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Alcohol Relapse Prevention and Naltrexone

naltrexoneThere are a few forms of problem drinking, including heavy drinking and binge drinking, but one of the most serious is alcohol use disorder. Formerly called alcoholism or alcohol addiction, alcohol use disorder (AUD) is a chronic behavioral disorder, like other addictions, that involves compulsive reward-seeking behaviors – in this case, consuming alcohol to feel good, relaxed, or normal. People who struggle with AUD have a challenging time controlling how much they drink and quitting drinking. In addition, they may drink more than they intend to on specific occasions.

What Is Alcohol Use Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5defines specific requirements for AUD, including:

  • Drinking more or longer than intended at several occasions
  • Attempts to cut down or stop drinking but being unable to do so
  • Spending a lot of time drinking and/or getting sick after drinking
  • Cravings for alcohol
  • Experiencing withdrawal symptoms as the effects of alcohol wear off
  • Having drinking, or illness afterward, interfere with family, work, or social responsibilities
  • Continuing to drink despite problems it causes at work or with family and friends
  • Having to drink more to get the original effects

The DSM-5 states that any one of these symptoms could be cause for concern, but displaying at least two of these 11 criteria for a 12-month (one-year) period may indicate AUD. It is important to seek help from a medical professional for a diagnosis and an evidence-based course of treatment.

One of the methods of treating alcohol abuse involves medications like naltrexone. This medication is designed to ease cravings after detox, so a person in a rehabilitation program and long-term recovery can maintain sobriety.

Alcohol Relapse and Treatment

While there is still too much social stigma attached to the idea of relapse, the National Institute on Drug Abuse (NIDA) states that it is an expected occurrence when a person has a chronic condition like addiction. Like other chronic illnesses, a combination of environment, genetics, family history, and chemical imbalances (for addiction, in the brain specifically) can trigger the disease, and any combination of these risk factors can lead to relapse. Experiencing a lapse or a relapse does not mean that treatment has failed. NIDA shows that relapse rates for people who struggle with addiction are similar to those of other chronic illnesses, like diabetes, hypertension, and asthma.

In this context, relapse means that, during a maintenance period, symptoms of the condition return, and the individual should return to treatment and develop a new treatment plan. For people struggling with AUD, a period of sobriety may lead to overconfidence or complacency in the recovery plan, or the person could enter a situation in which they are psychologically or emotionally triggered and experience cravings to consume alcohol.

Common relapse triggers may include:

  • Feelings or emotions that are scattered or up and down
  • Experiencing negative emotions from regular, daily stresses more intensely
  • The staunch belief that the individual will never drink again
  • Experiencing irrational or quick anger
  • Losing commitment to the recovery program
  • Visiting old drinking locations or hanging out with old drinking buddies

Medications like naltrexone can be used during recovery to reduce the risk of relapse. By reducing cravings and the experience of pleasure associated with alcohol, naltrexone may help people retrain their minds and behaviors to avoid alcohol as a solution to emotional or psychological triggers.

Naltrexone for Alcohol Use Disorder Treatment

Naltrexone is a generic name, and this medication is most often found under the brand name Vivitrol. This medication helps to reduce the risk of relapse for people struggling with AUD, and it also works for people overcoming addiction to opioid drugs. The medication is not intended to reduce withdrawal symptoms other than cravings; other medical assistance is required to safely detox from both opioids and alcohol.

The Food and Drug Administration (FDA) approved naltrexone to treat AUD in 1994, making this medication only the second approved to treat alcohol abuse and dependence. Unlike disulfiram, the previously approved medication, naltrexone does not interact with alcohol; disulfiram was designed to cause intense illness and discomfort in a person who relapsed back into alcohol abuse by interacting with how the body processes alcohol. Naltrexone, on the other hand, does not interact with alcohol or opioids. If a person consumed an alcoholic beverage, whether accidentally or during a lapse, they will not experience physical illness, but they will also not experience brain chemistry changes that make alcohol desirable.

How Does Naltrexone Stop Cravings?

The base chemical of naltrexone is an opioid receptor antagonist. It binds with the receptors, preventing other chemicals like opioids or GABA from binding to these receptors and stimulating the release of neurotransmitters like dopamine and serotonin. By preventing the release of brain chemicals that trigger the reward system, induce relaxation, and increase pleasure, naltrexone reduces the intoxicant’s reinforcement of addictive behaviors. A person taking naltrexone may drink a lot during a lapse or relapse, but the drug will not do anything pleasurable for them.

Naltrexone comes in two main forms. Vivitrol is a once-per-month injectable version of naltrexone, so a person in long-term recovery does not have to think about taking medication. ReVia is a brand name is a once-per-day oral medication, which may work better for some people.

Interactions and Side Effects

Naltrexone does not interact negatively with many drugs, including alcohol and opioids. However, it is intended for prescription use after a person has detoxed and no longer has any of the drug in their body. For people on maintenance medications like buprenorphine, for example, naltrexone will prevent the drug from working properly.

Other substances that naltrexone interacts with include:

  • Disulfiram
  • Thioridazine, which treats schizophrenia
  • Medications with small doses of opioids to treat diarrhea, cough, or pain
  • Methadone and other maintenance medications

side-effects

Naltrexone can cause some side effects, including:

  • Nausea, vomiting, diarrhea, or constipation
  • Stomach pain and cramping
  • Appetite changes, especially loss of appetite
  • Dizziness
  • Headaches
  • Anxiety, nervousness, or irritability
  • Watery eyes or tearfulness
  • Changes in physical energy
  • Trouble falling or staying asleep
  • Rash
  • Drowsiness or fatigue
  • Pain in muscles or joints

If side effects do not go away or become more severe, contact the prescribing physician.

Naltrexone as Part of a Comprehensive Treatment Regime

Like other medications used in recovery, it is important to use naltrexone in combination with other forms of behavioral and psychological treatment – working with a therapist, attending regular support groups, and getting regular checkups with a physician. There is no cure for addiction, and medication alone will not stop the condition from recurring. However, working with therapists to understand addictive behaviors and make changes, getting social support from peer groups, and receiving love and support from friends and family, alongside medication, will help to reduce relapse risks and maintain sobriety and health.