How Long Should I Stay On Naltrexone?

Naltrexone is a medication that can help people drink less or quit drinking completely. It is one of the most effective tools available to help people recover from alcohol use disorder. But how long should patients continue using the medication?

In general, doctors recommend taking naltrexone for at least one year if it is helping. They also recommend giving it at least three months to see if it works for you.

But there is no one-size-fits-all answer. Your goals, progress and personal preferences matter.

Let’s unpack it.

How long should I stay on naltrexone if it doesn’t seem to be helping?

Don’t stop too quickly. Experts say to try naltrexone for at least three months before deciding it isn’t helping.

Many people notice an immediate change in how much they are drinking, how strong their cravings are, and how easy it is to meet their moderation or sobriety goals. But plenty of others find that it takes a while for naltrexone to work for them.

Naltrexone’s full benefits often take time to show up because of the way that naltrexone works. The medication blocks receptors in the brain, making alcohol less rewarding. This blockade can have immediate effects, like fewer cravings and less binge drinking. But it also means that over time, the association between alcohol and reward is getting weaker, making it easier to resist alcohol’s allure and meet sobriety or moderation goals. Over time, your brain can “unlearn” the habit of drinking excessively.

If your drinking doesn’t change right away, you don’t have to sit around waiting for naltrexone to do all the work. Naltrexone, like many medications, should be part of an overall behavior change strategy. There are several proactive things you can do:

• Take your medication consistently: it may sound obvious, but taking naltrexone every day can make a big difference. Oar Health members who take their medication every day are twice as likely to report they are meeting their drinking goals. Advocates for
• Set specific goals: for example, reducing your weekly drinks, increasing your alcohol-free days, avoiding heavy drinking (defined as five or more drinks on any day or 15 or more per week for men and four or more on any day or eight or more drinks per week for women)
• Track your drinking: track total drinks and alcohol-free days. Keep an objective record, celebrate progress, and try to learn from setbacks
• Consider new goals: even if moderation is your long term goal, would 30 days of sobriety help you to reset your relationship with alcohol?
• Add new healthy habits: what can you say “yes” or “more” to when you’re saying “no” or “less” to alcohol? The list of activities that activate natural, healthy reward pathways is almost endless. But activities that involve movement, getting outside, connecting with others (in ways that don’t revolve around alcohol), and doing things that help other people or animals are great places to start.

Layer on support: taking naltrexone as prescribed is complementary to, not competitive with, other forms of evidence-based treatment. Consider attending a mutual peer support group meeting through Alcoholics Anonymous, SMART Recovery or Moderation Management. Oar Health’s team hosts a SMART Recovery meeting every Sunday. Or, connect with a behavioral health professional like a therapist, counselor or coach. Oar Health members have access to unlimited coaching from National Board-certified health and wellness coaches as part of their membership.

How long should I stay on naltrexone if I’m meeting my goals?

Experts recommend continuing treatment with naltrexone for at least one year if it is helping. Many successful patients use naltrexone for multiple years or even indefinitely.

Research and clinical practice both indicate that longer-term treatment leads to better results, in particular a lower risk of relapse. It’s also common sense. Most of us did not develop problematic alcohol use patterns overnight. Consistent treatment over a sustained period of time helps to rewire our brains, heal our bodies, and establish healthier habits.

Stopping treatment with naltrexone is not one-size-fits-all. Some people continue taking naltrexone as a maintenance medication indefinitely. This is considered safe and appropriate for most people. Others have the goal of maintaining a healthier relationship with alcohol (or none at all) without medication. That’s okay too.

Shared decision-making with a healthcare professional (such as your Oar Health medical provider) is the best way to determine how long you should stay on naltrexone. Here are some questions that you and your healthcare professional may consider to make the best decision for you:

• How consistently and reliably are you meeting your goal, whether it is moderation or sobriety? Do you have several months of success under your belt? 
• Does meeting your goals feel like it’s routine or is it still a frequent struggle? The basic rule of thumb is that the more consistent and durable your progress, the more logical to see what maintaining that progress without medication feels like.
• If your goal is moderation or you plan to drink occasionally, would it be helpful to continue treatment indefinitely? Or to take naltrexone on a targeted, as-needed basis as a step down from taking it every day?
• Is naltrexone proving helpful with any other health goals, such as quitting tobacco use or weight loss? Or, conversely, causing side effects that are no longer outweighed by the benefits?

Stopping naltrexone does not need to be an all-or-nothing, lifelong decision. Some people stop taking naltrexone every day, but keep a supply of unexpired medication on hand to use in high-risk situations or when they know they will be drinking.

Others take a break from the medication, but keep an eye on their drinking, knowing they can return the medication to their toolkit if they start to see slippage or if meeting their goals is starting to feel harder. At Oar Health, we make it easy to reconnect with a medical provider and restart treatment at any time.

For those following The Sinclair Method, its “golden rule” of taking naltrexone at least one hour before every drinking occasion provides clear guidance to continue taking naltrexone as-needed. People following TSM may take naltrexone for several years or indefinitely even as drinking occasions become less and less frequent.

Bottom line

Keep taking naltrexone as long as it helps you meet your goals. At least three months to see if it works and a year or more if it’s helping. Work with your doctor to adjust your plan.

We believe that every person changing their relationship with alcohol has the right and the responsibility to assemble the recovery toolkit that fits them. It is natural and appropriate to increase the intensity of support during tough times and decrease it when things are going well. 

Medication may be a crucial tool at some times and a backup plan at others. We’re always here to advise and support you in your unique journey to take back control over alcohol.