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Naltrexone for drinking

Eleven men take it for one to stop going back to heavy drinking.

Also called Naltrexone, Naltrexone hydrochloride, Oral naltrexone, Targeted naltrexone, As-needed naltrexone, The Sinclair Method

An FDA-approved medicine

Who it's forAny man who means to have two and finishes most weeks on his eighth.

The item

Three squares: proven in human trials. Two: a strong signal. One: early human data. Striped: the trials disagree.

Start today

  1. Book a doctor's appointment this week and ask for naltrexone, 50 mg, by name.

Why it works

Naltrexone is a 50 mg tablet that blocks the opioid receptors alcohol works through. Drinking releases the body's own opioids into the nucleus accumbens and the orbitofrontal cortex. That release is what makes the fourth drink call for a fifth. Block the receptor and the drink still tastes like a drink and still gets you drunk. It just stops paying off. It is approved for alcohol use disorder. It is generic, and an ordinary family doctor can prescribe it. It is the best-proven pill a man can take to drink less. For every eleven men who take it, one stops going back to heavy drinking. In the largest integrated health system in the United States, 224,319 patients had an alcohol use disorder diagnosis. Only 2.75 percent were prescribed it.

Drinking releases the body's own opioids. Naltrexone sits on those receptors first. The alcohol still arrives and the release still happens, but it lands somewhere already occupied. The first drink stops recruiting the second.

It works by extinction, and extinction only weakens a response that actually happens while the reward is blocked. In the trials that tested it both ways, naltrexone beat placebo when paired with therapy that accepted drinking would happen and taught men to handle it. It did not beat placebo when paired with support for staying sober. The animal work says the same. Opioid blockers worked when paired with drinking and did nothing when given during abstinence. So the dosing rule follows from how it works, not from habit. Take it when you are going to drink, keep drinking, and let each blocked session unwind the habit a little further.

Alcohol-dependent men and women scanned on day five of abstinence carried higher mu-opioid receptor binding potential than matched controls across several regions including the ventral striatum. That is the receptor population naltrexone occupies.

Where it fits

Naltrexone for drinking is a move in 3 protocols. Each one opens the plan it sits in.

What people say

Here is what doctors, influencers and men online say about Naltrexone for drinking, word for word.

Experts

Clinicians, authorities

  • “A Cochrane review that included 50 randomized trials and 7,793 patients found that oral naltrexone decreased heavy drinking (NNT = 10) and slightly decreased daily drinking (NNT = 25).”

    American Family Physician (American Academy of Family Physicians) · 7,793

  • “And it's true, about 80% of people had at least some improvement using the Sinclair Method, but about half had a dramatic effect where it really reduced their craving.”

    WBUR On Point (NPR member station), interviewing an addiction psychiatrist who ran the first naltrexone-for-alcohol trial · 200

  • “Primary care and mental health providers can provide effective AUD treatment by combining new medications with brief counseling visits.”

    National Institute on Alcohol Abuse and Alcoholism (NIAAA, U.S. NIH)

Gurus

Podcasts, channels, influencers

  • “It’s called the Sinclair Method (TSM), and it flips abstinence-based recovery on its head: Instead of never touching alcohol, you keep drinking, but first take an opioid blocker.”

    author's essay in an opinion outlet · 80 percent

  • “The opiate blocker chemically disrupts the body’s behavior/reward cycle causing you to want to drink less instead of more.”

    method-advocacy nonprofit site · 78%

  • “Three FDA-approved medications (naltrexone, acamprosate, disulfiram) are effective, non-addictive, and significantly underused.”

    quit-drinking method author's site article

Regular people

Forums, reviews, comments

  • “Then just drink as normal. The naltrexone blocks the alcohol buzz, and you learn to not love it anymore over a period of months.”

    Hacker News thread 'Ask HN: How did you stop drinking?', 378 points, 584 comments

  • “I do not obsess over alcohol like I used to. On occasion when I have wanted a glass of wine, I take it approximately an hour prior and can actually drink like a normal person”

    Drugs.com user reviews, naltrexone for alcohol use disorder: 8.4/10 from 355 reviews (81% positive)

  • “All the person has to do is take a pill daily. The person doesn't need to change any other behaviors or quit cold turkey.”

    Lemmy (lemmy.nz) 'YSK' post on a subsidised alcohol-craving medication, score 52, 3 comments

Questions

What does it actually do?
It blocks the opioid receptors alcohol releases endorphins onto. The drink still tastes the same and still gets you drunk. It stops making you want the next one. Eleven men take it for one to stop returning to heavy drinking.
Do I have to stop drinking to start it?
No. The trial that settled the question enrolled 121 outpatients who were still drinking and detoxified none of them, and the injection trials enrolled actively drinking patients. Stopping first is not a prerequisite.
Do I have to take it every day?
Two schedules work. 50 mg daily is the best-evidenced. Taking one in anticipation of drinking is the other, and in men who are still drinking and want to cut down rather than quit, targeted dosing produced the larger fall in drinks per day.
Is it bad for the liver?
No. 3,285 patients with cirrhosis were started on it and formal causality scoring found no case of drug-induced liver injury, no death and no decompensation attributable to it. Across the 26 trials against a placebo that recorded serious side effects, it did not raise them over placebo.
Who do I ask for it?
A regular doctor. In a trial, 197 alcohol-dependent adults got naltrexone with either primary care follow-up or cognitive behavioral therapy. In the primary care group, 84.1 percent avoided persistent heavy drinking, against 86.5 percent of the therapy group. Short check-ins with that doctor are all it takes.
How long do I stay on it?
As long as you want the effect. Primary care responders were split again for a further 24 weeks. They held their response 80.8 percent of the time on naltrexone, against 51.9 percent on placebo.
Why has nobody mentioned it to me?
Because it almost never gets written. In the US Veterans Health Administration, 2.75 percent of patients with an alcohol use disorder diagnosis filled a prescription for it in a year. Of the doctors who wrote a prescription for any alcohol use disorder medication at all, 59 percent wrote it for a single patient.
What is the one thing I must not do?
Take it while you are using opioids. It blocks them, so opioid painkillers will not work, and starting it too soon after an opioid throws you into a withdrawal severe enough to need a hospital.

The studies

Every study behind this page.

Words on this page

Placebo
A dummy treatment that looks like the real one.
PMID
A study's ID number in PubMed, the public index of medical research.

Ask a regular doctor for naltrexone. You don't have to quit first to start it.

Emergency: call 911.

I am not a doctor. This is not medical advice. This is self-education. Talk to a physician who has your history before you change anything.