A Comprehensive Approach: Integrating Naltrexone in Alcohol Addiction Treatment

Dr. John David Sinclair was a pioneer. An American-born scientist, he relocated to Finland in the 1970s to devote himself to the study of alcohol addiction and discover more effective ways of treating the disorder according to solid scientific principles, driven by an understanding of alcoholism as a brain disease. “Sinclair came to believe that people develop drinking problems through a chemical process: Each time they drink, the endorphins released in the brain strengthen certain synapses.” If the strengthening of these synapses is what creates the overwhelming drive toward addictive behavior, preventing the fortification process from occurring could disrupt alcohol addiction on a neurological level and act as an extinction method.

Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to the specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less.

Based on his research on rat populations, he began studying the effects of the opioid antagonist naltrexone on alcohol consumption amongst patients in alcohol addiction treatment. The results were remarkable; when people with alcohol-use disorder were given naltrexone, 78% of patients were able to decrease their alcohol consumption to safe levels and many were able to stop drinking altogether. Unlike alcohol-deterrent medications like Antabuse, which works by altering the body’s metabolic response to alcohol to induce unpleasant physical effects, naltrexone directly targets the powerhouse of addiction—the brain—to reduce the desire to drink with minimal side effects, leading to greater adherence and significantly higher success rates. By the time Sinclair passed last spring, the naltrexone extinction method was the mainstay of alcohol addiction treatment in clinics across Finland, and is increasingly becoming used across Europe.

Naltrexone gained FDA approval for the treatment of alcohol-use disorder in 1994. Despite over 20 years of availability in the United States, less than 1% of alcoholics are prescribed naltrexone as part of their addiction treatment. The reasons for this are twofold: rehabs often don’t have the ability to prescribe medications due to a lack of medical staff, and resistance to treating addiction as a disease persists even within the medical community. Scheff points out that, “Even psychiatrists and psychologists wrestle with [understanding addiction as a disease]. A lot don’t get it; they just don’t buy it.” Compounding the problem is the fact that even clinicians who do ostensibly recognize alcohol addiction as a disease are often reluctant to provide pharmacological interventions aimed at treating the addiction, largely due to pervasive and powerful anti-drug sentiment in both medical and recovery communities. For some, even the use of psychotropics for the treatment of co-occurring mental health disorders is frowned upon, as no distinction is made between harmful and therapeutic drug use.

Dr. Markus Heilig, clinical director of the National Institute on Alcohol Abuse and Alcoholism says he was trained to believe that treating alcohol addiction with drugs was antithetical to recovery. “When I went to medical school, if you suggested targeting alcoholism with a drug, people would say to you, ‘Young man, how could you ever hope to treat a chemical dependence with another chemical?’” According to Gabrielle Glaser, the aversion to pharmacological intervention is partially a reaction against unsavory addiction treatment practices in the past. “When doctors were trying to get people away from their alcohol addiction in the 1950s and ’60s, they were also prescribing Valium. So many people would become addicted to both Valium and alcohol,” she says. “[Naltrexone] is a completely different drug. It’s nonaddicting. It’s been shown in dozens and dozens of studies to be safe. So there’s a whole kit of tools out there that have been ignored.” This resistance to meaningful medical intervention speaks to the deep-seated contradictions within many addiction treatment programs, even those staffed by medical professionals, which struggle to reconcile modern science with powerful preconceptions surrounding addiction, ultimately keeping people from getting the help they need to recover.

Despite the troubled state of many addiction treatment programs in the United States, inroads are being made. As scientific knowledge regarding alcoholism grows and the public becomes increasingly cognizant of what effective treatment looks like, demand for evidence-based treatment is expanding. Simultaneously, media coverage of naltrexone by major news outlets is breaking down barriers to medicine-based intervention and introducing the possibilities of pharmacological extinction to people struggling with alcohol addiction and their families. In 2014, actress Claudia Christian produced a documentary called One Little Pill, with the aim of raising awareness about the naltrexone extinction method after using it herself to break free from years of alcoholism. Slowly, the idea that treating alcoholism by using medications that treat it as a brain disease is starting to take root. Dr. Katharine A. Bradley, a senior investigator at the Group Health Research Institute in Seattle, says, “It’s been a slow transition getting [naltrexone] onto the medical agenda. But patients need to know that addiction is a biological condition of the brain and we have treatments to improve it.” A growing number of addiction experts now believe that increased acceptance of pharmacological interventions such as naltrexone in alcohol addiction treatment will soon allow clinicians to offer more diverse, tailored, and effective help for people struggling with alcohol addiction, giving clients more choices for recovery.

Naltrexone isn’t a cure-all. Alcohol addiction is a multidimensional disorder that affects each person in unique ways and its expressions are informed by a complex network of biological, environmental, and psychological factors. However, for many, the drug can make a significant difference in treatment outcomes, particularly when used as part of a comprehensive, evidence-based treatment program that addresses the psychosocial aspects of addiction in conjunction with the neurological component. By reducing cravings, naltrexone helps ease withdrawal, creates the emotional space to meaningfully engage in psychological and behavioral treatment, and guards against relapse in early recovery to increase chances of long-term success. Patty Hendricks, a 53-year-old recovering alcoholic, credits the drug with helping her finally recover from her addiction after four unsuccessful attempts at rehab. “I don’t think I could have gotten sober without it,” she says. “I think eventually I was strong enough to talk myself out of the cravings. But you go through such withdrawal in the beginning, and naltrexone helped make the cravings shorter and less intense.”