Naltrexone: How Taking a Pill May Help Curb Binge Drinking

People who binge drink may be able to curb their alcohol consumption with a pill that’s already on the market—welcome news, as binge drinking among Americans, particularly during the COVID-19 pandemic, is on the rise.

The drug, naltrexone, is already approved by the U.S. Food and Drug Administration (FDA) to treat alcohol use disorder (AUD) and opioid use disorder (OUD). But new research published in December found that when used occasionally, the pill can also help curb binge drinking in people who were not severely dependent on alcohol.

“Most people who binge drink don’t fall under the criteria for severe alcohol use disorder,” lead study author Glenn-Milo Santos, PhD, MPH, a professor in the Department of Community Health Systems and Division of Prevention Science at the University of California, San Francisco, told Health. “It’s a neglected part of the group who could potentially benefit from this medication.”

Though people who binge drink aren’t dependent on alcohol—and thus, binge drinking isn’t considered quite as serious as alcohol dependence—it still carries the risk of serious injuries and diseases, and is associated with a heightened risk of AUD.

“It’s a big public health issue,” Santos said—and for the 17% of U.S. adults who binge drink, a treatment option like naltrexone may significantly decrease the numerous health risks associated with excessive alcohol use.

Taking Naltrexone Before Drinking Curbs Intake

For the study, published in December in the American Journal of Psychiatry, Santos and his colleagues tested naltrexone’s efficacy against binge drinking in 120 gay and transgender men—all who were interested in reducing their alcohol consumption.

Half of the men received a 50mg dose of naltrexone when they were craving a binge drinking episode or anticipating drinking heavily; the other half received a placebo. All of the men also received once-weekly counseling sessions.

At the end of the 12-week study, the men who received naltrexone reported fewer binge-drinking episodes and less alcohol consumed overall, as compared to those who received placebo. The results were also long-lasting: people who used naltrexone saw reduced drinking patterns for up to six months after treatment.

The drug was also tolerable and safe among the study participants who took it—no serious adverse events were identified with naltrexone use. The most commonly reported side effect was nausea, which is typical with the drug, and resolved as participants adjusted to treatment.

Although the study was conducted on a non-diverse population—only sexual and gender minority men—and their reasons for drinking may be different among this population compared to others, Santos said the way the drug works is the same. 

“That gives us confidence in our ability to hypothesize it would have similar effects on other people who are binge drinkers,” he said. 

How Does Naltrexone Work?

Naltrexone works by reducing the rewarding feeling people feel when drinking alcohol, which can reduce the amount a person wants to drink, said Trent Hall, DO, an addiction medicine specialist and researcher in the Department of Psychiatry and Behavioral Medicine at The Ohio State University Wexner Medical Center.

When a person drinks alcohol, their brain produces dopamine, a feel-good chemical that makes people feel ‘buzzed’ and register being intoxicated as a pleasurable feeling. But naltrexone blocks the dopamine associated with drinking alcohol, which makes the experience less enjoyable.

“It does not prevent you from becoming intoxicated, but the intoxication isn’t as rewarding,” said Dr. Hall, who is also an assistant professor of Psychiatry and Behavioral Health at The Ohio State University College of Medicine, noting that a person may still stumble or slur their words and exhibit other signs of intoxication on the drug.

Expanding Substance Use Care

Naltrexone is already FDA-approved for AUD and OUD—and a similar drug named nalmefene is used in Europe among people trying to reduce drinking. Experts hope that naltrexone will also catch on in the U.S. as a way to curb binge drinking.

“People tend to not seek help for addiction and our reimbursements don’t cover addiction care very well,” Sarah W. Feldstein Ewing, PhD, the Prochaska Endowed Professor of Psychology at the University of Rhode Island, told Health. “Something that can be prescribed in a primary care setting is a great step forward in addiction care.”

According to Santos, people who think they may be able to benefit from naltrexone for binge drinking should speak to a healthcare provider about their needs and concerns about their alcohol intake.

A healthcare provider can then help determine if medication could help and if it’s safe for them to use (naltrexone can have adverse effects when mixed with certain medications, including opioids).

“It’s possible that in the past, folks may not have been interested in taking a daily medication for drinking, especially if they are binge drinking on the weekends but not on the weekdays,” said Santos. “This may be an option they can explore with their provider.”

In an ideal scenario, anyone who is prescribed a psychopharmacological medication like naltrexone would also receive counseling or therapy, said Feldstein Ewing.

“This is actually something that is going to be very helpful for a lot of people who are reluctant to seek help,” she said, noting that while it’s important that people can access naltrexone through their primary doctors now, there still needs to be a shift in how society views substance abuse care.

“As we are making this accessible,” said Feldstein Ewing, “we should also make steps to make behavioral health less stigmatized and more accessible.”