Naltrexone—a medicine that reduces your craving for alcohol—is the first FDA-approved drug used for the treatment of alcoholism. The drug works by blocking the part of the brain where you feel pleasure from drinking alcohol. In other words, the less pleasure you receive the less you’re likely to drink. Naltrexone goes by the brand names ReVia and Depade.

What is Alcoholism?
Before we look at naltrexone specifically, let’s see how one gets to the point where they need the drug.

According to the National Council on Alcoholism and Drug Dependence, "Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial."

The Symptoms of Alcoholism
The National Institute on Alcohol Abuse and Alcoholism says that alcoholism is characterized by the following four symptoms:

  • Craving: A strong need, or urge, to drink.
  • Loss of Control: Not being able to stop drinking once drinking has begun.
  • Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
  • Tolerance: The need to drink greater amounts of alcohol to get "high."

How Naltrexone Works
Alcohol stimulates release of opioids, which in turn stimulate release of dopamine—the chemical in the brain responsible for pleasure.

And as Richard Rosenthal, MD, states in The Journal of Family Practice, “Persons vulnerable to alcohol dependence generally have lower basal levels of opioid secretion and are stimulated at higher levels. As an opioid antagonist, naltrexone prevents opioids from binding with opioid receptors and modulates dopamine production. This may make drinking less “rewarding” and may reduce craving triggered by conditioned cues associated with alcohol use.”

Naltrexone is not addictive and does not provide the patient with any kind of high. There are no withdrawal symptoms when you stop taking it.

Does it Work?
In a number of controlled studies, naltrexone has been shown to help patients in their overall treatment for alcoholism. However, it is not a cure-all or “magic pill”. Think of naltrexone as just one arrow in your quiver—winning the battle against addiction will take many arrows (counseling, cognitive behavioral therapy [CBT], etc.). Here are the findings of some naltrexone studies.

The National Institutes of Health: “patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment.”

Institute of Clinical Neuroscience, Sweden: “This study supports the effect of naltrexone in outpatient treatment of alcohol dependence and suggests that a beneficial interaction effect with CBT can be expected.”

The Cochrane Collaboration (international medical research evaluator): “By blocking alcohol effects at these receptors, the opioid antagonists naltrexone and nalmefene can reduce alcohol ‘liking’ and ‘craving’ and thus support alcohol dependent patients in cutting down their drinking.”

Agency for Health Technology Assessment, Madrid, Spain: “Short-term administration of naltrexone reduced the relapse rate significantly, but was not associated with a significant modification in the abstinence rate.”

The Side Effects of Naltrexone
Naltrexone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • Nausea
  • Vomiting
  • Stomach Pain
  • Headache
  • Constipation
  • Diarrhea
  • Dizziness
  • Anxiety
  • Nervousness
  • Loss of Appetite
  • Irritability
  • Drowsiness
  • Increased or decreased energy
  • Muscle or joint pain

In addition, other possible side effects can be more serious. If you experience these symptoms, you should call your doctor immediately.

  • Hallucinations
  • Blurred vision
  • Confusion
  • Severe vomiting and/or diarrhea 

Before Taking Naltrexone
Familydoctor.org recommends that you not take any narcotics “such as codeine, morphine, or heroin, while you are taking naltrexone. Do not take any cough medicine with codeine in it while you are taking naltrexone. Naltrexone can cause or worsen withdrawal symptoms in people who take narcotics. You must stop taking all narcotics 7 to 10 days before you start taking naltrexone.”

Summary
Naltrexone is an effective drug to help alcoholics become and remain sober. But like any other aspect of addiction treatment, it is not a cure-all. Recovery and abstinence will take a combined approach using Naltrexone and other methods of treatment such as counseling and cognitive behavioral therapy.

Sources for more reading:
http://www.jfponline.com/Pages.asp?AID=3931
http://www.niaaa.nih.gov/FAQs/General-English/Pages/default.aspx
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000853/