A decades-old drug is helping people drink less alcohol—without giving it up completely
Naltrexone has long been used to treat alcohol use disorder. Now it’s gaining attention as a tool for people who want to cut back on drinking before it becomes a bigger health problem.
Kate Carbonari has been drinking since she was 15 years old. By her early 60s, she began to rethink her relationship with alcohol. “I’ve gone through a lot of different drinking cycles in my life, and I feel like now, finally, as a society, we’re starting to say, ‘What are we doing with this alcohol here? This is so not good for us,’” she says.
Her first step was tracking her intake with an app. On average, she was drinking about 28 drinks a week—an amount her doctor said raised her risk for several health conditions. A few months later, the company behind the app reached out to ask whether she’d be interested in trying naltrexone, a prescription medication that reduces alcohol’s rewarding effects in the brain. Her doctor agreed that the medication could be worth a try—and it was. Today, she’s drinking a max of seven drinks per week and taking at least three full days off per week.
Using naltrexone to cut back on drinking isn’t new, says Sarah Wakeman, a senior medical director for substance use disorder at Mass General Brigham. The approach dates back to the 1980s with the Sinclair method, which pairs drinking with naltrexone to blunt alcohol’s pleasurable effects. In parts of Europe, Wakeman adds, people have long used a “pill-in-the-pocket” strategy, taking the medication only when they anticipate drinking.
In the United States, however, naltrexone remains underused—even among people with alcohol use disorder. “It's in the single-digit percent of people with alcohol use disorder who take it,” Wakeman says. Still, clinicians are beginning to see growing interest among people who don’t meet the criteria for alcohol use disorder but regularly drink above recommended limits—more than 14 drinks per week for men and more than seven drinks per week for women. Direct-to-consumer companies are helping drive that shift by adding naltrexone prescriptions to their offerings.
Here’s why a decades-old medication is drawing new attention, how it works in the brain, and who it may help.
Why naltrexone is gaining new attention
Greater awareness of alcohol’s health risks—even among people who don’t have alcohol use disorder—may help explain why naltrexone is entering new spaces, says Wakeman. Another factor? Many patients who want to cut back aren’t being offered medication options by their doctors, she adds. That gap has opened the door for direct-to-consumer health companies. Sunnyside, for example, offers compounded naltrexone with vitamin B6, along with behavioral tools, to help people reduce their drinking over time.
Cultural shifts may also be playing a role. Consumers have become more comfortable with turning to prescription drugs for off-label uses. Ozempic, for example, is a diabetes medication now widely used off-label for weight loss.
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That comparison has led some to call naltrexone “the Ozempic for alcohol,” says Glenn-Milo Santos, a professor at UCSF Community Health Systems. “I think that’s super easy for the public to understand,” he adds. “It’s like an appetite suppressant for alcohol.” Greater familiarity, he notes, could encourage more people to learn about naltrexone and consider whether it’s appropriate for them.
What naltrexone does to the brain’s reward system
In short, naltrexone works by altering how the brain experiences reward. Alcohol triggers the release of endogenous opioids—chemicals produced by the body that activate the receptors that help create a pleasurable buzz. “[Naltrexone] sticks to the opioid receptors in the brain and blocks them, kind of like a security guard preventing anything from being able to activate those receptors,” says Wakeman.
“It makes drinking less fun or reduces the reward associated with drinking,” says Santos. It also reduces cravings for alcohol, and this combination tends to slow down the rate and volume of drinking.
Still, there are side effects for some, including nausea and headache. Carbonari experienced temporary constipation and some minor sleep disturbances. There are also some contraindications—and it’s important to talk to a medical professional especially if you are pregnant, have liver problems, or are taking any other medications.
Is it safe or effective for “weekend” drinkers?
From a safety standpoint, naltrexone is well studied, says Wakeman. “We have looked at it for many different types of health conditions and [in] many different studies, and it's generally a very safe medication,” Wakeman says. Naltrexone is also approved for managing opioid dependence, and it’s been studied as a tool for binge-eating and even to reduce itching.
Santos says that taking naltrexone in the absence of a true alcohol use disorder is kind of like taking steps to cut back on sugar when you have pre-diabetes, which can be effective. “It's sort of this paradigm shift that recognizes that cutting down heavy drinking is beneficial and addressing this issue before folks develop a severe alcohol use disorder is an important step in terms of interrupting that progression,” he says.
That “preventive mindset” may explain why companies like Sunnyside and Nurx are seeing interest from a much wider range of people, including moderate, “weekend,” and nightly wine drinkers. “As people become more aware of how alcohol affects sleep, mood, energy, and mental health, they’re paying attention earlier and looking for support before things feel like a real problem,” says Nick Allen, Sunnyside co-founder and CEO.
Evidence suggests that approach can work for some people. In 2022, Santos conducted a study that looked at whether naltrexone could be effective for gay men who binge drink but don’t have a severe alcohol use disorder. “We found that it’s an effective approach to help people cut down their alcohol but not necessarily quit,” he says. He points out that many people who drink on the weekend may not fall on the alcohol use disorder spectrum, but they do binge drink, which comes with its own dangers.
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The study also tested an as-needed approach. Instead of taking naltrexone daily, participants were instructed to use it in anticipation of drinking or when cravings hit. “We found that naltrexone significantly reduced the number of binge drinking days, the number of any weeks with binge drinking, the number of drinks during drinking days, and also significantly reduced craving for alcohol,” Santos says. Sixth months later, participants still had lower rates of binge drinking compared to those in the placebo group, “suggesting that there's a long-term and durable benefit.”
That said, naltrexone isn’t for everyone. “You never want to take a medicine if you don’t need it,” she says.
Still, Allen points to a customer who was drinking around 10 to 15 drinks per week but who felt alcohol was taking up more mental space than he wanted. After starting naltrexone, he cut back to closer to five drinks per week and thinks about drinking far less, while still enjoying it socially when it feels right.
The double-edged sword of easier access
One advantage of direct-to-consumer prescribing, says Santos, is reach. “By providing multiple ways for people to access this treatment option, we’re able to offer different tools to people to cut down their drinking sooner before they actually reach that severe use disorder stage,” he says. “For some people, it could be beneficial because they might not seek treatment from their primary care provider, but if they feel more comfortable seeking a prescription from a different platform, and I think that we should meet people where they’re at.”
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Still, Wakemans says one concern is that some DTC companies may bypass some of the aspects of holistic healthcare that are important: “Naltrexone is one of the tools that we have to help people, but not the only [one], and best case scenario, you're partnering with a doctor that you trust and actually working on this like you would with any other health condition,” Wakeman says.
Wakeman says that in an ideal world, people should talk to their physician if they‘re concerned about their alcohol use. Naltrexone can be a great tool for many more people than are currently using it, she says, but there are also other options—medications and otherwise—available. Carbonari says she still experiences cravings and attributes her overall success to behavioral tools as much as the medication. Because at the end of the day, “this is a health behavior, much like diabetes and other things, and we absolutely have tools to help,” Wakeman says.
