Why Isn’t Naltrexone Working for Me? Insights from Dr. Joseph Volpicelli

Why Naltrexone May Not Be Working for You

Introduction 

If you've started taking naltrexone to reduce your drinking but aren’t seeing results, you're not alone. While naltrexone is an FDA-approved medication proven to help reduce alcohol cravings and consumption, it doesn’t work the same for everyone. There are several reasons why naltrexone might not be working, ranging from dosage issues to how your body metabolizes the medication.

Let’s explore the most common reasons why naltrexone may not be effective and what you can do about it.

1. Understanding How Naltrexone Works

Naltrexone is designed to block the euphoric and pleasurable effects of alcohol. If you’re used to drinking for that initial buzz or excitement, naltrexone can help by blunting those effects, making alcohol less rewarding and making it easier to control drinking.

However, according to Dr. Joseph Volpicelli, naltrexone expert researcher and physician, naltrexone does not block the sedative effects of alcohol. Some people drink not for the initial euphoria but for the relaxing, numbing, or sleep-inducing effects. Since naltrexone only blocks the reward mechanism, it may not seem as effective for those who drink primarily to unwind or sleep.

💡 Solution: If you primarily drink for sedation or anxiety relief, naltrexone may work best when paired with alternative stress-reducing techniques such as therapy, relaxation exercises, or other medical interventions.

2. Are You Taking Naltrexone Correctly?

One of the biggest reasons people don’t see results with naltrexone is not taking it properly. If you're using naltrexone to cut back on alcohol, it must be consistently taken before drinking to effectively block the pleasurable effects of alcohol. Missing even one dose can reinforce old drinking patterns.

Brian Noonan, a medical professional specializing in The Sinclair Method (TSM), explains:

"Despite the simplicity of it—you take this medication before drinking—many people struggle to be perfect with it. If you occasionally miss a dose, that might be enough to prevent it from working as intended."

For those who take daily naltrexone for cravings, consistency is equally important. Naltrexone helps reduce the overall urge to drink, but skipping doses can allow cravings to resurface.

💡 Solution: Set reminders, use a habit tracker, or prepare your medication ahead of time to ensure you take it every single time before drinking (if using TSM) or as prescribed daily (if prescribed for cravings).

3. Genetic Differences in How You Metabolize Naltrexone

Another factor that could impact naltrexone’s effectiveness is how your body processes the medication. Some people are rapid metabolizers, meaning their bodies break down naltrexone too quickly to get full benefits. Others may be slow metabolizers, leading to stronger side effects or prolonged effects.

According to Brian Noonan:

"Some people might need a higher or lower dose based on their metabolism. A person who is a rapid metabolizer might require a 75mg dose, while someone who metabolizes it slowly may do better with just 25mg."

💡 Solution: If you suspect naltrexone isn’t working due to metabolism differences, talk to your doctor about adjusting your dose or considering a genetic test to determine your enzyme activity.

4. Tolerance, Detox, and Withdrawal Considerations

If you’ve been drinking heavily for a long time, your body may have developed a tolerance to alcohol, meaning you need more alcohol to feel the same effects. Over time, this can lead to physical dependence, where stopping or reducing alcohol intake leads to withdrawal symptoms.

Dr. Joseph Volpicelli, a leading researcher in naltrexone and addiction treatment, explains:

"If you drink large amounts of alcohol daily, your body may have adapted, making withdrawal symptoms like tremors, sweating, and anxiety more noticeable. In these cases, detoxification may be necessary before naltrexone can work effectively."

💡 Solution: If you are experiencing withdrawal symptoms, consult a doctor about medically supervised detox options. Some people find that once detox is complete, naltrexone becomes far more effective in helping reduce drinking urges.

5. Side Effects Preventing Consistent Use

For some people, naltrexone causes side effects such as nausea, fatigue, or headaches. While these often subside over time, they can discourage people from continuing the medication.

One surprising fact? Most naltrexone tablets contain lactose, which can cause stomach upset in people who are lactose intolerant.

Brian Noonan shares:

"If you’re lactose intolerant, the inactive ingredient in naltrexone could be triggering GI discomfort. Switching to a compounded lactose-free version may resolve this issue."

💡 Solution: If side effects persist, try taking naltrexone with food, talking to your doctor about reducing the dose (some people start with 25mg or even 12.5mg), or asking your doctor about a compounded version.

6. Combining Naltrexone with Support

While naltrexone can be effective on its own, it often works best when paired with additional support. Behavioral therapy, coaching, or structured guidance can help reinforce new drinking patterns and increase long-term success.

💡 Solution: Consider working with a doctor, addiction specialist, or support program to maximize naltrexone’s benefits.

Final Thoughts

If naltrexone isn’t working for you, don’t give up! Often, small adjustments in how, when, and why you take the medication can make a big difference. Working with a knowledgeable doctor or TSM specialist can help ensure you’re using it effectively.

For more guidance on how to succeed with naltrexone, check out our Thrive Membership program, where we offer expert support, resources, and a community of people on the same journey.

Medical Disclaimer: This content is not for medical advice, diagnosis, or treatment. Consult a healthcare professional for any medical concerns. Do not ignore or delay seeking medical advice based on what you read here.