Can naltrexone help reduce binge drinking?

It’s a weekend night and you think, “I worked hard all week. I need a drink. I deserve a drink. Then another and another and another…”

Maybe that pattern repeats all too often. Maybe you’ve distanced yourself from some friends and family members and avoided eye contact with a lot of people who used to be close to you.

If your drinking has spiraled out of control, there are many ways to help you slow down or stop, including counseling and Alcoholics Anonymous — but medications are an often-forgotten tool that can assist you in cutting back on drinking if not getting sober altogether.

Starting a conversation about medication to treat binge drinking

I’m a psychiatrist who specializes in addiction medicine, and when I meet with patients struggling with alcohol, I ask them whether their goal is to stop drinking entirely or reduce the number of drinks they have.

I might prescribe naltrexone, a drug that can reduce cravings for alcohol and may take away the urge to have too many drinks in quick succession. Naltrexone blocks brain receptors that trigger euphoria or calm when you drink. By eliminating or reducing alcohol’s buzz, the drug may lead you to fewer drinks. You can still get drunk while taking naltrexone. But by blocking the buzz and reducing cravings, naltrexone could deter you from drinking too much.

Naltrexone’s uses

Naltrexone also blocks the effect of painkillers such as oxycodone. So it can be prescribed to people with opioid use disorder as well as alcohol use disorder, the clinical terms for addictions to pain killers or alcohol, respectively.

Naltrexone sounds a lot like the drug naloxone, but they work very differently. While both drugs block the effects of opioids in your brain, naltrexone is a long-acting drug and naloxone, which sells under the brand name Narcan, works instantly to reverse an opioid overdose. Naloxone is given only to people who have overdosed on an opioid — not to people who have had too much to drink.

What should not be taken with naltrexone?

You shouldn’t take naltrexone if you’re using painkillers on a regular basis, say, for chronic pain, because naltrexone will cancel out or dull the effect of the pain relief.

What does naltrexone make you feel like?

Naltrexone doesn’t make you feel any differently except that you might no longer crave alcohol or opioids, or you’ll crave them less intensely than you did before you started on the drug.

Can naltrexone cause problems with your liver?

Yes. Naltrexone might harm your liver, but that’s not common. Before I prescribe it to a patient, I have them take a blood test measuring their liver enzymes. If they’re too high, that would be a sign their liver is already injured, so I wouldn’t prescribe them naltrexone. If their enzyme levels are normal, then I might prescribe naltrexone.

After the patient has been on naltrexone for one month, I’ll have them take a second blood test to see if their liver enzymes levels have changed. 

What are the most common side effects of naltrexone?

Nausea, headaches and tiredness are the most common side effects I hear about from patients taking naltrexone. Some people can experience flu-like symptoms, but all side effects generally go away after about two weeks of being on the medication. Overall, naltrexone is well tolerated, and patients rarely stop it because of the side effects.

What other drugs do doctors prescribe for alcoholism?

Besides naltrexone, which needs to be taken daily, the drug comes in an extended-release form called Vivitrol. That’s given as a shot once every 28 days.
Naltrexone or Vivitrol are the more common drugs prescribed for alcohol use disorder, but there are two other drugs that could be taken to reduce or stop drinking:

• Acamprosate is a drug that also decreases your cravings for alcohol and your risk of drinking heavily. The drug doesn’t get processed through your liver, so for people who have cirrhosis or other liver problems, this is a good alternative. The regimen includes two pills, three times a day, which can be tough for some people to do.
  
  
• Antabuse is the brand name of the drug disulfram. It can deter you from drinking by causing you to become ill if you have any alcohol in your system. It causes an aversive or bad reaction that includes nausea, vomiting and flushing. This isn’t a commonly used medication.

What is considered “heavy drinking”?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes “heavy drinking” as men who have more than 4 standard drinks on any day or more than 14 drinks a week. For women, more than 3 drinks a day or 7 drinks a week. Women have less water in their body than men do, so the concentration of alcohol in their blood is higher even if they drink the same amount.

Heavy drinking or out-of-control drinking over time can become problematic and meet criteria for alcohol use disorder. Alcohol use disorder was formally known as alcoholism, but this is a stigmatized term we no longer use.

As our education and knowledge on addiction has advanced, we now understand that addiction is a chronic disease similar to diabetes or hypertension. Addiction isn’t a moral failing or character flaw. And, like other chronic diseases, we use multiple tools to treat alcohol use disorder, including medications, lifestyle changes and talk therapy.

Does the urge to drink ever go away for those with alcohol use disorder?

For some patients it does, and for others it doesn’t go away completely but becomes less intense over time. The goal would be to find a treatment plan the minimizes the urge to drink.

What’s the best way to stop drinking?

The best method to curb or stop drinking depends on the person, their health and the number of years and amount they’ve been drinking. Alcohol withdrawal can be life-threatening. So if someone has been drinking a substantial amount — say, a liter a day of alcohol — they can’t just stop drinking and be safe. They may need to be admitted to a detox (inpatient withdrawal management) center where they’re monitored and given medication to prevent seizures and other severe alcohol withdrawal complications.

If someone hasn’t been drinking heavily for very long, they may be able to cut back on their drinking without the need for medical admission. But I always recommend patients speak with their doctors first to see what they recommend, based on their history.

I’ve seen many people successfully cut out or curb their drinking with medication and without it. It’s all about finding a treatment plan that works for you and gives you the support that you need.