Naltrexone Treatment for Drug & Alcohol Addiction
What is Naltrexone?
For many people struggling with addictions, treatment with naltrexone is a great option. By blocking some of the pleasurable reward associated with opioid and alcohol use, naltrexone works to reduce cravings and lower the desire to continue using the substance.
Why is Naltrexone used for addiction treatment?
Naltrexone is a medication frequently used to treat people with alcohol or opioid dependence (e.g., heroin, prescription pain medications). Naltrexone fits into a category of medications called opioid antagonists.1,2,3 This means that naltrexone can block the effects of opioid substances in the brain, and thus helps manage the temptation/craving for drugs or alcohol. Naltrexone may be taken daily in pill form, but is also available as a monthly injection.2
The principle behind naltrexone treatment is that if someone cannot feel the desired effects of opioids or alcohol, there will be no motivation to continue using those substances.
In its various forms, naltrexone is commonly known by the following brand names:2
Naltrexone is used in programs that utilize medication-assisted treatment. MAT is the use of medication to treat addiction, usually combined with a form of behavioral counseling or therapy.2 MAT may:2
- Decrease compulsive drug use behaviors.
- Reduce cravings for the substance.
- Relieve the discomfort of withdrawal when the drug of abuse is not available.
Despite its detractors, MAT does not substitute one addictive substance for another. It is part of a useful treatment plan that, for many individuals, has revolutionized substance abuse therapy. MAT medications can be effective in treating substance dependence without creating a new addiction when used as directed.2 In fact, in the case of an opioid antagonist such as naltrexone, addiction to the drug isn’t a concern at all.
Naltrexone is just one of the primary medications used to treat opioid and alcohol addiction. In opioid treatment, methadone and buprenorphine are other commonly used medications.
- Methadone is a long-acting, full opioid agonist.4 This means that it triggers opioid receptors in the brain, minimizing withdrawal symptoms and cravings, but also (when carefully dosed) avoids the pitfall of providing the same surging high that is experienced with abused opioids.
- Buprenorphine (available in combination with naloxone under the trade name Suboxone) is a partial opioid agonist.5 This means that it also triggers the same opioid receptors, but to a lesser extent than a full agonist, resulting in less potential for euphoria and sedation. Buprenorphine also imparts a ceiling to the full effects of any opioid, which further discourages simultaneous abuse while being taken.
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Naltrexone works differently than these options. Rather than activate the opioid receptors in the body, naltrexone blocks these receptors. While the receptors are blocked, other substances cannot activate them, meaning that someone on naltrexone will not feel the full desired effects from opioid or alcohol use.2,4
The principle behind naltrexone treatment is that if someone cannot feel the desired effects of opioids or alcohol, there will be no motivation to continue using those substances.2 Over time, the positive association to the substance will fade and cravings will no longer be present.
Benefits of Naltrexone Treatment
Compared to other forms of MAT for opioid and alcohol addiction, naltrexone holds many benefits. It is a desirable medication in MAT because naltrexone:2,3,4
- Is safe and effective when used as prescribed.
- Is not addictive. Someone can end use at any time without withdrawal symptoms, and there is no need to taper the dosage gradually.
- Does not create a “high” or respiratory depression.
- Is long-acting, especially as a monthly injection.
- Binds readily to the opioid receptors.
- Is attractive for people interested in ending all opioid and/or alcohol use.
- Does not cause depression, although some people experience mood symptoms while on the medication.
Weaknesses of Naltrexone Treatment
Despite the benefits of naltrexone as part of MAT, there are some weaknesses as well. These include:
- Naltrexone treatment can’t be started until all opioids and alcohol are processed and removed from the body. In many cases, this can take 7 to 10 days, which can create an unwanted situation as the individual will face the discomfort and potential danger of withdrawal symptoms.3,4
- If a person begins using naltrexone before their body is fully detoxified, they will encounter strong and persistent withdrawal symptoms. This occurs because naltrexone will displace the opioids and/or alcohol already attached to the receptors in the brain, sending the user into acute withdrawal. In individuals with significant physiological substance dependence, this may result in:5
- Fast pulse.
