Of all the types of mental health treatments, substance abuse recovery treatments are always evolving. From therapeutic modalities to medications to assist in recovery, substance abuse treatment is constantly capitalizing on gains in all forms of psychological and medical breakthroughs. Medication-Assisted Treatment (MAT) is a modality of treatment available to individuals with either opiate, tobacco or alcohol use disorders. MAT, in combination with a comprehensive treatment plan including counseling, is highly effective in treating these disorders. This article will provide a review of Naltrexone, a medication approved by the FDA to treat alcohol use disorders.
The use of medications in alcohol treatment began with Disulfiram over 50 years ago. Disulfiram, or Antabuse, comes in pill form and is considered an aversive medication because it makes the individual react negatively to alcohol. The idea was that if the individual experienced an adverse reaction to a substance, they would learn to avoid it. However, there was no assurance that the individual complied with their dosage and little evidence of the medications efficacy in assisting the individual in staying sober. Naltrexone does not work in this manner and, paired with counseling, is considered a viable option for alcohol dependency treatment.
Today, the MAT choice for alcohol use disorder is Naltrexone. In 1994, Naltrexone became the second FDA approved medication for the treatment of alcohol addiction. Naltrexone was first used to treat heroin addiction. The medication’s record of safety and efficacy was, in part, one of the reasons it was approved as a medication for alcoholism. Naltrexone, in combination with counseling, is an effective way to treat alcohol dependence because it decreases the cravings for alcohol.
Naltrexone comes in both pill and injectable form. Naltrexone dosage depends on the form that the individual receives. In pill form, the medication comes in 50 mg form to be taken once daily. The injectable extended release Naltrexone is given once per month and the dosage is 380mg. Low dose naltrexone is used to treat chronic pain conditions like fibromyalgia, multiple sclerosis and chronic fatigue syndrome. However, this treatment is still experimental in nature.
Naltrexone implants are used for polydrug dependence as well as alcohol dependence. The implant, which needs to be surgically placed within the body, releases medication over a sixmonth period. Individuals with this implant seem to have success staying sober and fewer mental health hospitalization. However, studies into the efficacy of Naltrexone are also showing that there may be a very deep connection between genetic coding and how the medication works.
How does Naltrexone work?
Unlike Disulfiram, Naltrexone is a mu-opioid receptor antagonist. Our brain produces natural opioid neurotransmitters to deal with pain. Neurotransmitters are the chemicals that allow our neurons to communicate with one another. The opioid peptides are released in the presence of a painful stimuli to provide an analgesic effect. Pain relief does not mean the pain is treated or reduced – simply put, the individual perceives less pain. Naltrexone works as an antagonist to pain receptors so, in simpler terms, it blocks the analgesic effects of those neurotransmitters. So, the individual does not experience the “pain relief” or the normal euphoric effects of the drugs. It is as if the “high” of alcohol or opiates were removed but the individual is left with the impairment of judgment and lack of coordination. If the individual does not feel drunk or high, then what is the purpose of drinking or using?
Naltrexone’s mechanism of action is not fully understood. Unlike the effects of Disulfuram which produces vomiting or physical discomfort after using alcohol, the resulting effects of using Naltrexone are subject to the veracity of the individual. They report not being “drunk”. The actual measurement of Naltrexone is hypothesized to work as an antagonist based on the reports of those tested. The research in this area reports a decrease not only of cravings, but also in the value of alcohol for the individual. If the alcohol can not provide the euphoric or sedative effects that the person craves, the value of the substance decreases.
There is a possibility of hepatotoxicity, or liver issues, which can arise if the individual receives larger doses of Naltrexone. Naltrexone should not be taken by individuals with known liver issues such as hepatitis or cirrhosis. Individuals who are prescribed this medication should have regular blood tests checking their liver functioning.
Naltrexone Weight Loss
Naltrexone Bupropion is a recent development of medications being used to treat chronic weight management issues. Low dose Naltrexone (LDN) is being used to treat weight issues but there are not clear indications of its efficacy for this purpose. Naltrexone weight loss seems to be working on different mechanisms in obesity such as appetite, insulin resistance, thyroid functioning and even sleep patterns. However, with the addition of Bupropion, an antidepressant, this combination seems to impact the reward center of the brain specifically in how it responds to eating. The medication pairs 36 mgs of Naltrexone with 360 mgs of Bupropion and is recommended to be used for weight loss, combined with a reduction of calorie intake and increased physical activity.
Naltrexone is an effective form of Medication-Assisted Treatment. Naltrexone is a viable addition to treatment for those individuals who have difficulty with cravings and frequent relapses. The effectiveness of the medication seems to be predicated on more than just the compliance of the individual. Research findings are showing that the success or failure of this form of alcohol use disorder treatment seems to be predicated on factors such as genetic markers, psycho-social support systems, the drug history of the individual and even the type of substance abuse treatment counseling that is done in conjunction with the medication. Like most medications for drug treatment, the FDA strongly encourages all who prescribe Naltrexone to require their patients to receive substance abuse counseling to address any co-occurring psychological issues, and to deal with any social and behavioral issues associated with their use.
These findings are further proof that drug and alcohol treatment is not “one size fits all”. Moreover, every individual who requires treatment should consult professionals who conduct thorough bio-psychosocial assessments to understand their unique needs and be wary of anyone offering a “sure fire” way of dealing with addictions.