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I didn’t learn about a medication called Naltrexone until well after I’d gotten sober, which is…really annoying. The drug was first approved in 1984 as an opioid antagonist (so it would block the effects of opioids) for people with opioid use disorder. Eleven years later, the FDA approved it as one of the few pharmacological treatments for alcohol use disorder (then called alcoholism).
I’ve sat through thousands of AA meetings where someone reads from the chapter in AA’s Big Book, More About Alcoholism, specifically the following lines: “Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.”
Even then, when I was deep in AA and pretty serene about the whole thing, I’d still take a few seconds to fantasize about that magic alcoholic transformed into a “normal” drinker pill. We can put a man on the moon! We can’t turn an alcoholic back into a normal drinker?! Get it together, NASA.
So, I was well into sobriety when I learned about Naltrexone and—even more exciting than its mere existence—the studies (and anecdotal reports) that suggested it was effective at helping reduce alcohol cravings. Some people stop drinking entirely, while others cut back. But it’s well tolerated, has a great safety profile, and…I want to know what it’s like!
My very good friend, who has asked that I give him the pseudonym Diego, started taking Naltrexone about three weeks ago. I asked him a few questions about his experience thus far.
This is the first AASL Q&A; a format some readers who took the newsletter survey said they’d be interested in seeing more of. Please take a read and let me know if this is the kind of thing you’d like me to add to the mix. All other suggestions and questions are, as always, very welcome.
Katie: How would you describe your alcohol use before starting Naltrexone? If you had to guess, how many drinks were you having per day or week?
Diego: By the time I got on Naltrexone, I had gone up from drinking maybe twice a week to 3-4 times a week. The biggest problem was that I would go to a bar, have a beer and a shot, and by the time I left, I had had about 6-10 beer & shot combos.
K: Had you tried to cut back or stop drinking before starting medication? If so, what did that look like?
D: Not in any meaningful way. When I went out to drink, I would still drink pretty hard. I started trying to do things that weren’t bar-related. The biggest obstacles were 1) I am on stimulants for ADHD that make me really want to drink by the end of the day, and 2) I stopped working from home, so leaving the office, I’d be inundated with dozens of bars with enticing happy hour specials.
K: Did you or your doctor raise the subject of Naltrexone? If you did, what prompted you to do so?
D: I got a new primary care physician, and she raised the idea of medicines for weight loss. In the course of the physical, she asked how much I drank, and I kinda brought up that I’ve been concerned with my lack of self-control when I do drink. She used that as an opportunity to suggest naltrexone could turn out to be a two birds with one stone situation.
K: Did you have any concerns before starting? If so, what were they?
D: I have a bad stomach, and I haven’t been on a single medicine that’s good for me that hasn’t made me feel like I’m getting stabbed in the gut. It turns out that wasn’t a problem. I also really wasn’t sure if I was ready to full-on quit drinking, but the doctor assured me, “You can still drink on this, you just may not want to as much.”
K: How long have you been taking it?
D: It’s been 3 weeks since I started.
K: Have you felt a difference?
D: I started feeling a difference by the second day of taking it.
K: What did that feel like?
D: I started the medication on a Wednesday. That Friday, I had an extremely long and stressful day at work. By the time I left work, the sun was setting, and it was a beautiful evening – at any other point in my life, I’d find a bar with big open windows and spend the evening exchanging my full paycheck for booze. I instead went to dinner and ordered a Sam Adams with my entree, and spent about 40 minutes sipping it slowly. When the waitress asked if I wanted another, I said no before I even thought about how I didn’t want another drink. I walked right past my favorite bar on the way home and had no interest in going inside.
Early on, it felt as close to a miracle drug as I’ve ever felt. The change wasn’t dramatic; I didn’t feel like anything had been taken from me or like I had lost any part of myself. I just…didn’t want to drink as much. I didn’t want to binge drink that night, and frankly, I didn’t even feel like casually drinking.
K: Has the effect fluctuated over the time you’ve been taking it?
D: I went to a baseball game with friends last weekend, and I had one beer. I wasn’t planning on having another, but my friend surprised me with a second beer. I drank it and by the end felt like I could go out drinking—the idea was more appealing to me than it had been before the second beer. We went to a bar after the game, but I didn’t drink anything and left pretty early. So I feel like the potential for binge drinking is still there—I don’t think the pill is like 100% inoculation against that—it just makes it seem much less appealing (and easier to follow through on going home instead).
K: On average, how much would you say you drink per week compared to before starting it?
D: At the time I started the medication, I could have between 36-40 drinks a week. In the three weeks since I started, I’ve had fewer than 10 drinks total.
[Katie’s note: going from 36-40 drinks in a week to ~three drinks per week is incredible. Can we take a second to appreciate how huge that difference is??]
K: Have you paired naltrexone with any other intervention, like a support group?
D: Not yet, but my doctor has given me lots of resources I can try if I feel like the pill alone isn’t working.
K: Have you had any unexpected reactions to the medication?
I don’t think it’s going to work as a weight loss drug, because since I’ve trimmed down on drinking, my sweet tooth has gone absolutely bonkers. I went to the movies just to get an extra large Cherry Coke. I didn’t even stay for the movie. I’ve bought more Snapple and candy in the past few weeks than my Amazon account knows what to do about.
K: Do you think you will stay on it for the foreseeable future?
D: Yes. Seeing how much I’ve slowed down has been the starkest way to see how out of control my drinking was getting. Even if I feel like it’s not doing all the heavy lifting for me like it was at the beginning, it feels like this pill has been a real asset in this fight.
K: Is there anything else you want to say about this that I didn’t ask?
D: For months, I felt like I should maybe try to get sober, but I didn’t want to lose bar life and drinking culture. It felt so extreme. But this has been a really, really good middle ground for me, so if you’re unhappy with your alcohol intake, I’d strongly encourage a conversation with your doctor. This turned out to be a lot less scary than I imagined. And maybe use some of your saved cash from the bar to become a paid subscriber to Ask A Sober Lady (Katie did not ask me to say that, and she’s probably embarrassed by this, but this newsletter has been a huge help in getting some clarity around my drinking!)
[I did not ask him to say that, and I am embarrassed, but…a good idea is a good idea.]
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I’m not a doctor or mental health professional, so my advice shouldn’t be construed as medical or therapeutic. You are free to take or leave it.
I like this Q&A addition. Also, the Parks meme
I wasn’t aware Naltrexone could be used to curb cravings for alcohol. Thanks Katie (and Diego) for the interview!