- Difficulty breathing.
- High blood pressure.
- Raised body temperature.
- Inability to sleep.
- Large pupils.
- Heightened reflexes.
- Muscle spasms.
- Naltrexone must be used consistently to obtain the desired results. The oral treatment requires the individual to take it every day or several times per week. Without proper adherence, the medication loses its effectiveness.3
- There is a lack of scientific research to prove naltrexone’s safety in special populations, such as women who are pregnant. The medication will negate the use of opioids for pain management, but could affect the mother’s milk production after birth.3
- Naltrexone presents a risk of liver problems, especially in the case of patients being treated for chronic alcohol abuse. Patients with acute hepatitis or other active liver diseases are cautioned against the use of naltrexone treatment, and doctors must be vigilant in monitoring for liver toxicity as an adverse side effect of the drug.6
Side-effects of Naltrexone Treatment
Beyond the limitations to naltrexone use, the medication can produce the following side effects, even when taken as prescribed:1,2
- Nausea and vomiting.
- Joint or muscle pain.
- Allergic reactions.
- Liver problems (noted by yellow skin or dark urine).
Despite its limitations and side effects, naltrexone remains a useful therapeutic agent for the management of alcohol or opioid addiction.
Starting Naltrexone Treatment
Before someone can begin MAT with naltrexone, they must be screened and assessed as appropriate candidates for treatment. The people best suited for naltrexone treatment:3
- Have already detoxed from opioids and alcohol. Typically, a drug test will be performed to screen for any active opioid use to avoid triggering withdrawal when naltrexone is administered.
- Remain at risk for relapse without treatment.
- Are motivated to maintain recovery and abstain from all opioids and alcohol.
- Have previously relapsed with other forms of MAT, such as methadone or buprenorphine.
- Used opioids for a short time or in low doses.
- Are currently using other forms of MAT but wish to switch to naltrexone treatment.
Once it is established that an individual is a good candidate for naltrexone, treatment can begin. Frequently, someone will enter treatment while still using alcohol and/or opioids. In this case, the process takes several steps, with a naltrexone treatment protocol that typically includes:3,6
- Evaluating the needs of the individual during intake.
- A toxicology screening (blood, breath, or urine) to determine current substance levels in the patient’s body.
- A physical exam to identify any medical issues (such as liver disease) that could be complicated by naltrexone use.
- Detox from alcohol and opioids.
- Opioid users may be treated with a buprenorphine/naloxone mix (Suboxone) for several days, with an eventual tapering of buprenorphine/naloxone based on the needs of the individual to limit withdrawal symptoms.
- Providing medications such as clonidine, ibuprofen, or hydroxyzine to ease other troublesome withdrawal symptoms that arise during the taper.
- Initiating oral naltrexone at 25 mg.
- Initiating oral naltrexone at 50 mg.
- Initiating an intramuscular injection of naltrexone if the oral medications were tolerated well.
Of course, many differences in treatment providers and the individual’s needs will dictate specific care with naltrexone, but the process above is a general guideline.
Inpatient and Outpatient Rehabs
Naltrexone treatment can occur in both inpatient and outpatient settings, with the risks and benefits of each depending on the current state of the person seeking to end their alcohol or opioid use.
About Inpatient Rehab
Inpatient naltrexone treatment programs will vary in duration. Some last for a few days, while others can last for up to a year.Inpatient treatment offers a safe, supportive environment with 24-hour staffing and care from medical providers. The individual lives at the treatment center, usually for a predetermined amount of time.4
This setting is beneficial for treating opioid addiction because the 7 to 10 days required to remove opioids from the body prior to naltrexone use can be quite difficult, with increased withdrawal symptoms and cravings.3 Detox and medically managed withdrawal will be the emphasis during the early days of treatment, with a later shift toward maintaining sobriety. Staff will provide observation, treatment, and encouragement to maintain the treatment plan.
