Naltrexone is an anti-opioid medication sometimes used to help people affected by alcohol use disorder or opioid use disorder.
Alcohol and opioids are different in many ways, but they both can result in a substance use disorder when consumed inappropriately or in excessive amounts. When used together, these substances can also trigger a dangerous reduction of activity inside the central nervous system.
Naltrexone[i] is an anti-opioid medication sometimes used to help people affected by alcohol use disorder or opioid use disorder. So, this medication also provides several important treatment benefits for people who are addicted to both drugs and alcohol. This combined disorder is sometimes called co-occurring alcohol and other drug use disorder (AODUD).
When they enter the bloodstream alcohol, opioid street drugs and opioid prescription medications travel to the brain, where they slow down the normal rate of information traveling to and from the spinal cord and throughout the rest of the body. These effects classify opioids and alcohol as central nervous system (CNS) depressants. Major organs such as the heart and lungs can only slow down their activity so much before they become dangerously unstable. Past a certain point, this instability can lead to the onset of an overdose.
On their own, drugs and alcohol can trigger an overdose when used in excessive amounts. When these CNS depressants are taken together, the risks for an overdose increase by a substantial margin. The Centers for Disease Control and Prevention report that more than 20 percent of all people who die in an emergency room after taking opioid painkillers also have alcohol[ii] in their systems.
Naltrexone is available as a tablet under the brand names ReVia and Depade. It also comes in an injectable form under the brand name Vivitrol[iii]. The medication belongs to a group of substances called opioid antagonists which help prevent naturally occurring and synthetic opioids from reaching the brain.
Opioid antagonists produce this effect by blocking sites in the body and brain called opioid receptors. Under normal conditions, these receptors provide passage to the brain for opioid drugs and medications, as well as the body’s natural opioid equivalents (e.g., endorphins). By blocking the opioid receptors, the antagonists stop opioid substances from producing their intense “high.”
Research shows that opioid receptors are also activated by the presence of alcohol. This means that the receptors are partly responsible for the intoxicating effects that characterize drinking. It also means that naltrexone has usefulness in both the treatment of alcohol-related problems, as well as opioid-related problems.
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Naltrexone is used to help people whose substance use problems are related to the intake of opioids or alcohol. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that people in treatment for opioid-related problems may receive the medication in the form of injectable Vivitrol. Vivitrol injections remain effective for up to 30 days at a time, which can make it easier for program participants to maintain compliance with the terms of their treatment plan.
By stopping opioids from reaching the brain, naltrexone use:
The effects of naltrexone also have specific treatment benefits for people with alcohol problems. These benefits include:
SAMHSA reports that naltrexone provides its maximum impact in alcohol-related treatment when used for a period of time lasting longer than three months. Since the medication does not produce a separate addiction risk or create toxic reactions when combined with alcohol, doctors can prescribe it on an open-ended basis.
When naltrexone enters the bloodstream, it immediately starts to block the effects of opioid substances. In a person going through the detox (detoxification) process, this rapid opioid shutdown can lead to the onset of significant withdrawal symptoms. For this reason, naltrexone use typically doesn’t begin until seven to 10 days after completing detox.
Use of naltrexone can also lead to the appearance of certain side effects, including:
In many cases, adjustments in medication dosage will eliminate these problems. If given in large amounts, naltrexone may also trigger liver damage. However, changes in liver function do not normally occur when the medication is consumed in typical therapeutic doses.
When used to help a person dealing with opioid- or alcohol-related problems, naltrexone often forms part of a larger course of treatment known as medication-assisted treatment (MAT). MAT[iv] may also involve the use of other medications, and includes participation in behavioral psychotherapy such as:
Research shows that medication-assisted treatment has clear usefulness for people who have substance problems associated with the consumption of opioids and/or alcohol. Treatment for overlapping symptoms of opioid use disorder and alcohol use disorder take place in a number of settings. For people with co-occurring alcohol and other drug use disorder, enrollment in a partial hospitalization treatment program is one option. Once a person leaves a treatment facility, such as Transformations Treatment Center, they have the option to continue care in an intensive outpatient program.
