PART 3: BREAKING THE CHAIN
Continued Options for Alcohol Abuse Treatment
Written By: Dr. Rodney C. Brunson
Published on April 3, 2025
FDA APPROVED - NALTREXONE (REVIA IN PILL FORM ) and VIVITROL(A LONG ACTING NALTREXONE IN A MONTHLY INJECTABLE FORM)
“The Sinclair Method”. John David Sinclair, MD, Journal Article Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Roy Eskarpa, PhD . The Cure For Alcoholism. NIH: national Library of Medicine. Incorporating Alcohol Pharmacotherapies Into Medical Practice.
Naltrexone is FDA approved for the treatment of AUD (alcohol use disorder formerly known as alcoholism ) Discussed above. It has been a medication used for AUD since 1994. It is prescribed to lower the rewarding (the liking) and the craving (the wanting) effects of alcohol caused by the feel good chemical that the brain releases in the blood - Dopamine. Using certain methods of taking it, it is more than 70% effective in extinguishing the uncontrolled use of alcohol ( David Sinclair: The Sinclair Method ).
HISTORY: Naltrexone was first developed to treat SUD (or addiction) involving Opioids (heroin, morphine, and oxycodone. This was in 1984. It was studied in the 1980’s for alcohol addiction where it was shown to decrease alcohol consumption in rats. These studies were followed by human studies and confirmed to be effective along with psychosocial therapy. Scientists showed that it decreased or reduced the consumption of alcohol, the cravings for alcohol, and the relapse rates for alcohol use. Naltrexone was rebranded as REVIA (oral form). The feel good feeling one gets from alcohol is known to result from the bodies production to opioids. Revia (naltrexone) blocks this reaction in the body leading to a far lesser reward from drinking alcohol. It is like eating sweets but not experiencing the sweetness or like riding a bicycle with two flat tires (not a rewarding experiences).
Naltrexone can work rapidly in the body, (from one to two hours after ingesting the pill but may last around 12 hours.) It is effective for, as mentioned, reducing the craving and enhancing a patients ability to abstain from drinking and by reducing the amount of drinking. Again it showed lowered relapse rates during active use of naltrexone and after having stopped the naltrexone. Further, for people who binge drink, naltrexone lowered the number of drinks consumed per day and also prevented one from falling into a full relapse. Naltrexone can cause liver toxicity and the liver should be looked at closely for liver damage through its use. If liver damage has already occurred naltrexone should probably not be used ( particularly in large doses. There is a warning to be careful or to monitor liver function if prescribed.
How to take it: Naltrexone works better if there are no signs or symptoms of acute withdrawal, the withdrawal symptoms should have subsided. There should be from 3 to 7 days of abstinence. It can be taken if actively drinking or under medical supervision Naltrexone comes in pill form or injectable form. Pill form is taken at least daily where the injection form is taken monthly (vivitrol). Doses can be given as low as 2 mg but the average dose is from 25 to 50 mg daily. It may take two weeks to reach the 50 mg dose which is the average maintenance dose. SIDE EFFECTS are mild with naltrexone mostly causing nausea or sedation. This is related to timing of the dose mostly. There are no worries about abuse of naltrexone.
WHO SHOULD NOT TAKE NALTREXONE. Persons who are taking opioids ( Suboxone, Methadone ) or opioids for pain in general. Those who are undergoing withdrawal from opioids. Hepatitis or liver failure. Those who will have to take opioids in the near future. Not recommended for adolescents. Carefully consider if pregnant.
