Alcohol feels less rewarding because naltrexone for alcohol use disorder blocks opioid receptors in the brain. You may drink less or have fewer cravings. It is not a cure. It does not promise you will stop drinking. It also does not treat alcohol withdrawal.
If you have severe withdrawal symptoms, call 911 or go to the nearest emergency room now.
We are an editorial team behind a U.S. treatment directory, not a treatment provider. This guide shows how naltrexone helps with cravings. It also gives safety questions to ask your prescriber. Read our guide on medications for alcohol use disorder for more options.
The Mechanism Behind Naltrexone for Alcohol Use Disorder
The brain's reward system relies on opioid receptors. Naltrexone blocks these spots. This block may help reduce the desire to drink and lower cravings.[1]
Set realistic expectations. Cravings do not vanish when you take this medicine. Its goal is to make urges feel less strong. This can help you stick to your plan.
Data on naltrexone for alcohol use disorder reflects group averages. It does not predict your personal outcome. Doctors use the number needed to treat (NNT). This figure shows how many people need the drug to prevent one bad result.
12
people treated to prevent one return to heavy drinking[2]
20
people treated to prevent one return to any drinking[2]
Studies comparing naltrexone to a control group produce these estimates. They are not guarantees or your personal odds. Your results may differ due to your health history.
Your treatment goals are up to you. Reducing heavy drinking is a valid aim. Stopping alcohol entirely is also a valid aim. Discuss what fits your life with your clinician. They can help you pick the right path.
How Naltrexone Is Used and the Sinclair Method
Naltrexone is available in two main ways. One is a pill you take daily. The other is a monthly injection named Vivitrol.[3] This injection is used for alcohol dependence.[3] Before you start either form, our guide to insurance coverage for naltrexone explains how to verify your benefits. If you are deciding between the two, our guide to naltrexone injection vs oral helps you weigh the options.
Outcomes differ for each person. Naltrexone does not promise that you will stop drinking. The American Psychiatric Association notes it works well for many. This is true for moderate to severe alcohol use disorder. You should aim to drink less or quit. You also need to have no medical reasons to avoid it.[2] Check our guide on naltrexone vs acamprosate if you are comparing choices.
| Format | What it is | Talk to your prescriber about |
|---|---|---|
| Oral naltrexone | A daily pill taken by mouth | How it fits your daily routine and other meds |
| Extended-release injectable (Vivitrol) | A monthly shot from a provider | Whether and how long you need to be opioid-free before the shot |
| The Sinclair Method | A way to use naltrexone while drinking | If this approach matches your treatment goals |
Basic Facts About the Sinclair Method
The Sinclair Method is a specific use of naltrexone. It links the medication with alcohol use. The aim is to cut down drinking over time. It is not a separate drug.
Talk to a qualified prescriber if you are weighing this approach. They can help you see if it matches your treatment goals. For a broader look at how medications fit into recovery, see our guide to mat for alcohol use disorder.
Internet guides may feel like step-by-step instructions. Yet they are not medical advice. Do not start, stop, or change your dose because of the web. Ask a qualified prescriber first. They can say if this method suits you. Read our guide on asking your doctor about medication for tips on that conversation.
Drinking on Naltrexone: What Happens?
Using naltrexone does not create a disulfiram-like reaction if you drink.[4][5] You will not have an aversive physical response. Still, the drug does not block alcohol’s effects. It does not make drinking safe.
Because naltrexone is often used to help reduce drinking or support abstinence, it is important to discuss your specific goals and any instances of drinking with your prescriber. They can help decide if the medication still fits your treatment plan.
If you have already had a drink, do not take extra medication. Do not stop your treatment on your own. Ask your prescriber for advice that matches your needs. For more help, you can read our guide on relapse on alcohol medication.
