Addiction
The Science Behind Recovery: Let's Talk About Naltrexone
A safe, effective addiction treatment exists, but most never hear of it.
Posted April 10, 2025 Reviewed by Gary Drevitch
Key points
- Naltrexone is a safe, affordable, and effective treatment for alcohol and opioid use disorders.
- It blocks the brain’s reward response, reducing cravings and helping people cut back or quit more easily.
- Stigma, limited awareness, and lack of training hinder use, though it's easy to prescribe and well tolerated.
If you’ve followed any health news lately, you’ve likely heard about Ozempic and similar drugs. GLP-1 medications, originally developed to treat diabetes, have gained widespread attention for their ability to support weight loss by curbing hunger and cravings. Researchers are even exploring GLP-1s for conditions beyond diabetes and weight loss—like heart disease and substance use disorders—because of their potential to reduce the drive to consume addictive substances. Weekly, dozens of articles highlight their promise in addiction treatment.
But as excitement builds around what’s next, we risk overlooking what’s already here. For decades, a safe, affordable, and effective treatment for addiction has existed, yet it remains largely underused: naltrexone.
What Is Naltrexone?
First developed 60 years ago, naltrexone is a once-daily pill (or monthly injection) that is approved by the FDA to treat both alcohol use disorders (AUDs) and opioid use disorders (OUDs). It works by targeting the brain’s opioid system, a key part of the reward pathway that makes alcohol and opioids feel rewarding. When someone drinks or uses drugs, the brain releases chemicals like dopamine, which produce feelings of pleasure and reduce both physical and emotional discomfort. Naltrexone blocks these effects, dulling the sense of reward that comes from substance use. For someone who drinks, that means the usual pleasure or “buzz” from alcohol is dampened. For someone who uses opioids, naltrexone, which is an opioid “antagonist,” prevents the high entirely. By taking away the reward, the urge to drink or use can be significantly reduced. Over time, alcohol or opioids become less pleasurable, and addictive behaviors may begin to fade.
Importantly, people do not have to be abstinent from alcohol to start taking naltrexone. It can support gradual reduction in alcohol use, making treatment more accessible to those who might not fit into traditional, abstinence-only models. It’s also been shown to reduce binge drinking, which many individuals seek to moderate without necessarily aiming for full sobriety.
Is Naltrexone Effective?
Research has shown that naltrexone can significantly improve outcomes for people with AUD, reducing the chances of returning to heavy drinking. Even when someone does drink, naltrexone helps them drink less and helps prevent potential brief recurrences that could turn into a full return to use. For opioid addiction, naltrexone can be life-saving. By blocking the effects of opioids, it removes the “high,” which can deter use and support ongoing recovery. It can also be a valuable option for individuals who can’t or don’t want to use the other gold-standard opioid-based treatments like methadone or buprenorphine. Each avoided binge, brief recurrence, or full return to use is meaningful, and for many, naltrexone makes those wins possible.
In 2023, the World Health Organization (WHO) added naltrexone to its list of essential medicines for treating AUDs. It’s also recommended as a first-line treatment in clinical guidelines from the American Psychiatric Association (APA) and other professional bodies for alcohol dependence.
The most common side effects are relatively minor – nausea, headache, or fatigue, especially in the first couple of weeks – though they often resolve with time. There’s no risk of addiction with naltrexone, and it doesn’t make people drowsy or impair their ability to function normally. However, it’s important to note that the medication is not appropriate for everyone, including people using opioid pain medications (as it blocks the effects of opioids) and should be used with caution in individuals with severe liver disease.
Why Don’t More People Get This Medication?
Naltrexone has minimal side effects, is well tolerated, and is easy to take. Yet despite its proven benefits, less than 2% of people with AUD receive this medication, even in the most coordinated systems of care. Some studies show prescribing rates as low as 5% during alcohol-related healthcare visits. Meanwhile, an estimated 28.9 million people ages 12 and older had AUD in the past year. So why the disconnect?
One major barrier is stigma, fueled by outdated beliefs that recovery should happen without medications. Patients and even providers may feel that using medication for a SUD is “cheating” or not addressing the “real issue." The reality is that addiction is a complex brain disease, not a moral failing—and there’s no shame in using effective medication to support recovery.
Another challenge is a lack of awareness and training. Many general physicians receive little to no training in addiction medicine. They might not think to offer naltrexone, or may feel uncertain about how to bring it up with a patient. But any licensed prescriber can write for naltrexone—no special waiver or certification is needed. While education efforts are underway, much more needs to be done to equip providers with the tools to talk confidently about medication options.
Patient awareness is another key gap. Many people struggling with alcohol or opioids simply don’t know that a medication like naltrexone exists, let alone that it could help them cut back or stay on track. Public awareness is slowly improving; some headlines have even started referring to naltrexone as the “Ozempic for alcohol” because of its ability to reduce cravings. Catchy comparisons can get people’s attention, but real impact comes when front-line providers routinely bring up the option. When doctors and therapists normalize talking about medication options, patients are much more likely to consider them.
Use the Full Toolbox to Treat Addiction
Everyone who seeks help for addiction deserves access to all the tools that might support their recovery. Therapy, support groups, lifestyle changes, and medications all have a place in that toolbox. Naltrexone is one tool—a powerful one—that should be utilized more widely. It’s not a magic cure (no single treatment is), but it can meaningfully tip the scales in the patient’s favor.
Just as people have embraced new solutions for weight loss and other health challenges, healthcare providers need to embrace existing medications for addiction with the same openness. In the end, the goal is simple: to help people get better. Naltrexone alone won’t solve the addiction crisis, but when it’s part of a comprehensive plan, it can save lives and aid recovery.
