Naltrexone is FDA-approved to treat alcohol use disorder. But what is it really like to incorporate naltrexone into your recovery?
My recovery from alcohol includes a prescription for naltrexone. We have several blog posts and pages about naltrexone, but the most common questions we get about it here at Workit Health are about what to expect. “What will I feel?” “Does it really help with cravings?” “Will there be any side effects?” While people react differently to all medications, I wanted to share my own personal experience to help answer any concerns you might have about naltrexone for alcohol use disorder.
Does naltrexone really help with alcohol cravings?
In my experience, yes. Naltrexone DOES help with alcohol cravings—I had fewer cravings, and the cravings I did have were less intense. It’s tough to quantify how much naltrexone helps to reduce my cravings for alcohol. After all, I’ve gotten sober many times before (both with and without formal rehab programs, with and without community support groups like AA), and each time has been a little different. There were times that I would go weeks without cravings for alcohol at all, and times I couldn’t go more than a few minutes without feeling like my body was crawling with electricity because of how badly I wanted a drink. However, after having used naltrexone while getting sober on two different occasions now (once in rehab, once in AA), I can definitely say that it does help for me. With naltrexone, I tend to avoid those excruciating periods of craving, although cravings did still pop up from time to time.
What about the side effects of naltrexone?
The other good news is that, by and large, naltrexone is really well tolerated by most people. I, myself, cannot say that I’ve ever experienced any side effects from the medication. Having said that, there’s a huge caveat to that statement: I’ve always started taking naltrexone while still in active withdrawal from alcohol. The most common side effects of naltrexone can be similar to those of alcohol withdrawal (nausea, headache, dizziness, anxiety, tiredness, or trouble sleeping)—all of those symptoms are ones that I’ve experienced every time I went through withdrawal. So it’s possible that some side effects of naltrexone occurred, but that I chalked them up to the withdrawal itself. Regardless, my alcohol withdrawal was no better or worse while taking naltrexone than at any other time.
How much does naltrexone cost?
Naltrexone in tablet form is also pretty easy on the pocketbook, particularly in comparison to the costs of some other medications. My insurance covers it the same as any other generic medication, and I have never encountered someone who has insurance that wouldn’t cover it. Even without insurance, naltrexone is relatively affordable: a search of GoodRX found that with a coupon card, a 30-day supply costs an average of $35 in my area.
Do you have to stay on naltrexone forever?
I’ve been on naltrexone pretty much continuously (more on that later) for almost 5 years now—and ACTUALLY continuously for 33 months (1,000 days!). My alcohol cravings tend to be few and far between, and generally of low intensity. I still experience no side effects.
Not everyone will decide to stay on the medication as long as I have—and that’s totally fine! Other people may stay on the medication even longer—also totally fine! The length of time that each person takes naltrexone is an individual choice, and a decision all their own (and made in consultation with appropriate medical providers).
Do I personally have plans for when I’ll get off of it? No, I don’t at the moment. As I mentioned before, my cravings are well under control and I’m having no side effects. I’m also fortunate enough to have insurance, which means that the medication costs me less than a quarter a day. It’s possible that I could stop taking naltrexone and be just fine—after all, I’ve done a lot of mental and emotional work in my sobriety, and I have ongoing support and engage actively in my recovery. However, in the past, I’ve struggled to get beyond a year or two worth of sobriety. And my life goes catastrophically wrong in frighteningly short order when I’m drinking. Right now things are going incredibly well, so I have no need to “prove to myself” (or anyone else!) that I can do it without medication. Put another way, because it’s so inexpensive and I have no side effects, I don’t see anything to gain from stopping the naltrexone, and I have EVERYTHING to lose.
What happens if I drink while I’m taking naltrexone?
This is the juicy part that many of you have probably been waiting for: what effect does naltrexone have if you drink while you’re taking it? Now, before I go on, I want to pause and reiterate again that this is my own experience with naltrexone in an abstinence-based medication model. I have not utilized the Sinclair Method or other naltrexone-based methods of moderation, so cannot say how similar those experiences might be.
