Learn / Naltrexone Treatment for Alcohol and Opioid Addiction   

Naltrexone Treatment for Alcohol and Opioid Addiction   

Kayla Gill
 May 27th, 2024

Key Points

  • Naltrexone reduces cravings and relapse risk for alcohol and opioid addiction.
  • It works best with therapy to address addiction causes and coping mechanisms.
  • Naltrexone has some side effects, but is safe and effective when used properly.

Naltrexone is a medication used to treat alcohol and opioid dependence. Many people find it helps them reduce cravings and prevent relapse—but it’s not perfect. Is it right for you? 

Let’s look at how this medication works, its effectiveness in treating these substance use disorders, and how it can work as part of a comprehensive recovery plan.

How Naltrexone Works

Naltrexone (the active ingredient in Vivitrol, ReVia, and Depade) is a medication used to treat both alcohol and opioid dependence. It works by interfering with the brain’s reward system: the same system responsible for forming an addiction. 

Opioids and alcohol create pleasurable feelings because they affect your brain’s opioid receptors.1 Naltrexone works by blocking these receptors. That means if you use opioids or drink alcohol while taking naltrexone, you won’t experience the same high. This lack of positive reinforcement interrupts the cycle that causes cravings, reducing the risk of relapse.

One of naltrexone’s main advantages is that its effects differ from other addiction medications. Unlike methadone or buprenorphine, which replace other opioids, naltrexone doesn’t have psychoactive effects. As a result, people who take naltrexone aren’t at risk of becoming dependent on it.

Naltrexone comes in various forms, including tablets and implants. Another method that treatment professionals often prefer is the extended-release injectable formulation.2 A single injection releases a steady dose of naltrexone over a certain period—usually one month. With this method, there’s no need to remember to take a pill every day, which can be a challenge for some people. The steady release of naltrexone means it continuously blocks opioid receptors. For some, this serves as a reliable foundation that helps them manage cravings and prevent relapse over the course of the month.

The Role of Naltrexone in Alcohol and Opioid Addiction Treatment 

With its ability to regulate the brain’s reward system, naltrexone can be a useful tool for treating substance use disorders.

Treating Alcohol Dependency With Naltrexone

Alcohol dependency develops as long-term alcohol use rewires the brain.3 When you drink alcohol repeatedly, over time, your brain adapts to its presence. Eventually, you develop new neurochemical pathways that signal an overwhelming urge to drink—even if you desperately want to stay sober. Naltrexone treats alcohol dependency by targeting these pathways.

Naltrexone is proven effective for treating alcohol dependence4 in 2 ways: 

  1. It eases cravings. One study found that “subjects taking naltrexone reported significantly less alcohol craving and days in which any alcohol was consumed.”
  2. It reduces relapse. The same study found that only 23% of people who took naltrexone relapsed, compared with 54.3% of those who didn’t. 

Research also shows naltrexone can normalize brain chemistry over time,5 evening out the heightened response to the rewards of drinking. For many, this gives them the breathing room they need to start making changes that support sustained sobriety. 

Treating Opioid Dependency With Naltrexone

The opioid crisis remains a significant public health threat, with outbreaks of overdose deaths6 continuing to plague communities. Naltrexone, as part of a medication-assisted therapy (MAT) program, is an important intervention for addressing opioid dependency.

As with alcohol, naltrexone treats opioid dependency7 by blocking opioid receptors so those taking it no longer feel the same high. And it’s effective. According to one systematic review, “Findings confirm that injection naltrexone produces extinction of drug-seeking behavior after episodes of opiate use…The observation of high treatment retention among naltrexone-treated patients…suggests naltrexone may also exert direct effects on opiate-taking behavior.”

Naltrexone works best when combined with behavioral therapies8 like cognitive behavioral therapy (CBT). These therapies help us identify and address triggers, develop coping strategies, and build life skills to manage stress and reduce relapse rates. 

Making Naltrexone a Part of Your Addiction Treatment Plan

Addiction treatment professionals understand that medication alone isn’t enough for long-term recovery. Long-term recovery requires a comprehensive approach that combines medication-assisted treatment (MAT) with behavioral therapy.

