Naltrexone was originally intended to help users of heroin and other opiates. But after its discovery, studies showed that naltrexone had positive effects on people drinking too much alcohol. In 1994 the U.S. Food & Drug Administration approved its use for alcohol use disorder. Despite the medication's history of success, and with a record of few side effects, many people are unaware of its existence, let alone of its ability to help people manage their drinking.
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Approved for more than 20 years by the FDA, naltrexone has shown to also be highly effective in treating alcohol use disorder.
In 1963, searching for a solution to help opioid users, Endo Laboratories created naltrexone, which quells the desire for opiates. In 1984, the U.S. Food and Drug Administration approved the use of naltrexone to treat addiction to heroin, morphine, and oxycodone.
Later studies showed that naltrexone had positive effects on alcohol use disorder (AUD). It reduces the craving for alcohol particularly when combined with a strong support regime.
In 1994 the FDA approved the use of naltrexone as an oral medication that is taken in tablet form. It is currently marketed as ReVia® (made by Barr Pharmaceuticals) and Depade® (Mallinckrodt).
Naltrexone is prescribed as a medication that reduces a patients cravings for alcohol. Its operation is significantly different from Antabuse™, which induces extreme nausea and vomiting as an intended consequence of drinking. Unlike medications such as suboxone, naltrexone is not addictive. Side effects of naltrexone can include stomach pain, anxiety, or feeling tired.
One of the earliest, strongest advocates for naltrexone was John David Sinclair, Ph.D. (d. 2015), an American scientist who relocated to Finland in the 1970s and practiced there for over 40 years, eventually founding the Sinclair Method. In a paper titled “How Opioid Antagonists Reduce the Craving for Alcohol,” Sinclair observed, “Patients themselves often comment after a couple of months of treatment that, to their surprise, they no longer are particularly interested in drinking.”
Dr. Sinclair's findings inspired the creation of the C Three Foundation (www.cthreefoundation.org), founded by actress Claudia Christian, who has overcome alcohol addiction using naltrexone. Christian also narrated the documentary film called One Little Pill (2015, dir. Adam Schomer), which describes the struggle in educating the addiction community about this modern way to help alcoholics.
Naltrexone works by using the brain's own mechanism to cause what Sinclair called “pharmacological extinction” of the desire for alcohol. But some medical professionals—such as John E. Mendelson, MD of the San Francisco-based company DxRx Medical—prefer the term “competitive learning,” in which the brain replaces the old behavior with a new one that is less damaging.
Dr. Sinclair's research showed that alcohol abstinence, in certain cases, can actually increase the desire for alcohol. There are many accounts of alcoholics who have drunk after taking Antabuse™ (disulfiram) and "powered through" the resulting extreme nausea and vomiting to satisfy their craving. Alcoholics Anonymous teaches that abstaining from the first drink will eliminate any allergic craving for a 2nd drink. This is an objective truth. There can be no physiological response to nothing ingested. But it does not address the physiological or social conditioning that creates any initial cravings.
Extreme alcoholism is the combination of a mental health disorder and an allergic/physiological response to sugar/alcohol. There are patients where recovery requires complete abstinence, a strong support group, professional physiological help and a complete spiritual/physic change. Alcoholics Anonymous has its roots in these cases.
Alcohol User Disorder (AUD) exists at many levels of severity. The FDA found that naltrexone could be effective in helping patients control their drinking if they were emotionally and psychologically committed to reducing their alcohol consumption. We urge patients to remember the potentially progressive and addictive response to alcohol as they age. The reduction in cravings offered by naltrexone might prove to be an interim mechanism to regain drinking control in some patients.
In addition to monitoring use of naltrexone, the FDA recommends that patients combine naltrexone with behavioral counseling, alcohol monitoring and support from family, friends and the work place to receive the most benefits.