As a music journalist, Erica, a 39-year-old in Queens, New York, is constantly surrounded by alcohol. She says it flows freely at concerts, over drinks with publicists, and on the flights to and from the festivals she covers.
“In the rock ’n’ roll culture that I work in, it becomes very normalized to drink a lot,” she says. “And when that was combined with situations that make me anxious, like interviewing people and traveling alone, I would often ‘pregame’ by having a drink before an event just to feel less nervous,” Erica explains.
While she never got to the point where she believed she was addicted to alcohol, Erica was drinking not only at work events, where she says she would usually have around four drinks, but whenever she wanted to feel better, like after a breakup or when she was particularly stressed at work. She tried being more mindful about her alcohol use—a method that had worked with food when she wanted to lose weight over the pandemic—but she says while tracking her drinking made her more aware of her patterns, it wasn’t helping her cut down as much as she wanted.
“Then, one day I was scrolling TikTok and I saw this woman talking about her experience with naltrexone,” Erica says. “She said she took this pill, then had a drink, and then she just didn’t want to have the second drink. She wasn’t labeling herself as an alcoholic or putting a lot of pressure on herself, she was just taking control over how much she drank, and that really spoke to me.”
Erica got a prescription for naltrexone online, an option that has been growing in the past few years, as more telehealth companies have emerged to offer discreet options for getting AUD meds; more than seven months in, she says her desire to drink has dwindled, and “finishing one drink over the entire night” has become her new standard.
While Erica managed to get her drinking under control before it became a serious health issue, issues with excessive drinking are common—and deadly—in the U.S.: Excessive alcohol use causes an estimated 178,000 deaths a year, making it a leading cause of preventable death. And according to the latest data from the National Survey on Drug Use and Health, more than 25 million Americans age 12 and older have an alcohol use disorder (AUD), defined as an inability to stop or control drinking despite dire consequences to health, relationships, or work life. Yet, according to the same survey, just 2.6% received medication to manage AUD, including naltrexone (the medication most often prescribed), as well as acamprosate and disulfiram.
More than 25 million Americans age 12 and older have alcohol use disorder… just 2.6% receive medication to manage it.
In other words, there is a safe, widely available medication that has the potential to help millions of people cut back or quit drinking entirely, saving lives and keeping families together, but only a tiny fraction of the people who can benefit have actually used it.
However, thanks to both social media and the popularity of another kind of medicine that cuts certain cravings, that may change.
What Exactly Is Naltrexone, and How Does It Work?
Naltrexone was first approved by the FDA in 1984 to treat people with opioid addiction. (It’s related to naloxone, the medication in the nasal spray Narcan, which can reverse an opioid overdose.) The medication is covered by most insurance plans, says Joseph R. Volpicelli, M.D., Ph.D., executive director of the Institute of Addiction Medicine and senior health adviser at Oar Health, a telehealth platform that educates patients and prescribes naltrexone. Any licensed physician, including primary care doctors, psychiatrists, and telehealth providers, can prescribe the medication.
In 1994, after Dr. Volpicelli and other researchers proved that naltrexone could reduce drinking in people who were addicted to alcohol, the FDA approved the drug to treat people with AUD.
Continued research backs up the benefits: A systematic review and meta-analysis published in JAMA in 2023, involving more than 20,000 participants, confirmed that a daily dose of 50 mg of naltrexone can help people with AUD avoid returning to drinking—especially to heavy drinking.
The drug works by blocking one of the pathways in the brain that makes alcohol pleasurable for people, says Sarah Wakeman, M.D., medical director for substance use disorder at Mass General Brigham, and an associate professor of medicine at Harvard Medical School.
“When people drink alcohol, particularly those who have a risk for AUD, there is a release of endogenous opioids [feel-good chemicals produced in the body], which bind to the opioid receptors in the brain,” Wakeman explains. “Naltrexone blocks the opioid receptors, so that even if you drink, you don’t get the same pleasurable effect.”
In other words, you may enjoy the taste of a glass of chardonnay, but you won’t feel compelled to empty the bottle or maybe even refill your glass. “It helps to control the craving, to quiet the noise in your head,” says Dr. Volpicelli. “So you don’t have to think about alcohol all the time and if you have a slip, it doesn’t turn into a full-blown relapse.”
