Naltrexone for Alcohol Cravings: How It Cuts the Urge

Sep, 14 2025

Naltrexone is an opioid receptor antagonist medication that blocks the rewarding effects of alcohol, thereby reducing cravings.

Alcohol Use Disorder (AUD) is a chronic condition characterized by an inability to control drinking despite negative consequences.

Quick Take

• Naltrexone blocks opioid receptors, dampening alcohol’s pleasure signals.
• Both oral tablets (50mg daily) and extended‑release injections (380mg monthly) are FDA‑approved.
• Best for people who can stay abstinent for a few days before starting.
• Works best when paired with counseling or support groups.
• Side effects are usually mild; liver function should be checked.

How Naltrexone Works

When you drink, alcohol triggers the brain’s opioid receptor system, releasing dopamine that creates a feeling of reward. Naltrexone binds to these receptors without activating them, acting like a “plug” that stops alcohol‑induced dopamine spikes. The result is a muted pleasure response, which translates into fewer intense cravings.

Think of the brain’s reward pathway as a radio. Alcohol turns the volume up; naltrexone turns the knob down to a whisper.

Who Benefits Most

Clinical research shows three groups see the biggest drop in drinking days:

1. People with a strong family history of AUD.
2. Those who can maintain at least 48hours of sobriety before the first dose.
3. Individuals who combine the medication with behavioral therapy.

In a clinical trial conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), participants on oral naltrexone reduced heavy‑drinking days by 30% compared with placebo.

Forms of Naltrexone: Pill vs Injection

The oral tablet (50mg) is taken once a day. It’s inexpensive and flexible, but adherence can be an issue.

The long‑acting injectable, marketed as Vivitrol, an extended‑release formulation of naltrexone, delivers a steady dose for a month. This eliminates daily‑pill forgetfulness and provides a clear visual cue of treatment commitment.

Comparing Naltrexone with Other AUD Medications

In short, naltrexone targets the reward system, disulfiram creates an aversive reaction to alcohol, and acamprosate steadies brain chemistry after withdrawal. Choose based on personal health profile, side‑effect tolerance, and treatment goals.

Safety, Side Effects, and Monitoring

The most common side effects are nausea, headache, and fatigue. Less than 5% stop treatment because of severe reactions.

Because naltrexone is processed by the liver, the FDA recommends baseline liver‑function tests (ALT, AST) and repeat testing if symptoms arise.

Pregnant or nursing people should avoid naltrexone unless the benefits clearly outweigh the risks.

Integrating Medication with Therapy

Medication alone rarely produces lasting change. Pairing naltrexone with cognitive‑behavioral therapy (CBT), motivational interviewing, or peer‑support groups (like AA) boosts success rates by up to 40%.

One practical framework:

1. Week1‑2: Baseline assessment, liver tests, and start oral naltrexone.
2. Week3‑4: Introduce weekly CBT sessions.
3. Month2 onward: Switch to Vivitrol if adherence is poor.
4. Every 3months: Review drinking patterns, adjust therapy, and repeat labs.

Practical Tips and Common Pitfalls

• Start after detox. Naltrexone will cause severe nausea if alcohol is still in the system.
• Don’t stop abruptly. Taper the oral dose before moving to the injectable.
• Watch for drug interactions. Opioid pain meds (e.g., morphine) become ineffective while on naltrexone.
• Stay hydrated. Mild nausea often improves with fluids and light meals.
• Track cravings. Use a simple diary; seeing a downward trend reinforces motivation.

Next Steps for Readers

If you think naltrexone might fit your recovery plan, take these actions:

1. Schedule a visit with a primary‑care physician or addiction specialist.
2. Ask about baseline liver‑function testing.
3. Discuss whether oral tablets or the monthly injection better suit your lifestyle.
4. Enroll in a counseling program that complements medication.
5. Set a realistic goal-e.g., “reduce heavy‑drinking days from 6 to 2 per week in three months.”

naltrexone offers a pharmacological edge for people ready to curb alcohol cravings, especially when paired with solid counselling and regular health checks. The right choice depends on your medical history, lifestyle, and support network-talk to a health professional to map out a plan that fits you.