For individuals who find themselves having one too many during happy hour or a night on the town, there’s a decades-old drug that might help them to drink in moderation.
The medication, naltrexone, has been prescribed since the 1980s to treat people with alcohol use disorder (AUD). It works by blocking endorphins — “feel-good” chemicals in the brain that help produce a happy buzz. The drug is usually taken daily to reduce cravings and make drinking less pleasurable, so it's easier for people to cut back or stop altogether.
Now, a new study suggests that a single dose of naltrexone, taken right before a night out or just as the urge to drink hits, might help people avoid binges and consume less alcohol.
“Targeted use of naltrexone, or taking it on an as-needed basis, can be an important tool for people interested in cutting down their heavy alcohol use,” says lead study author Glenn-Milo Santos, PhD, MPH, a substance use researcher and professor at the University of California San Francisco.
Participants Drank Less Even After Treatment Ended
For the study, researchers asked 120 men with mild to moderate alcohol use disorder who wanted to cut back on binge drinking to take a pill if they felt a craving or planned to drink. Scientists randomly selected half of the men to receive naltrexone to take as needed, while the rest of the men took a placebo. All of the participants also had weekly counseling to help them curb their alcohol use.
After 12 weeks of treatment, the men taking naltrexone as needed had significantly fewer cravings, fewer total days with binge drinking, and fewer total drinks per month, according to study results published in December 2022 in the American Journal of Psychiatry.
Six months after treatment ended, men who had been given naltrexone still saw benefits: They had significantly fewer drinks per month, and fewer binge-drinking days, than the participants who had been given a placebo.
A Desire to Cut Back May Have Helped Participants Drink Less
One limitation to the findings is that people willing to join a clinical trial testing a treatment for binge drinking may have more willingness to reduce their alcohol consumption than might happen with other individuals.
Another limitation of the study is that all of the participants were sexual and gender minority men living in San Francisco, including gay men or men who'd had sex with other men within the past three months. It’s possible that results might differ for people from other backgrounds or communities.
Even so, the results suggest that as-needed naltrexone may provide a flexible treatment approach to people who aren’t interested in complete abstinence but who want to drink less in certain situations like a first date, a work holiday party, or a family gathering, Dr. Santos says.
“This study showed that targeted naltrexone can be helpful for people who binge drink and want to reduce the amount that they drink, even if they do not have severe alcohol use disorder,” Santos adds. “This is important because even modest reductions in alcohol use can have positive health impacts.”
It’s also possible that some people who aren’t willing to take a daily pill might be more open to treatment for problem drinking if they could take a pill on an as-needed basis instead, says Henry Kranzler, MD, an addiction researcher and professor of psychiatry at the University of Pennsylvania Perelman School of Medicine in Philadelphia, who wasn’t involved in the new study.
“For a subgroup of individuals with alcohol use disorder, the appeal of being able to control the dosing and thereby avoid unnecessary drug exposure could encourage them to get treatment,” Dr. Kranzler says.
Significant Barriers to Alcohol Use Disorder Treatment Remain
For most people with alcohol use disorder, however, the main obstacles to treatment have less to do with taking a pill and more to do with stigma related to alcoholism, lack of access to care, or ambivalence about giving up a daily habit, Kranzler says. Another challenge is that many primary care providers aren’t comfortable prescribing naltrexone or treating alcohol use disorder in general, he adds.
If you need treatment and your primary care provider won’t help, you should ask for a referral to an addiction specialist or ask for recommendations for new primary care providers who can help you manage your drinking, Kranzler advises. As-needed treatment may also be easier to get from a provider who has more experience helping people with alcohol use disorder.
“I would not prescribe naltrexone for primary prevention: to prevent someone who is drinking at modest levels from increasing to problematic levels,” Kranzler says. “However, using a medication in early problem drinkers to prevent the development of more severe AUD seems like a good strategy and justifies exposure to the medication.”