Side Effects of Naltrexone and Why It May Not Fit
For most people, naltrexone is easy to handle. Still, some side effects are common. Understanding these helps you chat with your prescriber.
| Area | What may occur | What to discuss with a prescriber | When to seek medical advice |
|---|---|---|---|
| Common oral effects | Nausea, headache, dizziness, or fatigue[6][4] | How to manage symptoms or if a dose change is okay | If symptoms are bad or do not go away |
| Liver health | Liver injury or hepatitis has been reported with naltrexone[7] | Your liver history and any new symptoms like dark urine or yellow skin | If you notice signs of liver trouble, call your care team soon |
| Opioid use | Naltrexone can block opioid pain medicines[8] and may trigger withdrawal in people dependent on opioids[9] | All current opioid medicines, including pain relief, cough, or cold products | If you take opioids, tell your prescriber before starting naltrexone |
| Injection site (Vivitrol) | Pain, tenderness, swelling, redness, bruising, or itching at the injection site[10] | Any changes at the injection site, especially if they worsen | If you see signs of serious infection or tissue damage, contact your care team promptly |
Naltrexone may not be right if you use opioids for pain. It can block pain, cough, or cold medicines that contain opioids. Tell your clinician before getting pain treatment.[8] Also, naltrexone may trigger opioid withdrawal in people who depend on opioids.[9] Read more in our guide on naltrexone and opioid use.
Important Safety Warning: Opioid Overdose Risk
Opioid effects are blocked by naltrexone. A safety risk exists if you skip a dose or quit naltrexone. Your opioid tolerance may fall. If you then use opioids, even at a dose you previously tolerated, you are at risk for a serious or fatal overdose. Never take extra opioids to beat the block. Speak to your prescriber before taking any opioid while on naltrexone or soon after ending it. If you or someone else shows signs of an opioid overdose, such as unresponsiveness, slow or stopped breathing, or blue-tinged lips, call 911 immediately. Use naloxone if you have it while awaiting emergency aid.
Talk about your liver health too. Reports link naltrexone to liver injury and hepatitis. Do not guess your own diagnosis. Give your team your full history to help them protect you.
Nausea is a known side effect of oral naltrexone. Some patients stopped the drug because of it.[6] Dizziness, headache, and fatigue are also reported.[4] Tell your prescriber if these are a problem. See alcohol medication side effects for more info on other drugs.
Alcohol Withdrawal Is Not Treated by Naltrexone
Naltrexone works for alcohol use disorder. It does not handle acute alcohol withdrawal or the symptoms that come with it.[11] If you are worried about withdrawal, you need a medical check.
Work through this check to spot the safest path ahead.
What Kind of Help Is Safest Now?
This self-check is for information only and isn't a diagnosis. It cannot tell if it is safe to withdraw without medical care.
Supplements and Nutrition: Key Points
More adequately powered, rigorous studies are needed to establish conclusive evidence on most complementary approaches for substance use disorders.[12]
People often ask about supplements that cut alcohol cravings. We do not have a clear answer yet. Speak with a clinician or pharmacist before adding a new product. Some dietary supplements can clash with prescription medicines. This makes them less safe or alters how your medication works.[13]
You might wonder about vitamin gaps in alcohol use disorder. Drinking a lot can stop your body from using thiamine (vitamin B1) right.[14] Many nutrients are often low at once in these cases. Folate and fat-soluble vitamins A, D, and E are common low levels.[15]
Do not guess which nutrient you are missing. Talk to a clinician about your nutrition worries and any supplements you plan to take.
When Naltrexone Starts Helping and How Care Is Checked
No one day marks when naltrexone for alcohol use disorder stops cravings. Blood drug levels do not match how you feel. Oral naltrexone peaks in blood about one hour after you take it. This timing does not show when cravings drop.[16] Your prescriber will not give a set date for change. Care is an ongoing chat about your goals, drinking, and how the drug fits your life.
Before starting
You and your prescriber discuss your health history, current medications, and personal goals for drinking.