WHO SHOULD TAKE NALTREXONE? ANYONE WHO WISHES TO STOP DRINKING ALCOHOL AND WHO ARE NOT TAKING OPIOIDS, WHO ARE ACTIVELY UNDERGOING DETOXIFICATION FROM OPIOIDS OR HAVE LIVER FAILURE OR HEPATITIS. USE WITH CAUTION IF PREGNANT
“PATIENTS PRESENT TO ME LOOKNG FOR ANSWERS WITH QUESTIONS ON THE TREATMENT OF ALCOHOLISM /AUD. THEY MAY PRESENT CONVINCED THAT THEY ABSOLUTELY ARE OPPOSED TO EVER DRINKING AGAIN once they stop. THEY WONDER IF IT IS TRUE THAT THIER ALCOHOL DRINKING PROBLEM CAN BE CURED WITH THE HELP OF A DAILY PILL OR A MONTHLY INJECTION. “DOC WILL NALTREXONE (REVIA OR VIVITROL) HELP ME STOP DRINKING TOO MUCH OR HELP MY ADDICTION TO ALCOHOL WITHOUT GETTING HOOKED ON NALTREXONE IT? CAN THIS TREATMENT TRULY BE THE END OF MY ADDICTION? (SEE SINCLAIR METHOD)? HOW LONG CAN I TAKE IT? CAN IT BE TAKEN FOR AS LONG AS I WANT OR NEED IT? “. THE ANSWER TO ALL OF THESE QUESTIONS IS A RESOUNDING YES. NALTREXONE IS AN EXCELLENT CHOICE FOR THOSE WHO WANT TO REDUCE THE AMOUNT OF ALCOHOL INTAKE OR TO EXTINGUISH THEIR USE OF ALCOHOL IF THAT IS THE GOAL. DR. RODNEY CLAY BRUNSON, DO,FASAM OSTEOPATHIC PHYSICIAN AND SURGEON ******** AN OSTEOPATHIC PHYSICIAN IS A DOCTOR OF OSTEOPATHY (D.O.) AND IS ONE OF THE TWO TYPES OF PHYSICIANS LICENSED TO PRACTICE MEDICINE AND SURGERY IN THE WESTERN HEMISPHERE. DO’S ARE FULLY QUALIFIED PHYSICIANS LICENSED TO PRESCRIBE MEDICINE AND PERFORM SURGERY IN ALL 50 STATES
********YOU MAY FIND A DO IN ALL SPECIALITIES INCLUDING ADDICTION MEDICINE “WHAT WOULD YOU SAY IF I TOLD YOU THAT I KNOW A WAY OF TAKING THE FUN OUT OF DRINKING”? IT WOULD BE LIKE EATING ICE CREAM WITHOUT THE SWEETNESS. OR LIKE TAKING THE EXHILARATION OUT OF DOWNHILL SNOW SKIING”.
Alcoholism can and does affect all of us. It has affected my life indirectly and everyone that I know (and in a negative way at that) I do not have or have not had a personal problem with drinking alcohol but many of family members do. They have an abnormal relationship with alcohol. In American families in general may have relatives, aunts and uncles, who may have passed away from alcohol use physical complications. We all have community members, friends, you name it, who could not control alcohol consumption. Many are embarrassed to even talk about their drinking problem, or embarresed to admit to a drinking problem Quite often they receive complaints that they are drinking too much and should stop. “STOP you say? Just stop? Only if it was so easy to “just stop.”Some may say this is a moral failing. AUD is a problem far beyond ones conscious control.
But what if one makes a conscious decision to change voluntarily. Can it be done? Yes it can.
Just by taking one little pill it could be the end of your alcohol addiction. Dr. John David Sinclair found out that it was possible to cure alcoholism. His experimentation with rats using “Naltrexone” proved exactly that. “How to cure society from the ravages of alcohol. He developed a method to cure alcoholism. Dr. Sinclair used rats in his laboratory as his subjects. He wanted to see if they could be taught to stop drinking. He gave the rats several different types of pills before coming across one that did just. Simplifying the process he addicted the rats to alcohol then deprived them of the alcohol for a while. Predictably the rats began to exhibit hyperactive behavior (a symptom of withdrawal). He then gave them alcohol again which calmed them down. However he noticed that the rats would consume far more alcohol in a shorter period of time than ever observed before. This deprivation effect can be observed in humans as well and is known as withdrawal and then binge drinking. We humans are supposedly much smarter than rats so we figured out that if we binge or drink excessively we get hangovers, the shakes, irritable so we drink and if we return to drinking the symptoms will go away. Boy are we smart. Problem is that we didn’t realize that if we repeated this process over and over again pretty soon we develop a habit of needing the alcohol to just feel normal as we felt before beginning to drink in the first place. Well thank you Dr. Sinclair for developing a method to break this chain of events. He surmised that the drive to consume alcohol in the first place can become extinguished leading to very low or no alcohol consumption. By using an anti opioid medication he could block the euphoria of alcohol use, that is Naltrexone. It is a prescribed medication that can be used to STOP or to at least significantly “cut down” on the amount of alcohol consumed.