A Pill a Day or Just When You Need It
Dr. Wakeman points out that naltrexone can be a game-changer for people all along the spectrum of unhealthy alcohol use. It is certainly a crucial tool for people with an alcohol addiction: “The hallmarks of AUD are loss of control over your use, despite the consequences, and a mental obsession where you can’t get the idea of having a drink out of your mind,” says Dr. Wakeman.
These were the symptoms Jillian, a 46-year-old in Boston, experienced. She found her alcohol use spiraling after her divorce. “When my marriage ended, I went into a deep depression, and I started drinking quite a bit to cope,” she explains. At one point she was drinking a bottle of vodka a day.
After her doctor warned her that her liver was swollen, Jillian went to Alcoholics Anonymous meetings and worked with a harm-reduction therapist (they help people devise strategies to reduce the negative effects of addiction without requiring them to quit entirely). “Things would get better for a while, but then something would happen and I would have to start all over,” Jillian says. “I knew if I kept drinking, awful things were going to happen, but I didn’t think that I would ever be able to stop after years of trying and relapsing.”
About 18 months ago, Jillian started dating someone new. He turned to the internet to see what other options were out there for her and told her about naltrexone. “Within a couple of days of starting naltrexone, my cravings went down massively,” Jillian says.
After a couple of earlier relapses, when she had stopped taking the medication daily, Jillian says she has now been completely sober for nine months and has been able to successfully switch to taking it only on days when, say, she’s going to a work event with an open bar. “I literally thought alcohol was going to kill me, but my liver is in excellent condition now,” she says. “Naltrexone was the last puzzle piece I needed to stay sober.”
Dr. Wakeman points out that different people use naltrexone in different ways, depending on where they are on their sobriety journey and their goals. People with AUD may take the pill every day, with the goal of preventing all drinking or reducing heavy drinking. (It’s also available as an injection, given once every four weeks in a health provider’s office.) For those cases, experts most often recommend using the med in conjunction with therapy, support groups, and other psychosocial treatments, Dr. Wakeman explains.
But for those who are not at the level of clinical AUD, or who find their drinking is very situational and they don’t want to take a medication every day, there is another strategy, known as the Sinclair method.
Dr. Wakeman describes this as taking naltrexone as needed, at least one hour before going to an event that may trigger you to drink, like at a party or holiday gathering. One dose lasts for about 24 hours, she says. This is how naltrexone can help people who are “either binge drinking or drinking at a level that they know is not going to be healthy over the long term, and they’re having a hard time cutting back,” says Dr. Wakeman.
In many of these cases, it allows people to have, say, a glass of champagne at a wedding or a single beer at a baseball game without bingeing, Dr. Wakeman says.
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What’s the Catch on Popping a Pill for Alcohol Use?
As for the medication’s side effects, Dr. Volpicelli estimates that between 20% and 30% of users experience nausea, headaches, or fatigue at first, but those effects tend to subside within a week or two.
At one point, the medication came with a warning about its use in patients with liver disease, but the warning was removed in 2013 after there were no cases found of the drug causing or worsening liver disease. A 2024 study confirmed that naltrexone is even safe in patients with cirrhosis.
“We know alcohol is a toxin to the liver and absolutely causes liver problems, so for sure naltrexone is safer for those patients than ongoing alcohol use,” says Dr. Wakeman. “We even use it in patients with end-stage cirrhosis.”
But one important factor is that you have to be committed to taking the pills, and for some, the psychological or social urges to drink may just be too great: “Sometimes people are ambivalent about giving up alcohol,” Dr. Volpicelli says. “On Monday, after a bad weekend, they may say, ‘I’m going to take the naltrexone,’ but by Friday, when their friends call and say, ‘Let’s go out to the party,’ they may not be as motivated to take it.”
This is why the experts say that, ideally, naltrexone should be used in conjunction with therapy and support groups to address underlying issues that have led to the addiction.
So Why Do So Few People Take This Medication?
While naltrexone is still only used by a tiny fraction of those who could benefit from it, there are signs that it is changing. “The climate right now is very different,” says Dr. Volpicelli, “and in recent years, we’ve seen an uptick in people using it. More people are willing to come out and talk about how naltrexone helped them in their recovery.”
