Alcohol use disorder (AUD), once called alcoholism or alcohol addiction, is a condition in which problem drinking or heavy drinking becomes compulsive. If a person’s psychological wellbeing relies on consuming alcohol, and they experience cravings, mood swings, or withdrawal symptoms if they are not able to consume it, they may have AUD. However, only a medical professional like a physician or a therapist can diagnose this condition.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines specific symptoms that can be used to diagnose AUD; if a person experiences two of these symptoms for a year, then they likely have this chronic behavioral condition. Once a doctor or therapist gives the diagnosis, medical professionals can develop a treatment plan. This plan will likely include behavioral therapy, rehabilitation, and support groups. It may also include maintenance medication, one of which is Vivitrol.
Vivitrol to Reduce Relapse Risk
As medical professionals understand it now, addiction is a chronic disease that affects the structure of the brain, especially the reward pathways. The National Institute on Drug Abuse (NIDA) notes that, while relapse can be emotionally difficult for people experiencing addiction, it is an expected part of how this disease manifests. The term relapse, when dealing with medical conditions, simply means that symptoms of the disease re-emerge after a period of treatment and stability.
NIDA compares rates of alcohol use disorder relapse to other chronic health conditions, which typically have similar rates of symptom relapse.
- About 40-60 percent of people struggling with addiction relapse.
- Roughly 30-50 percent of those with type I diabetes relapse.
- Approximately 50-70 percent of people managing hypertension relapse.
- About 50-70 percent of individuals with asthma relapse.
When a person with diabetes or asthma experiences a return of symptoms or worsening symptoms, they go back to their doctor and come up with a new treatment plan. NIDA states that the same evidence-based treatment must apply to addiction. One of the medications used in evidence-based addiction treatment is Vivitrol.
How Vivitrol Works
Vivitrol is one of the brand-name versions of naltrexone, a medication that reduces cravings for alcohol in most people who use it as prescribed. This medication can be used as a maintenance medication to help people stay abstinent when they are recovering from both alcohol and opioid addiction. Approved by the Food and Drug Administration (FDA) for prescription use in the US in 1994, naltrexone is the second medication approved for use in people who are working to overcome AUD.
When taken for opioid addiction, Vivitrol blocks opioids from binding to the receptors and releasing neurotransmitters. For people who may lapse or relapse during treatment, the presence of naltrexone in the brain’s opioid receptors will prevent drugs like heroin or OxyContin from producing any intoxicating effects; however, if a person tries to take a very large dose of these drugs to bypass the naltrexone, they may still experience an overdose. In order to avoid intense withdrawal symptoms, people who take Vivitrol to stay abstinent from opioids must have stopped taking these drugs for at least seven days, and they cannot be on medication-assisted therapies like methadone or buprenorphine because these medications will stop working.
Vivitrol works similarly with alcohol cravings, although the mechanisms for why it works are less well understood. The medication does appear to block cravings for alcohol as well, and if a person lapses and consumes alcohol, they are less likely to feel any effect from the intoxicant. People who want naltrexone as part of their AUD treatment plan must also stop drinking completely before they can take it.
The specific administration method for Vivitrol is an intramuscular injection, which is given once per month. There are no pills or daily doses to worry about, and the drug works automatically when a person consumes alcohol. The long-acting shot will help the person stay in treatment and recovery. Other alcohol use disorder treatment medications, like disulfiram, are less effective, in part, because some people simply stop taking them and then relapse back into alcohol abuse.
Interactions with the Body and Other Drugs
- Painkillers, antidiarrheal. medicines, or cough medicines that have small amounts of opioids
- Maintenance drugs like buprenorphine and methadone
- Thioridazine, which treats schizophrenia
The medication can also cause mild, but uncomfortable, side effects, including:
- Gastrointestinal changes like nausea, vomiting, diarrhea, and constipation
- Pain or cramping in the stomach
- Appetite changes, especially loss of appetite
- Mood swings, irritability, nervousness, and anxiety
- Changes in physical energy, either increased or decreased
- Insomnia or other sleep disturbances
- Pain in muscles or joints
If these get worse or do not go away, it is important to report them to a doctor. The drug may also cause liver damage or hepatitis, especially if the person has some liver damage due to alcohol abuse over time.
