From the Guidelines
Naloxone is not approved for the treatment of alcohol abuse in remission. Naloxone is an opioid antagonist primarily used to reverse opioid overdoses by blocking opioid receptors 1. For alcohol use disorder in remission, FDA-approved medications include naltrexone (oral or injectable), acamprosate, and disulfiram. Naltrexone, which is related to naloxone but longer-acting, is specifically approved for alcohol dependence and works by blocking opioid receptors involved in alcohol's rewarding effects, reducing cravings and the pleasure associated with drinking.
Key Points to Consider
- The typical oral dose of naltrexone is 50 mg daily, while the injectable form (Vivitrol) is administered as 380 mg monthly.
- Acamprosate helps restore brain chemical balance disrupted by chronic alcohol use, while disulfiram creates unpleasant reactions when alcohol is consumed.
- These medications are most effective when combined with counseling and support groups.
- Patients in remission should work with healthcare providers to determine the most appropriate medication based on their specific situation, medical history, and recovery goals. According to the American College of Physicians position paper, substance use disorder should be accepted by healthcare practitioners, insurers, and employers as a chronic condition and illness, rather than a character weakness 1. The Surgeon General's report on addiction also emphasizes the importance of evidence-based prevention programs, approaches to screening, diagnosis, and treatment of substance use disorders, and recovery models 1.
Treatment Approaches
- Behavioral therapies, medication-assisted therapies, and peer support/12-step fellowship approaches have shown at least some degree of effectiveness in the treatment of substance use disorder.
- Evidence-based medication-assisted therapy approaches are available for the treatment of opioid use disorder, tobacco, and alcohol.
- The opioid antagonist naloxone is not a treatment for opioid use disorder but is highly effective for reversing acute opioid overdose 1.
From the Research
Naloxone Use for Alcohol Abuse in Remission
- There is no direct evidence to support the use of naloxone for alcohol abuse in remission 2, 3, 4, 5, 6.
- Naloxone is primarily used as an opioid antidote, and its use is not approved for alcohol abuse treatment 4, 5, 6.
- The studies provided focus on the use of naltrexone, not naloxone, for the treatment of alcohol dependence 2, 3.
- Naltrexone is an opioid antagonist that has been shown to reduce relapse and heavy drinking in alcohol-dependent patients 2, 3.
- There is no evidence to suggest that naloxone is effective or approved for use in alcohol abuse treatment, including in remission 2, 3, 4, 5, 6.