Early follow-up
You track cravings, drinking patterns, and any side effects. This helps you and your care team see if the plan is working for you.
Ongoing reviews
You meet regularly to check if benefits and treatment goals remain aligned. You can adjust the plan if it no longer fits.
Fixed timeframes appear in some studies to measure results. The COMBINE trial ran oral naltrexone for 16 weeks.[17] One trial of the extended-release injectable form ran for 24 weeks.[10] These times are research setups, not rules for how long you take the drug.
VA/DoD guidance suggests checking treatment response and tolerability at follow-ups. It does not use one study’s time as a set course. Regular checks use valid, standard tools to track your response.[18] This keeps the plan a good fit. Do not start, stop, or change your dose alone. Tell your prescriber about any worries or feeling changes.
Questions for Your Doctor and Finding Care
Ask your prescriber if naltrexone is right for you. That is the best way to check. Bring a list of questions to help you share your health history and goals.
Questions to Take to a Prescriber
Your ticks are saved on this device only.
You can also read our guide on asking your doctor about medication for more details. Medication and behavioral treatments can work together to help you reach your goals in alcohol use disorder care.[19]
If you want to explore local options, you can use the free and confidential SAMHSA National Helpline for treatment referrals anytime.[20] You can also search for substance use treatment services in the United States through SAMHSA’s FindTreatment.gov service.[21]
Frequently Asked Questions
How long does naltrexone take to work for alcoholism?
There is no single day when everyone feels a change. After taking the pill, peak blood levels hit within about one hour.[16] This timing does not tell you when you will feel fewer cravings. Track your urges and drinking over the next few weeks. Check in with your prescriber to review your progress. Do not stop or change your treatment just because you do not feel a quick difference.
What happens if you drink alcohol on naltrexone—does it cause a disulfiram-like reaction?
Naltrexone does not cause the severe reaction seen with disulfiram. But drinking while on this medicine is not safe. It can hurt your treatment goals. If you have already drunk, do not take extra medicine or stop without advice. Call 911 or go to the ER now if someone cannot wake up, has trouble breathing, or has a seizure.[22]
What is the downside of taking naltrexone?
Side effects and health issues decide if this medicine fits you. Look at the side-effect list from your provider. Talk to your prescriber about any worries. If you use the shot, ask about site reactions like tenderness or swelling.[10] Your doctor can help weigh the risks and benefits for you.
Why don't doctors like naltrexone?
Doctors do not generally dislike naltrexone. They may pick other options based on your health history. Other medicines, personal choices, or goals can shape this choice.[2] Naltrexone is an option for some patients, not all.[2] Ask your prescriber why they chose this path and what else is available.
What supplements can help reduce alcohol cravings?
No supplement replaces professional treatment for alcohol use disorder. Some products claim to cut cravings, but proof varies. Ask a clinician or pharmacist before using any product. This is key if you take naltrexone to avoid bad interactions.
What vitamin deficiency do people with alcohol use disorder get?
Alcohol use can lead to many nutritional gaps, not just one vitamin shortage. Every body reacts differently, so no single gap fits everyone. A medical check-up is the best way to find any missing nutrients. Do not guess or start supplements without talking to your care team first.
What is the Sinclair Method?
The Sinclair Method pairs medicine with specific drinking patterns. Research exists on this method, but it is not a safe self-directed plan for everyone. Read the earlier section in this guide for a basic overview of how it works. Always work with a licensed pro to build a safe plan for you.
Is naltrexone a treatment for alcohol withdrawal?
No, naltrexone does not treat alcohol withdrawal on its own. Withdrawal signs can start 6 to 24 hours after you cut back or stop drinking.[23] Alcohol withdrawal can be life-threatening.[24] Call 911 or go to the ER now for seizures, severe confusion, hallucinations, a high fever, or a racing heart during withdrawal. For withdrawal symptoms that are not emergency danger signs, seek timely medical care.
