Why Naltrexone May Not Work for Some People

Naltrexone is a powerful tool for changing one’s relationship with alcohol, but it’s not a one-size-fits-all solution. In this article, Dr. Joseph Volpicelli, a leading naltrexone expert, explores why the medication may not work as effectively for certain individuals and offers insights into strategies that can improve success.

Understanding How Naltrexone Works

Naltrexone blocks the euphoric and rewarding effects of alcohol by targeting the brain’s opioid receptors. This diminishes the craving for alcohol, particularly for those who drink to experience its stimulating effects.

“For some, alcohol initially provides an increase in energy, motivation, and sociability,” explains Dr. Volpicelli. “But as the effects wear off, cravings for the next drink can increase, leading to impaired control.”

However, not everyone drinks alcohol for its stimulating effects. This distinction is key to understanding why naltrexone may not work equally well for everyone.

The Role of Sedative Effects in Alcohol Use

While many people drink to feel energized or euphoric, others turn to alcohol for its sedative properties, using it as a way to unwind, manage anxiety, or fall asleep.

“For some people, alcohol’s sedative effects are the main appeal,” says Dr. Volpicelli. “They might drink to calm their nerves, cope with stress, or simply knock themselves out to sleep. Over time, they build tolerance, requiring more alcohol to achieve the same effect.”

Naltrexone primarily addresses the reward pathway associated with alcohol’s stimulating effects. For those who rely on alcohol’s sedative properties, naltrexone may not provide the same level of benefit.

Daily Drinking and Tolerance: A Challenge for Naltrexone

Daily drinkers, especially those who consume large amounts, often drink both for the euphoric effects and to avoid withdrawal symptoms. This combination can make it harder for naltrexone to work effectively without additional support.

“If someone drinks to both get high and stave off withdrawal, their body has adapted to alcohol in multiple ways,” explains Dr. Volpicelli. “For these individuals, detoxification can be an essential first step. It allows the body to reset, making it easier to benefit from naltrexone.”

Detoxification doesn’t always require a hospital stay. Dr. Volpicelli emphasizes the availability of outpatient options using medications like gabapentin or benzodiazepines to ease withdrawal symptoms safely.

Three Types of Drinkers and Their Responses to Naltrexone

Dr. Volpicelli identifies three categories of drinkers:

1. Those who drink for the euphoric effects: Naltrexone works well for these individuals by blocking the brain’s reward response to alcohol.

2. Those who drink for both the euphoria and to avoid withdrawal: These individuals may see slower progress unless withdrawal symptoms are addressed through detoxification.

3. Those who drink solely for the sedative effects: For this group, naltrexone is less effective. Alternative treatments, such as therapy, support groups, and medications targeting anxiety or sleep issues, may be more helpful.

The Importance of Psychosocial Support

Success with naltrexone isn’t just about the medication. Social support, therapy, and learning new coping mechanisms are critical components of recovery. Thrive's program specializes in supporting people using naltrexone to drink less.

“One of the things AA gets right is the value of peer support,” says Dr. Volpicelli. “Having someone to hold you accountable, provide encouragement, and help you navigate challenges is incredibly important.”

Katie, Thrive founder and a participant in the Sinclair Method, shares her experience: “I thought naltrexone would solve everything, but I realized I also needed to develop new coping skills. For me, therapy and building healthier habits made all the difference.”

A New Perspective on Alcohol

For those willing to embrace change, life without excessive drinking can be incredibly rewarding.

“As I started to loosen alcohol’s grip, the whole world opened up,” Katie reflects. “Hiking in nature after a stressful day nourished my soul in ways alcohol never could.”

Dr. Volpicelli underscores this point: “Recovery isn’t about fighting cravings forever. It’s about freedom from the problem and discovering new, fulfilling ways to enjoy life.”

Final Thoughts

Naltrexone is a groundbreaking tool for treating Alcohol Use Disorder, but its effectiveness depends on individual drinking patterns and motivations. For those who don’t see immediate results, understanding the root cause of their drinking and incorporating additional support can make all the difference. Whether it’s detoxification, therapy, or building a support network, there’s hope for everyone to achieve freedom from alcohol’s hold.

“Life without alcohol can be wonderful,” says Dr. Volpicelli. “You just need the right tools and support to get there.”

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.