While Vivitrol does not work for everyone, it has worked for many people, making it an important option for AUD treatment. Many studies show that taking Vivitrol, especially in combination with behavioral therapy, reduces the number of drinking days during a relapse and improves how many people stay abstinent for one year after detox and rehabilitation.
One study found that only 20 percent of those taking Vivitrol relapsed in the first year compared to the standard 40 percent in the placebo group. Other studies found that people who took Vivitrol remained in treatment for longer. The drug also reduced cravings across the board. The pharmaceutical company’s official Vivitrol website states that the treatment population in a six-month, double-blind study had a 25 percent greater reduction in days of heavy drinking when they took Vivitrol while also undergoing behavioral counseling.
Treatment with Vivitrol
NIDA is clear that there is no one solution that is perfect for everyone overcoming addiction. A combination of maintenance medication, therapy, and peer support appears to work for the majority of people, and staying in rehabilitation at least 90 days (three months) seems to bring about the best outcome. Medication is not a cure, but Vivitrol, with behavioral counseling, can help people overcome alcohol use disorder and get healthy.
What Are the Side Effects of Vivitrol?
Although Vivitrol is a safe drug when monitored by the prescribing physician, it can still produce some side effects, including:
- Gastrointestinal problems like nausea, vomiting, diarrhea, and constipation
- Pain or cramps in the stomach
- Appetite changes, especially a loss of appetite
- Mood changes like anxiety, irritability, or nervousness
- Watery eyes or tearfulness
- Changes in physical energy, either increased or decreased
- Muscle or joint pain
- Discomfort at the injection site
If these side effects do not go away, or they get worse, it is important to contact the prescribing physician. The dose may need to be adjusted.
Naltrexone-based medications, including Vivitrol, can produce dangerous side effects, too, especially if the individual has pre-existing health conditions. Hallucinations, constant or severe vomiting or diarrhea, coughing or other breathing problems, confusion, or changes in vision can all indicate serious problems. Contact a physician immediately.
What Are the Risks of Long-Term Use of Vivitrol?
In general, long-term use of Vivitrol for alcohol or opioid dependence has been shown to be safe and effective. A one-year study conducted in 2010 found that the naltrexone medication, when combined with counseling or therapy, helped 65 percent of the prescribed patients maintain abstinence from opioids for 18 months, which represents a high clinical trial completion rate. There were no incidents of severe adverse reactions and no serious injection site reactions; there was a low incidence of clinical adverse events and low rates of injection site pain. The most common reaction was an allergic reaction, which was treated in the clinic. Serious allergic reactions or injection site reactions, including tissue death around the injection site, are possible but extremely unlikely.
Acute side effects, including mental state changes, breathing depression or irregularity, and gastrointestinal problems may cause enough harm to require hospitalization, but if the person receives emergency medical attention, these do go away.
Naltrexone does interact with some other medications, especially those that contain small doses of opioids, so it is important for doctors to know all the medications their patients are taking before prescribing naltrexone drugs like Vivitrol.
This medication is generally safe, although it should not be taken without a doctor’s prescription and supervision. It will not cure opioid or alcohol addiction; instead, it is an important maintenance medication that works alongside therapy and peer support groups to manage addiction. However, it is safe for most people and has few long-term, harmful side effects.
Are There Alternatives to Vivitrol?
When managing recovery from alcohol use disorder, there are few medications that are safer than naltrexone (Vivitrol), except, possibly, acamprosate (Campral).
The downsides of Campral include:
- It must be taken three times per day while Vivitrol is a once-a-month shot.
- It minimizes the imbalance of neurotransmitters, which improves mood but may not stop cravings.
Benefits of Campral compared to Vivitrol include:
- The person in recovery must be sober for seven days before they can take Vivitrol while Campral only requires five days of sobriety.
- Campral causes fewer side effects.
Ultimately, finding the best medication to reduce cravings and improve recovery outcomes after alcohol abuse involves a conversation between the individual and their doctor. However, Vivitrol is a very safe medication for most people.
Is Vivitrol Addictive?
No, Vivitrol is not addictive. It is an opioid antagonist, so it binds to opioid receptors in the brain without creating any effects like relaxation or intoxication.