Substance guides
Naltrexone for alcohol: How it reduces cravings
Naltrexone is one of three FDA-approved medications for alcohol use disorder and one of the most effective tools available for reducing drinking.
How it works
Naltrexone blocks opioid receptors, which are involved in the pleasurable effects of alcohol. With naltrexone on board, alcohol produces less pleasure, reducing the reinforcement that drives continued drinking. Over time, this weakens the learned association between alcohol and reward.
Dosing options
Daily oral naltrexone (50mg tablet): taken every day regardless of drinking. The Sinclair Method: naltrexone taken specifically 1 hour before drinking (targeted pharmacological extinction). Vivitrol injection: 380mg monthly injection for those who prefer not to take daily pills or have adherence challenges.
The Sinclair Method
TSM uses naltrexone only before drinking sessions, allowing the brain to gradually unlearn the alcohol-reward association through pharmacological extinction. Studies show 78% reduction in drinking over 3-4 months. Some people achieve complete abstinence; others achieve controlled, non-problematic drinking.
Side effects
Nausea (usually resolves within a week), headache, fatigue, and reduced appetite. Starting at half dose for the first week reduces nausea. Cannot be taken with opioid medications.
Frequently asked questions
Does naltrexone work for alcoholism?
What is the Sinclair Method?
Can I drink on naltrexone?
Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.