrexone works by directly interfering with this process. As an opioid antagonist, it binds to those same opioid receptors and effectively blocks them. It’s like putting a cover over a keyhole.

When a person taking naltrexone drinks alcohol, the endorphins that are released have nowhere to bind. The chain reaction is stopped before it can start. The dopamine rush is significantly blunted or eliminated.

This mechanism achieves two life-changing goals:

• It reduces cravings: Because the brain is no longer receiving the massive reward it has come to expect from alcohol, the intense, psychological pull to drink, the craving begins to fade over time.
• It prevents relapse: If a person in recovery does have a slip and a drink, naltrexone for alcohol abuse can prevent that single slip from turning into a full-blown relapse. Since the drink does not produce the expected euphoria, that feeling of positive reinforcement is gone, making it much easier to stop and get back on track. This makes using naltrexone for relapse prevention a vital tool.

Is Naltrexone Effective for Alcohol Use Disorder?

The evidence for naltrexone’s effectiveness in treating alcohol use disorder is well-established through decades of clinical research. It is considered a first-line treatment by the Substance Abuse and Mental Health Services Administration (SAMHSA) and other leading medical bodies.

A comprehensive review and meta-analysis of naltrexone for alcohol dependence found that it was consistently effective in reducing the risk of relapse.² Patients taking naltrexone were found to have fewer heavy drinking days and were more likely to remain abstinent compared to those who received a placebo.

The benefits of naltrexone for recovery are clear and measurable. It provides a pharmacological safety net that supports a person’s psychological and behavioral efforts in therapy. Turning down the volume on cravings gives individuals the mental and emotional breathing room they need to engage in their recovery, learn new skills, and build a fulfilling life without alcohol.

This is why we believe so strongly in its use as part of a comprehensive plan. It is one of the most powerful and reliable tools in modern medication-assisted treatment (MAT).

What to Expect on Naltrexone

Starting a new medication can be an intimidating step, so it is important to be transparent about the process. A prescription for naltrexone should only come after a thorough medical evaluation by a qualified healthcare provider.

The most critical first step, before the first dose is ever taken, is detoxification. Naltrexone can only be started after a person is no longer physically dependent on alcohol or any opioids. A safe, comfortable, and supervised medical detox is the essential first phase of care.

This is especially crucial for individuals who may also be using opioids. Because naltrexone blocks opioid receptors, taking it while opioids are still in your system can cause what’s known as precipitated withdrawal. This is a sudden, severe, and very unpleasant withdrawal state. To prevent this, medical guidelines state a person must be opioid-free for 7 to 10 days before starting naltrexone.³

Like any medication, naltrexone can have side effects. The most common is nausea, which is often mild and tends to fade after the first week of treatment. Other potential side effects can include headache, dizziness, fatigue, or trouble sleeping.³ Your medical team will monitor you closely to manage any side effects and ensure the medication is a good fit.

Naltrexone for Alcohol Abuse: Why Therapy Is the Other Half of the Solution

This is perhaps the most important point we can make. Medication alone is not recovery. Naltrexone for alcohol abuse is a powerful tool, but it is just one part of a much larger, more holistic process of healing.

Think of it this way. Naltrexone is like a cast on a broken leg. It holds the bone in place, provides stability, and prevents further injury, which in this case are cravings and relapse. However, the cast itself does not heal the leg. The healing is a biological process that includes physical therapy to rebuild strength and mobility.

Addiction is a complex condition with deep psychological, behavioral, emotional, and social roots. Naltrexone can quiet the biological noise of addiction, but it does not resolve the underlying issues that may have led to the substance use in the first place.

This is where the combination of naltrexone and therapy for alcoholism creates a truly transformative and lasting path to recovery. While the medication holds the cravings at bay, therapy is where you do the work of rebuilding your life.

In our therapy programs, we use evidence-based models to help you heal the why behind the addiction:

• Cognitive behavioral therapy (CBT): This approach enables you to identify the specific thoughts, feelings, and situations (triggers) that lead to drinking. You then work with a therapist to develop new, healthier coping strategies to manage those triggers.
• Dialectical behavior therapy (DBT): This is exceptionally effective for individuals who struggle with intense emotions. DBT teaches practical skills in four key areas of mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
• Group therapy: This core component breaks the shame and isolation that so often accompany addiction. It allows you to build a community of support with peers who truly understand your journey.
• Individual therapy: This provides a safe, one-on-one space to explore and heal personal issues, such as past trauma or co-occurring mental health conditions.

Who Is a Good Candidate for a Naltrexone Treatment Program?

A naltrexone treatment program is not the right fit for everyone. However, for many, it is a life-changing option. The decision to use this medication must be made in consultation with a medical professional after a full evaluation.

Naltrexone may be an ideal choice for individuals who:

• Have completed detoxification and are no longer physically dependent on alcohol.
• Are highly motivated to reduce their drinking or stop completely.
• Continue to struggle with persistent, high-level alcohol cravings.
• Are committed to participating in a comprehensive therapy and treatment program.
• Have a history of relapse after previous attempts at recovery.

Naltrexone is not recommended for:

• Individuals who are currently dependent on or actively using any opioid, including prescription painkillers, like oxycodone or hydrocodone, or illicit opioids, like heroin.
• Individuals with acute hepatitis or severe liver failure. Because the liver processes naltrexone, a doctor must evaluate your liver function before prescribing it.³
• Individuals who are pregnant or breastfeeding should discuss the risks and benefits with their doctor.

Often, alcohol use disorder co-exists with mental health conditions like depression, anxiety, or post-traumatic stress disorder (PTSD). Our dual-diagnosis programs are designed to treat both AUD and a mental health condition simultaneously, which is essential for lasting recovery.

Frequently Asked Questions