Inpatient naltrexone treatment programs will vary in duration. Some last for a few days, while others can last for up to a year.4
About Outpatient Rehab
Another treatment option is outpatient naltrexone treatment. Unlike inpatient programs, the individual participating in outpatient treatment comes to the treatment center during the day, attends treatment for various lengths of time, and then returns home. This option is ideal for people who have work or family responsibilities that require them to be at home. It is very important that people in outpatient treatment have a strong, stable support system in place to aid in their recovery.4
Outpatient naltrexone treatment can range from 30 hours per week to one hour per month. It can be individual therapy, group therapy, or a combination of the two.4
People can take naltrexone for days, months, or years. Because of this, aftercare is an essential part of MAT. Aftercare options generally represent a lower, less intense level of care than the initial treatment. For example, if someone began treatment in a residential setting, moving to outpatient therapy would be their aftercare.
Behavioral therapy is an important component throughout treatment. Several therapeutic styles have proven effective in MAT when combined with naltrexone. People who use both medication and psychotherapy have longer periods of abstinence than people with medication only.3 Some common therapy options are:3,4
- Cognitive-behavioral therapy (CBT). This therapy style strives to improve how a person identifies and manages unwanted behaviors through enhancing self-control and coping skills. CBT is effective for many substance use disorders as well as co-occurring mental health problems.
- Contingency management (CM). Based on the notion of using external rewards to counteract the physical “rewards” of substance use (i.e., feelings of euphoria, etc.), CM provides tangible reinforcement in the form of prizes, tickets, and money when participants complete healthy, substance-free behaviors.
People may also choose to participate in support groups such as 12-step programs or SMART Recovery to complement their professional treatment during aftercare.4
How to Find the Best Treatment for You
If you or someone you care about is ready to make a change, finding the best naltrexone treatment is an excellent first step. The best treatment options are ones that consider the entire person being treated, not only the addiction, and tailor the interventions to those distinctive differences.4
With this in mind, you might be interested in treatments that:
- Address aspects of mental illness as well as addiction. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 8 million people have both substance use issues and mental health disorders.1
- Cater to people with certain religious beliefs, gender identities, or sexual orientations.
- Are closer to or farther away from home depending on your preference, supports, and stressors.
- Allow you to manage work responsibilities in an executive rehab, or receive a high level of comfort in a luxury rehab.
- Maintain consistency in staffing and treatment styles.
Choosing a 30-Day Addiction Rehab Program
If you or someone you know is having a hard time quitting drinking alcohol or abstaining from drug use, you might want to consider a 30-day addiction rehabilitation (rehab) program.
One-month rehab centers provide a chance to get and stay clean without requiring long-term commitment. Read More
Getting Help for Drug or Alcohol Addiction
In 2015, SAMHSA reported there were:7
- Nearly 330,000 people abusing heroin.
- An estimated 3.8 million people abusing prescription opioids/painkiller medications.
- About 17.3 million people drinking alcohol heavily.
Abusing these substances can lead to addiction and the negative mental, physical, and social consequences that frequently accompany addiction. Relationships can worsen with increased conflict and changing social networks. Managing the responsibilities of home, work, and school life can become overwhelming. Financial and legal troubles can arise as compulsive drug or alcohol use becomes the user’s priority.
- U.S. National Library of Medicine: MedlinePlus. (2010). Naltrexone Injection.
- Substance Abuse and Mental Health Services Administration. (2012). The Facts about Naltrexone.
- Substance Abuse and Mental Health Services Administration. (2016). Clinical Advances in Non-Agonist Therapies.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- Substance Abuse and Mental Health Services Administration. (2009). Incorporating Alcohol Pharmacotherapies into Medical Practice.
- Substance Abuse and Mental Health Services Administration. (2016). Substance Use and Mental Health Estimates from the 2015 National Survey on Drug Use and Health: Overview of Findings.