I have been trying something new to me called Naltrexone, if you have not heard of it I am not surprised. Google Naltrexone or Claudia Christian Ted Talk. This could be a great help to dealing with cravings.
Hi @happyguy – I’ve been offered this and I’m keen to know what side effects you’ve experienced if any ? Does it take a while to kick in? I’ve googled Naltrexone but get mixed write ups on it …..?? I’ve listened to the TED talk you mention and it seems quite effective …..hhmmm 🤔
Hi @Happyguy Naltrexone is an extremely interesting medication and one that I suspect will become central to most supervised recovery programmes. What I find most interesting is not its use for reducing cravings, that’s not what it was developed to do, but how it can be used to re-train the reward system.
All of what follows is my personal observations and opinions. I am an inquisitive recovered alcoholic, not a medical professional.
When we take our first drink of a session we get a huge “aaahhh!”, a sense of ease and comfort washes through us. It isn’t alcohol that does this… it can’t possibly be as we get this sensation IMMEDIATELY on taking the drink. This is minutes before alcohol actually gets transported to the stomach, absorbed into the bloodstream, passes through the liver, then through the heart before finally getting to the brain. That wave of relaxation and relief is caused by a big burst of a chemical “dopamine” that is released in the brain at the instruction of the “reward system”, and it happens completely automatically.
It is the reward system that induced the craving that lead to us seeking that drink, and it is the reward system that causes the dopamine to be released. But this dopamine does more than just give us that feeling of relief; it also modifies the reward system. The craving begins in response to us being in circumstances that have previously yielded alcohol… a drinking “trigger”, and that particular trigger is modified dependant on whether or not it is successful in delivering alcohol again. If the trigger was successful, we had a drink, then the trigger is made more important (the intensity of the next craving it launches is increased). If there was no alcohol forthcoming from the trigger’s craving then the importance of the trigger is reduced (then next craving from that trigger will be smaller). The reward system uses the dopamine release to detect if the trigger was successful, and this is where naltrexone is so clever. What naltrexone does is it blocks the brain’s ability to detect the presence of the particular variant of dopamine (D2) that is responsible for that sensation of relief. So when we take naltrexone AND THEN DRINK in response to a craving we do not get the rewarding “aaahhh!”… we get nothing because the brain is block from detecting its release. The reward system notes the absence of the rewarding dopamine and determines that the trigger was NOT successful in yielding alcohol, so it reduces its importance… and next craving from that trigger will be smaller.
Cravings are reduced in intensity by denying them, that’s how we take the power over time, but naltrexone fools the brain into thinking the trigger was unsuccessful DESPITE the fact that we actually drank.
Naltrexone does not really prevent cravings, what it does is it makes drinking in response to them an unrewarding experience, and we quite literally lose interest in having a drink. Naltrexone works when we experience a large craving, and then take a small drink… and experience no “reward”. It works by retraining the reward system. For it to work then we have to take naltrexone and then drink a little in response to cravings as they come, and this means using it in a very structured way. It is my expectation that future treatments for addiction will emerge that fully utilize what naltrexone has to offer in a structured learning environment. This would require that we go about deliberately triggering ourselves and then drinking a little to reduce the power of the trigger. We would be exposing ourselves to all the triggers we are going to meet in our normal lives and methodically knocking the power out of them. I haven’t seen any program yet that does this, but I’m sure they will come.
Does using naltrexone like this mean that we carry on happily drinking ourselves stupid? No it doesn’t. If you put a glass of wine (beer/vodka/rum/gin pick your own poison here) in front of an alcoholic on naltrexone then they get a strong craving in response to alcohol being visible and close. But when they take a drink they get no “aaahhh!”, they get nothing at all! All that they get is the taste of the drink… but no desire to have more of it. People taking naltrexone will not normally even finish that one glass in front of them let alone polish off the whole bottle as it lacks any reward in the brain… alcohol becomes uninteresting.
But even though Naltrexone seems like a miracle cure it is not. It is only successful (long-term successful) in about 25% of cases. The remaining 75% is all up to the initial commitment of the individual to stop drinking. Nevertheless the 25% result of naltrexone is still far, far better than the 4% that is general across all other recovery methods.
If you want to understand more about naltrexone then you can look up the Doctor that developed it “J. David Sinclair”.
Hi guys, I’ve read lots about this treatment, THE SINCLAIR METHOD! It’s a strange thing, I know to do this I should drink one hour after Naltrexone, but I just don’t want to. But I have a sip and I’m done . Like Pavlov’s dogs experiments. The goal is to create behaviour extinction. And get the control back.
Heh, makes me recall a time when I haphazardly went to a counselor once, well I did. I think she wanted me to stop drinking more than I did. She suggested I take Naltrexone because when I drank on it, I wouldn’t feel any pleasure from drinking. I thought she was nuts. I mean, so what’s the use in taking it?? Aha.
HI @malibustacey It wouldn’t have worked for you. It will only help people that actually want to stop. If you don’t then at the end of the medication period you will simply carry on drinking again and bring the triggers right back to where they were.