If you’re taking naltrexone, it’s a great idea to do so alongside addiction counseling to increase your chances of successful treatment outcomes. Therapists can help you understand the underlying causes of your addiction and develop healthy coping strategies to manage cravings and work through difficult emotions. CBT is one behavioral therapy that’s commonly used in addiction treatment. It teaches you how to identify and challenge negative thought patterns that trigger cravings, and develop practical skills for managing stress. Learning to manage cravings goes a long way toward preventing relapse—tools like CBT can support your recovery for years to come. 

Considering Naltrexone as a Viable Option: Benefits, Risks, and Controversies


Naltrexone offers clear benefits when used as part of a comprehensive treatment plan, as it effectively reduces alcohol cravings and prevents relapse during and after treatment. Studies show that “subjects treated with naltrexone experience significantly fewer episodes of relapse, and significantly more remain abstinent” than people who don’t, and that “naltrexone-treated subjects also consume significantly less alcohol.”9 

It’s also proven effective for those in opioid addiction recovery. One study found that “long-acting injectable naltrexone protected against relapse10 after discharge from short-term inpatient treatment” among patients with opioid addiction.

However, like other forms of MAT, naltrexone carries some risks. 

Potential Risks

The most common side effects of naltrexone11 are nausea and vomiting. There is some concern about the drug increasing risks of liver or cardiovascular damage in this already vulnerable population. But most studies conclude that these risks are relatively low, especially compared with its benefits.

Starting naltrexone while you’re still physically dependent on opioids will trigger withdrawal symptoms. It’s critical to complete detox under medical supervision before starting naltrexone therapy. Proper medical oversight can help mitigate other potential side effects like nausea, headaches, and fatigue, which are usually mild and temporary.

One meta-analysis of several studies found that while naltrexone reduces relapse rates12 in the short term, it did not increase retention rates in addiction treatment, and found no clear evidence that it supports sobriety over the long term.  

“Our alcoholism takes over.”

There’s always a chance that MAT won’t work as intended. One man in alcohol recovery, Wayne, was prescribed naltrexone as part of his addiction counseling program. Even though he said it took away the pleasurable effects of drinking, he was still determined to drink on naltrexone:13 

I didn’t exactly intend on drinking over naltrexone but my alcoholic mind—the rewiring of my brain—said, ‘You could get over this one too; this doesn’t have to be your game stopper.’ So I had to drink double the amount, and I had to drink almost all the time, in order to still get that feeling that I had before. A lot of us are in the same boat: our alcoholism takes over and we challenge ourselves to get drunker and drunker.

Naltrexone has its drawbacks, and it’s not for everyone. But when used appropriately as part of a comprehensive recovery plan under medical supervision, it can be a valuable asset for those fighting addiction. 

Regulations and Drug Safety 

Naltrexone has undergone extensive testing and evaluation to ensure its safety and efficacy. 

Naltrexone is a longer-acting version of naloxone,14 which has been used since 1971 for reversing opioid overdoses in a medical emergency setting. It was approved by the FDA in 1984 for treating heroin addiction. In 2006, the naltrexone injections, branded as Vivitrol, were approved for alcohol dependence, and later used to treat opioid dependence. 

Any healthcare provider who is licensed to prescribe medications can prescribe naltrexone. Specialized training is not required. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides free training15 and mentoring to clinicians to identify and treat opioid use disorder. 

Naltrexone Therapy: One of Many Tools on Your Path to Recovery

Naltrexone therapy can be an effective tool for treating addiction. By reducing cravings and blocking the pleasurable effects of substances, it can significantly increase the chances of long-term recovery. 

Naltrexone’s non-addictive approach to relapse prevention is a stepping stone for many on their journey toward recovery. But it’s important to remember that naltrexone is most effective when integrated into a comprehensive treatment plan. Through therapy, you’ll address unresolved trauma and other underlying causes of addiction, and learn skills for life in sobriety. This holistic approach empowers you to manage cravings, make healthier choices, and take back control of your life.

If you’re struggling with addiction, don’t hesitate to seek out the care you need. Talk to your doctor or therapist, or use our addiction treatment finder to search for programs that fit your needs. 

You deserve to live a full, free life—and that change can start now. 

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