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Naltrexone: Not a Magic Bullet, But Still Pretty Darn Good

Aug 18, 2007
As the treatment of alcohol related conditions has become more sophisticated, the use of medications has too. Until recently the only commonly prescribed adjunct was disulfiram (Antabuse), an aversive drug whose use resulted in violent illness when combined with even trace amounts of alcohol. That worked for those willing to risk the results and fit well with the frequently punitive nature of many treatment regimens.

Currently, however, a preferable alternative has appeared. Naltrexone (ReVia) affects drinking behaviors in two non-aversive ways. First, it functions in somewhat the same way nicotine patches do for smokers, it cuts the craving for alcohol. Second, it interferes with the brain's feeling of wellbeing that is associated with drinking. Simply put, one has less desire to drink and none of the usual rewards from drinking.

Because of its two-pronged, but non-aversive, effects, Naltrexone has also been found to be effective in helping some people moderate their alcohol use. Obviously, with cravings gone and effects muted, many drinkers will find their consumption declining. Less drinking tends to free up time for other activities and some find themselves easing back out of alcohol abuse and dependence in much the same way they fell into it.

But it isn't a magic bullet.

The usual problems associated with any medication occur with Naltrexone too. Many people will follow their prescription for a period of time then stop, with the result that the old behaviors reassert themselves. Obviously, if the effects of drinking are curtailed, then the choice is to develop new behavior patterns, or rekindle the effects by returning to drinking. Most people find it easier to stop taking their medications than to develop new interests.

Consequently, Naltrexone, like Antabuse and Campral, works best as a support in conjunction with competent professional counseling whether the goal is abstinence or moderation. Generally speaking, this will involve short-term cognitive behavioral therapy (CBT) in an outpatient setting. Ideally, the Naltrexone phase in a person's behavioral change program should last from three to six months with a gradual phase-out. The actual time will, of course, vary with different individuals, but the timing is flexible and can easily be tailored to preferences or needs.

The establishment of real change takes about a year (see Prochaska, Norcross, and DiClemente: Changing For Good) and a gradual transition away from medical and therapeutic support is usually most effective. The success that people achieve is, after all, usually based on motivation, support, knowledge, and the assumption of responsibility for their own continued wellbeing. All of these components are most effectively created with accountability and insight, along with the introduction of new and rewarding social and recreational activities.

No, Naltrexone isn't a magic bullet but it does help create a window of opportunity - a window that will close unless it is used. Opportunity with planning, activity, and support will make change possible. Initially it won't always be a lot of fun. Yes, it will be frustrating and difficult at times - just ask any ex-smoker - but a reclaimed life is a tremendous gift to give, both to yourself and those around you.
About the Author
Dr. Edward Wilson has been developing and providing alternative alcohol counseling including moderation, since 1990. He is co-founder and Clinical Director of Your Empowering Solutions, Inc. located in suburban Los Angeles. You can learn more about Dr. Wilson's innovative work in 12 step alternatives for alcohol problems by visiting his website.
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