We know nearly exactly how it works. It works in the brain on special cells in certain areas of the brain.
HOW NALTREXONE CHANGES YOUR MIND ABOUT DRINKING
Alcohol works on the brain to cause one to feel good or euphoric after drinking. Who doesn’t like to feel good? Instead of missing out on all the fun we join in with the use the universal social lubricant, alcohol. It is this fun time or feel good helper that causes us to continue to drink when we should stop (liking food getting full and pushing there plate away). But if the effects of the alcohol, or euphoria, is extinguished, that is we do not get the reward then what is the use of drinking in the first place. Dr. Sinclair found that the fun part of drinking can be extinguished with a pill - Naltrexone If taken before drinking alcohol one doesn’t get the feel good sensations ( dopamine effect ) the reward. The blocking effect or the extinguishing effect of the reward from drinking works. As long as a person takes the pill naltrexone or receives the injection the effect lasts.
Naltrexone is safe and is effective so much that the FDA approved it for the treatment of alcoholism in 1994.
“There is now a cure in the treatment of alcoholism. Alcoholism can now be CURED”.
Doctors can treat this disease successfully right in the office with a very inexpensive medication.
EXPERIMENTAL - RESEARCH STAGE. CUTTING EDGE MEDICATIONS LIKELY TO BE FUTURE TREATMENTS
SEMIGLUTIDE. WEGOVY. TRULICITY. LIRAGLUTIDE. LIXISENATIDE. OZEMPIC. RYBELSUS.
A NAME FOR TREATING ADDICTIONS WITH WEIGHT LOSS MEDICATIONS, GLP 1 AGONISTS, COULD BE “ NEUROBALANCE THERAPY.”
GLP 1 AGONISTS FOR ALCOHOL, OPIOIDS AND STIMULANTS OR GLP - Therapy for Addiction (GTA)
GLP - 1 receptor agonists, are the next cutting edge discovery for treatment of addiction. GLP 1’s were originally developed to treat type 2 diabetes and obesity. They are now being intensely studied to use to treat addiction. You probably are familiar with the names of some of them: Ozempic, Wegovy, Saxenda and Victoza. That list is expected to grow. The generic names are Semiglutide and Liraglutide. They all work by mimicking the appetite hormone which regulate blood glucose and appetite. Anecdotal (patient testimonials) evidence that which is reported by patients and found in rat and primate research have found that these medications also may reduce cravings and addiction related to substances like alcohol, nicotine, opioids, and of course food. Lets talk about How GLP 1 may help with addictions.
GLP 1 agonists uses for addictions. These medications not only help with food addictions but also have been shown experimentally to help with other addictions. Shown scientifically in mice, rat and primate studies two studies so far but also anecdotally ( testimonials ) in patients who have AUD and obesity. So far it has been tested in obese individuals who use GLP 1 medications. GLP 1 affects Dopamine in the brain and body ( dopamine is a hormone and neurotransmitter) it acts in the brain as the chemical responsible for reward and motivation. Its release at times is related to the calories in foods and alcohol. GLP 1 agonist cause addictive substances to give less of a reward thereby leading to less compulsive use of addictive substances like alcohol. Cravings and alcohol consumption are lessened by preventing overconsumption and binging. How do we know this is true? Because food addictions share the same neural pathways as alcohol addictions. Keep in mind that GLP 1 for addictions to alcohol has not been approved but the FDA. They have potential side effects and may not work for all types of addictions. Although not common, GLP 1 may be used off label.
Non FDA approved Medications
GLP 1 agonist
Topiramate
Varenicline
Zonisamide
Topiramate