In 2017, Katie Lane was blacking out multiple times a week from drinking. She’d down at least a bottle of wine every weeknight, sometimes more, and large quantities of vodka on weekends. But even after she suffered a pulmonary embolism in her 30s and doctors diagnosed her with excessive drinking, she struggled to stop.
Later that year, her doctor prescribed naltrexone, a drug that blocks chemical reactions in the brain’s reward center. She noticed an immediate change. “I’d pour myself a third glass of wine and it just stayed there,” she says. “I couldn’t believe it. My life changed.” As of this writing, she’s been sober for four years.
According to the Centers for Disease Control and Prevention, approximately 12 million people in the United States suffer from alcohol use disorder. Alcohol use disorder is defined as drinking four or more drinks on one occasion for women and six or more drinks on one occasion for men. Alcohol use disorder can be caused by: 500 deaths Every day, lives are lost to car accidents, organ failure, related cancers, acute alcohol poisoning, and more.
While naltrexone is not a cure-all, hundreds of studies have shown it to be a safe and effective medication to help people reduce or stop drinking. Classified as an opioid antagonist, the drug was first approved by the Food and Drug Administration to treat alcohol use disorder 30 years ago, in 1994.
Yet despite its effectiveness, naltrexone is rarely prescribed: In the United States, about 1% of people with alcohol use disorder were prescribed naltrexone in a 2023 national survey. study A study published this spring found that people with alcohol use disorders were the least likely to receive a prescription for naltrexone compared to people with other substance use disorders.
The reasons are complex, but experts I spoke to said they believe it boils down to two factors: a lack of knowledge about naltrexone and the stigma surrounding alcohol use disorder, which is often viewed as a lack of willpower rather than a medical problem.
“Many in the medical field think of alcoholism as ‘making a bad choice,'” Andrew Saxon, an addiction psychiatrist and professor at the University of Washington School of Medicine, told me. “They don’t see treating substance use disorders as their job.”
As a result, many doctors haven’t kept up with the latest research in addiction treatment, which has changed dramatically over the past decade. “Until very recently, it was believed that the only treatment for alcohol use disorder was complete abstinence,” Saxon says. But that’s no longer the case.
Eden Bernstein, a primary care researcher at Harvard Medical School and Massachusetts General Hospital, said she agrees with that assessment. “Many medical professionals believe that alcoholism is a kind of personal moral failing that doesn’t lend itself to treatment with medicine,” Bernstein said.
The emphasis on abstinence is part of the core philosophy of Alcoholics Anonymous, which eschews drug treatment, sees recovery as an all-or-nothing proposition and believes that one drink can erase years of sobriety. But among addiction researchers, even a small reduction in drinking is increasingly considered a victory.
In addition to naltrexone, there are two other medications approved by the FDA to treat alcohol use disorder: acamprosate and disulfiram. Both can make you feel really bad if you drink alcohol. But skipping a dose when you plan to drink can help prevent you from feeling bad.
In contrast, naltrexone works by blocking neurotransmitters in the brain’s reward system, blunting the positive feelings that alcohol produces. NarcanNaltrexone is an overdose antidote that recently became available over the counter. But rather than administering large amounts of the drug directly to the brain via a nasal spray, naltrexone is a slower-acting pill that interrupts the addiction feedback loop.
“Naltrexone is almost always my first choice when treating alcohol use disorder,” Saxon says.
Despite this, it remains extremely hard to find a prescription for the drug. Lane visited five doctors who would prescribe naltrexone, which she learned about on YouTube, before finding one. The reasons the doctors gave her reflected common misconceptions about the drug: One said they couldn’t prescribe it unless she’d abstained from alcohol for five consecutive days; the other recommended she attend an inpatient rehab program instead.
“There’s a misconception that patients taking naltrexone have to be abstinent,” Jonathan Leon, a Mayo Clinic physician who surveyed Mayo Clinic physicians about naltrexone, told me. investigation A study published in the journal Frontiers in Psychiatry in 2022 found that most of the 150 physicians at three Mayo Clinic centers in Arizona, Minnesota, and Florida had never heard of naltrexone or didn’t know enough about it to prescribe it. Doctors who didn’t prescribe the drug were more likely to report misinformation about how it works, its effectiveness, and its safety.
“Compared to many common medications, naltrexone is very effective,” Bernstein said, with the caveat that, like many medications, “everyone responds differently.” For some, “the response may be life-changing,” while for others the effects may be minimal.
in the studyPatients with alcohol use disorder who received naltrexone showed a significant reduction in both monthly drinking frequency and amount compared to patients who received a placebo. Naltrexone prescribed at the time of discharge reduced the risk of alcohol use by 42%. Death toll falls You may be readmitted to hospital after 30 days.
There is also evidence that naltrexone works best if patients continue to drink alcohol as usual, at least at the beginning of the medication. Meta-analysis A study published in the journal Addiction found that patients who took naltrexone drank an average of two fewer alcohol days per month than those who took a placebo, and the reductions were even greater when subjects were not required to abstain.
Another commonly cited reason for doctors not prescribing naltrexone is that patients aren’t getting “appropriate follow-up care” or treatment. This is another misconception, according to the researchers. “Naltrexone is a fairly harmless drug,” Saxon says. “It has virtually no side effects, so the risk to a person is very low and the benefits are potentially very high.”
Because the brain’s reward system is involved to some degree in almost every type of addiction, naltrexone has shown promise in treating other problems as well. Naltrexone was originally developed and approved to treat opioid addiction. When combined with the antidepressant bupropion, it is approved as a weight loss management drug under the name Contrave.
Saxon sees other similarities between alcohol use disorder and overeating: There’s a lot of stigma around obesity and being overweight, and like alcohol use disorder, they’re seen as a lack of willpower rather than a legitimate medical illness.
As a result, when Ozempic and other GLP-1 agonists hit the market last year as the first truly effective weight-loss drugs, Repulsion This is based, at least in part, on the idea that taking medication to lose weight is a form of “cheat,” a way to avoid the effort needed to make up for being fat in the first place.
But despite this stigma and a host of harsh side effects, Ozempic and related weight-loss drugs have proven wildly popular, and Bernstein suggests their success may hold lessons for expanding access to naltrexone.
The demand for Ozempic and other weight-loss drugs has mainly come from patients who have heard about them through news articles and drug advertisements and have asked their doctors for prescriptions. “While advertising has helped raise cultural awareness of these drugs as an option for treating obesity, the same has not been seen for drugs used to treat alcohol use disorder,” Bernstein said.
In contrast to Ozempic, which may not be covered by insurance, naltrexone is inexpensive and typically covered by insurance, but without the same advertising and promotion efforts, it may be up to doctors to raise awareness among patients.
a study A February study in the journal Academic Emergency Medicine found that when simple instructions were added to routine medical checkups, prescriptions for naltrexone increased sixfold. Bernstein also thinks that people who are “curious about abstinence” might be interested in the drug. “We know that more people are looking to cut down, even if they’re not ready to quit completely,” he says.
“If I ever get the urge to drink again, I might do it again, but I’m glad alcohol isn’t forbidden fruit,” Laing said. “I feel like naltrexone has erased the addiction for me. freedom.”