But remember how earlier I mentioned that I had been taking naltrexone “pretty much continuously”? Yeah, about that … I’d been sober for about a year and a half (while taking naltrexone) when I wound up relapsing on inhalants. That led to a relapse with alcohol, as well. In the beginning, I continued to take the naltrexone while I was drinking, though I did NOT take it as intended for moderation nor did I utilize the Sinclair Method. Trying to describe the sensation is very difficult, but the closest I can come is “really f****** strange.” Like, I know how I tend to feel after reaching certain drinking benchmarks; I know how I feel after a couple shots, after a pint, and after a fifth. There’s a specific euphoric sense (along with a strange pressure in my head) that I’ve only ever experienced with alcohol, and that feeling is generally what I’m trying to achieve when I drink. The feeling tends to barely appear after a few shots, be very nicely present after a pint, and (because how can you not want more of this feeling?!) I’m swimming in it right around a fifth.
However, naltrexone denied me that euphoric sensation, that unique bit of bliss that I was generally after. Please do not misunderstand—I was still absolutely drunk. Naltrexone does not change your level of inebriation, but rather—for me, at least—it changes how I experience that inebriation. I would still have increased talkativeness, loss of balance and coordination, loss of social filter, loss of focus and attention … but I wouldn’t have the pressure-in-the-head euphoria. In numerous treatment programs (both medical and community-based), there is a common theory that alcoholics and people who struggle to control their drinking experience the effects of alcohol differently than “normal drinkers” do. If you ascribe to this theory (as I do), it may simply be that naltrexone gives me a similar reaction to alcohol as a “normal drinker,” and prevents me from reacting to alcohol in the alcoholic way. Because I’m an alcoholic, when I drink (without naltrexone), I get a specific and incredibly intense sense of euphoria that “normal drinkers” never experience. When I take naltrexone, that euphoric feeling is blocked, so I may be experiencing the same kind of drunkenness as a “normal” drinker.
Does naltrexone make you stop drinking?
Naltrexone doesn’t force any action; we’re still responsible for our own choices. Practically speaking, what naltrexone does for me is make it easier for me to stop drinking. I might drink for an evening or an afternoon, and then when my supply ran out, I could simply let it be gone … without having to rush out to buy more. I could wake up the next day without despairing that I’d lost that sense of euphoria, and without the feeling that the day would be nearly impossible to get through without it. I might still occasionally think about drinking at inappropriate times (like in the morning or at work), but it was a passing thought I was able to let slide by.
Had I decided that I was ready to go back to total abstinence again at that point, I may have found it easier. However, I did not decide to become abstinent again at that time. And I only received the benefit of naltrexone as long as I continued taking the medication each day. If I decided that I really wanted to have that alcoholically euphoric feeling again, I might stop taking the meds for a few days so that when I drank I could get the feeling I was craving. Then I would start taking the medication again the next day. Of course, because I’m an alcoholic, this system was untenable for me and I eventually stopped taking the medication altogether so that I could just drink the way I wanted to without the hassle of planning or stopping.
Fast forward a few months, after many blackouts (including coming-to in an emergency room), losing a job, losing my housing, and much untold misery, I decided to sober up again. I was very motivated to stop drinking again, and fortunate enough to be able to start taking naltrexone again immediately. When I did, I found that it once again helped immensely with my cravings. I did not notice any difference in naltrexone side effects between my first and second time getting sober with its support. I was grateful to have it available to help me once I was ready to stop drinking again.
To sum up my experiences with naltrexone:
Like many medications, each individual person’s reaction may be different from another. You may find your experience is similar to mine, or yours might be quite different. While I can’t tell you what is right for you, I can give you some summary points about naltrexone that may be helpful in your journey:
- Naltrexone reduced the frequency and intensity of my cravings for alcohol.
- Naltrexone had minimal side effects for me, and (relatively) does not cost much
- When I relapsed, naltrexone fundamentally changed the way that I experienced drunkenness
- This may have been beneficial for helping me to come back from the relapse
- I only get the benefits of naltrexone when I actually take it—if I stop, so do the benefits
