Perhaps you have heard about various medications that may help you change your relationship to alcohol. One such medication is naltrexone, a drug that helps curb urges to drink and can be useful both for those wishing to abstain and those wishing to moderate.
This medication has been around for many years, approved by the US Food and Drug Administration for the treatment of alcohol abuse and alcoholism in 1994.
A major proponent of its use, Dr. John David Sinclair, proposed several years earlier that drinking problems develop through a chemical process such that, with each drink, the endorphins released in the brain strengthen specific synapses. As these synapses become stronger, the likelihood increases that the drinker will be thinking about, and eventually compulsively craving, alcohol.
Sinclair further proposed that these synapses could be gradually weakened, thereby reducing cravings, by stopping the endorphins from reaching the brain’s opiate receptors. He set out to test this hypothesis with a group of rats bred to love alcohol. Administering drugs that block opiate receptors, he found that if the rats took the opioid antagonist each time they were given alcohol, they gradually decreased the amount they drank. These positive results were replicated in human studies using another opioid antagonist, naltrexone. And in 2001 Sinclair published a paper in the journal Alcohol and Alcoholism reporting a 78 percent success rate in helping patients reduce their alcohol consumption or stop drinking entirely.
In terms of administration of naltrexone, Sinclair proposed taking the drug an hour before drinking to reduce cravings and increase control of alcohol consumption. This came to be known as the Sinclair Method and is common throughout Europe. In the US, naltrexone is more commonly prescribed as a daily medication that helps curb cravings even if drinking has not be initiated. This makes it very useful for those who are abstaining, as well as those who are attempting to moderate their use.
A description of one user’s experience is illustrative of how naltrexone works: Gabrielle Glaser, a journalist, wanted to try out the drug for an article she was writing. She did not have a drinking problem, nonetheless her experience was telling.
“The first night, I took a pill at 6:30. An hour later, I sipped a glass of wine and felt almost nothing—-no calming effect, none of the warm contentment that usually signals the end of my workday and the beginning of a relaxing evening. I finished the glass and poured a second. By the end of dinner, I looked up to see that I had barely touched it. I had never found wine so uninteresting. Was this a placebo effect? Possibly. But so it went. On the third night, at a restaurant where my husband and I split a bottle of wine, the waitress came to refill his glass twice; mine, not once. That had never happened before, except when I was pregnant. At the end of 10 days, I found I no longer looked forward to a glass of wine with dinner. (Interestingly, I also found myself feeling full much quicker than normal, and I lost two pounds. In Europe, an opioid antagonist is being tested on binge eaters.)”
Many patients wishing to control their drinking have similar experiences and value the benefits associated with reducing their alcohol intake. Often these benefits include better sleep, increased energy and focus, and pride in being able to make important changes in their lives.
Generally, most experts agree that naltrexone is most effective for either moderation or abstinence when used in conjunction with other supports –- self help groups, individual counseling and group therapy.
Other kinds of psychopharmacological supports may also be helpful along with naltrexone to help with anxiety, depression, and other issues that the drinker may have been attempting to treat by the use of alcohol. Although there is no single magic bullet that cures a drinking problem, there are many supports that can be helpful once you embark on this important journey.
This post is based heavily on a portion of a 2015 paper written in The Atlantic magazine by Gabrielle Glaser that provides a useful discussion of naltrexone, despite its unfortunate title and equally unfortunate bashing of AA. Many of my clients use AA with great success, and many of them find naltrexone useful for supporting abstinence, particularly early on. I am confident that sophisticated readers who link to Glaser’s article will be able to take away what is useful—-and, as is said in AA, will “take what you can use and leave the rest.”