But there is still a lot of work to do to get both the public and the medical providers who serve them to see naltrexone as an option, says Dr. Wakeman. “One of our big challenges is bridging the gap between what we’ve known from years and years of science is effective, and actually getting it into clinical practice,” she says.
Studies suggest that a big part of the problem is that primary care providers aren’t always aware of the safety and efficacy of the medication, and the vast majority of patients who could use the medicine aren’t going to see addiction specialists.
In a survey conducted by the Mayo Clinic and published in 2022, 146 internists, family medicine specialists, and psychiatrists answered questions about naltrexone, and while 23% had prescribed it in the previous three months, those who hadn’t said they were either unfamiliar with the medication’s use for AUD or they thought it should be used in conjunction with formal treatment programs with follow-up appointments.
Another issue is the way our country thinks about addiction in general. “Despite more attention recently to talking about addiction as an illness, as a society, we have historically approached addiction as being an issue of bad behavior or willpower or morality,” says Dr. Wakeman.
Instead of insisting people with addiction just pull themselves up by their bootstraps, says Dr. Wakeman, we should be saying, “Of course we want to make it easier for people to drink less and stay in recovery and not end up dying from liver failure!”
The Alcoholics Anonymous model, which has dominated the conversation about alcohol addiction in America for nearly a century, has historically been about surrendering oneself to a higher power and maintaining complete sobriety, though Dr. Wakeman says that many of the groups are now changing.
After a bumpy start with a “very controlling” sponsor, Jillian found—and now co-hosts—a more progressive AA meeting, where she says she shares openly that she uses naltrexone. “The only requirement for anyone to be in this meeting is the desire to stop drinking,” she says.
Still, there may have been a feeling in the past that using naltrexone is somehow “cheating,” and that full sobriety through sheer will is the more noble outcome. However, a large review published in 2020, involving 22 studies and more than 4,000 patients, found that research does not support 100% abstinence as the only approach in treating AUD, and controlled drinking accompanied by therapy may be a better approach for some.
“If you’re not educated about naltrexone, there’s a stigma around it that makes it seem like it’s only for people with severe alcohol use disorder or only for people who have a goal of total sobriety, and that couldn’t be further from the truth,” says Ian Anderson, who started up the telehealth company Sunnyside after his own experience of trying to control his drinking after losing his mother and other family members to alcohol-related deaths.
But the conversation has started to change, say both Dr. Wakeman and Dr. Volpicelli. One reason is due to people sharing their experiences on social media. A TED Talk by Babylon 5 actress Claudia Christian about her naltrexone experience has more than 5 million views on YouTube, for example, while you can also find videos on TikTok with people sharing how naltrexone helped them mend their relationship with alcohol.
Another reason more people may hear about naltrexone comes down to the Ozempic Effect. With the number of Americans taking GLP-1s for weight loss booming from 3% in 2024 to 11% in 2026, old ideas about food cravings and weight management have started to shift to a biological issue rather than a moral issue, and with that, people may think differently about alcohol addiction as well.
“People who go on GLP-1s talk about how it helps remove the noise, the craving, that once you start, you have trouble controlling how much you eat,” says Dr. Volpicelli, who points out that naltrexone has a similar effect with alcohol. “Naltrexone challenges the fundamental notion that addiction is a defect in character,” adds Dr. Volpicelli. “It’s not poor willpower, and it’s not a defect in character. It has to do with your biology and learning, and it’s possible to correct those.”
How to Get Help
The bottom line: Whether alcohol negatively affects your health, work, or social life, or you just feel like you need help cutting down, it’s well worth having a conversation with your doctor about options, including naltrexone.
Dr. Wakeman points out that naltrexone isn’t perfect (some people may react differently to it due to genetics or their drinking patterns, and you can’t take it if you are on opioids for pain relief).
If it doesn’t work for you, there are other medications in the addiction toolbox, though most require more than one pill a day. Several telehealth companies, including Oar Health and SunnysideMed, now prescribe and provide naltrexone, along with community support and coaching.
Navigating the stressful moments in life without alcohol has been an adjustment for Erica, but it’s also been eye-opening. “It’s so validating to realize, Oh, I don’t need to be buzzed to feel comfortable,” she says. “I can just do these things completely stone cold sober and feel uncomfortable and feel nervous and still be fine.”
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