Alcoholics and their friends and family members have long hoped for a cure for alcohol addiction. But few people know about naltrexone, a drug that by most accounts has a phenomenal success rate for curing addiction to alcohol.
Why? It's not as if naltrexone is a fringe or alternative treatment. The drug is widely used in Europe to combat alcohol addiction and has been approved in the U.S. since 1994.
What Is Naltrexone?
Naltrexone is an opioid antagonist — a drug that blocks the brain's reward system from responding to alcohol or drugs like heroin and prescription painkillers. When these substances hit the brain's opioid receptors, they trigger showers of feel-good endorphins and dopamine. And if you're an alcoholic, that's what keeps you coming back for more.
It works by shutting down the addictive response that keeps alcoholics drinking long after they've passed their limits. When this occurs, former problem drinkers are enabled to imbibe without bingeing — as long as they keep taking the medicine.
Proponents of the drug say 80 percent of those treated with naltrexone end their binge drinking and either abstain or drink moderately.
"When you first hear about it, you think it's got to be some kind of gimmick," says actress Claudia Christian, who cured herself of alcoholism several years ago using the Sinclair Method, a process of deliberately drinking after taking naltrexone. "But I know many people whose lives have been saved, including my own."
What’s the Sinclair Method?
Christian was a binge drinker who would drink all night and start up again in the morning. "I couldn't touch a drink without going on a binge," she says. Her final spree landed her in the emergency room with seizures. She learned about naltrexone from a pamphlet she picked up on her way out of an expensive rehab.
So she embarked on the Sinclair Method, dutifully taking naltrexone one hour before drinking. She responded almost immediately. That was in 2009, and she has not had a binge since. Her own turnaround inspired her to create the C Three Foundation to educate people about the Sinclair Method. Christian became an addiction counselor and also produced a documentary film called "One Little Pill" that explains the Sinclair approach to alcoholism.
"[With other treatments,] people can achieve abstinence for some pretty impressive stretches of time," says Christian, "but you're still obsessed with alcohol. That's my definition of a 'dry drunk': someone who can stay sober, but all the while [has] painful and distracting cravings."
What Makes Naltrexone Different?
The theory goes like this: Addiction is a learned behavior, but some people are more genetically disposed to it than others. When alcoholics drink, the brain releases an abnormally large amount of endorphins that reinforces the impulse to drink more. Once that mechanism gets triggered, it can be nearly impossible to stop drinking.
What's more, the longer there's a period of total abstinence, the more the brain is redoubling its message that you really need to keep drinking. This is what drives many people to relapse, says Sinclair Method co-founder, Roy Eskapa, Ph.D., in his book "The Cure for Alcoholism: The Medically Proven Way to Eliminate Alcoholic Addiction."
The drug works by repatterning the brain's response to alcohol, returning it to that of a normal drinker who is satisfied with very little alcohol. By causing what's known as "extinction of the addictive pathway," naltrexone gradually reduces the compulsion to binge drink.
Naltrexone does not, like disulfiram (sold under the trade name Antabuse), cause a violent or unpleasant reaction to alcohol. For many, it may not change the effect alcohol has at all — just the compulsion to drink to excess. Although there may be such side effects as upset stomach or headache, most are passing.
Does Naltrexone Work?
Naltrexone's lack of support in the U.S. happens through a combination of ignorance and self-interest, says Marc Kern, Ph.D., an addiction specialist. "It's not a moneymaker, so addiction specialists aren't eager to find out about it," says Kern, who provides coaching on the Sinclair Method and other non-12 Step measures.
"Frankly, it's bad for business because very quickly people don't need me," he says jokingly. "But it really works — when it's used right."
However, both Kern and Christian point out that it is frequently not used correctly. Perhaps because of a reluctance to encourage drinking at all, it's prescribed to ward off cravings. Not only does it fail in this respect, it can actually demotivate the person taking it in other areas of his or her life.
Naltrexone has been shown to effectively demotivate people from gambling and other compulsive behaviors. That's a good thing. But taken indiscriminately, it can also demotivate people from healthy activities like sex or exercise, says Kern.
"There are a lot of things that aren't really clear," says Kenneth Roy, M.D., a psychiatrist specializing in addiction and a member of the American Society of Addictive Medicine, which does not have a black-and-white policy on the use of naltrexone. "It's unclear whether the 'extinction' of the addictive pathway only happens to alcoholics or if it demotivates everyone. It's a little murky in terms of what the mechanism is."
Dr. Roy believes naltrexone should only be prescribed as part of a comprehensive recovery program that has abstinence as a goal.
What Do YOU Think?
Have you or a loved one struggled with alcohol addiction? What kinds of treatments have you heard of or tried? Have you ever heard of naltrexone before? What do you think after reading this piece? Remember to always consult with a doctor before embarking on any treatment program. And share your thoughts, stories and questions in the comments below!