Medication That Helps With Alcohol Cravings: How Naltrexone Reduces the Urge to Drink

Medication that helps with alcohol cravings works by changing how your brain responds to alcohol, making it easier to drink less without relying on willpower alone.

What You'll Discover:

• Why alcohol cravings happen at a biological level.

• How medication targets the brain's craving mechanism.

• How naltrexone specifically reduces the urge to drink.

• What to expect when you start taking craving medication.

• Standard dosage and timing options.

• Side effects and safety considerations.

• Who benefits most from medication for cravings.

• How to access medication through a prescription.

If you've tried to cut back on drinking and found yourself fighting strong urges, you're experiencing something biological, not a failure of willpower. Alcohol cravings are driven by brain chemistry and learned associations that operate below conscious control. FDA-approved medication exists that can significantly reduce these cravings and make changing your drinking habits much more achievable.

According to the Substance Abuse and Mental Health Services Administration, medications for alcohol use disorder have been available for decades. The most commonly prescribed medication that helps with alcohol cravings is naltrexone, which targets the brain's reward response to alcohol.

Why Alcohol Cravings Happen

Understanding why cravings occur helps explain how medication can address them. Alcohol cravings are rooted in brain chemistry and learned associations developed over time.

When you drink alcohol, your brain releases endorphins that bind to opioid receptors. These endorphins trigger the release of dopamine in the brain's reward center, specifically in an area called the nucleus accumbens. This dopamine surge creates the pleasurable "buzz" that makes drinking feel good.

Over time, your brain learns to associate alcohol with this pleasurable reward. Environmental cues like seeing a beer commercial, walking past a bar, arriving home after work, or feeling stressed can trigger the expectation of reward. This expectation manifests as a craving. The brain essentially signals: "alcohol made us feel good before, let's do that again."

If it seems like cravings have a mind of their own, that's because in a sense they do. The craving response operates below conscious control. It's not about wanting alcohol intellectually; it's about your brain's reward system driving behavior based on learned patterns.

A good example of how this works: You've had a long, stressful day at work. As you drive home, you pass the liquor store where you usually stop. Before you've consciously thought about drinking, you feel a pull to turn in. That's the craving response activating based on learned associations between stress, that location, and the reward your brain expects from alcohol.

The more frequently you drink and the more your brain experiences this reward cycle, the stronger the learned association becomes. This is why cravings tend to intensify with regular drinking and why willpower alone often isn't enough to overcome them.

How Medication Targets Alcohol Cravings

Medication that helps with alcohol cravings works by interrupting the reward cycle that drives the urge to drink. Rather than requiring you to fight through cravings using willpower, medication changes the underlying brain chemistry.

The first thing to know is that craving medication doesn't work like an "off switch" that immediately eliminates all desire to drink. Instead, it gradually weakens the association between alcohol and reward. Over time, as this association weakens, cravings naturally decrease.

This approach is sometimes called pharmacological extinction. The medication prevents alcohol from producing its usual rewarding effects. When you drink without getting the expected reward, your brain begins to unlearn the association. Eventually, the automatic urge to drink loses its power.

This is different from approaches that make you sick if you drink. Craving medication doesn't produce unpleasant reactions. It simply makes alcohol less rewarding, which reduces the biological drive to consume it.

How Naltrexone Reduces Cravings

Naltrexone is the most commonly prescribed medication that helps with alcohol cravings. It's been FDA-approved for alcohol use disorder since 1994 and has decades of research supporting its effectiveness.

So, how does naltrexone actually work? The short answer is that it blocks opioid receptors in the brain. When these receptors are blocked, the endorphins released by alcohol can't produce their usual effect. You don't get the same buzz, and the reward signal that drives cravings is interrupted.

Here's what happens at a biological level:

Research published by the National Institute on Alcohol Abuse and Alcoholism shows that naltrexone significantly reduces heavy drinking days compared to placebo. Many people report that after taking naltrexone consistently, alcohol simply becomes less interesting. The automatic pull toward drinking fades.

For more detail on naltrexone's mechanism, see our article on how to use naltrexone to stop alcohol cravings.

What to Expect When Taking Craving Medication

Starting medication for alcohol cravings comes with questions about what the experience will be like. Here's a realistic timeline based on how most people respond to naltrexone.

Days 1 through 3 - Some people experience mild side effects during the first few days. The most common include nausea, headache, dizziness, and fatigue. These typically improve as your body adjusts. Taking naltrexone with food can help reduce nausea.

Week 1 through 2 - You may start to notice that drinking feels different. The buzz might be less intense, or you might find yourself naturally stopping after fewer drinks than usual. Studies show that people taking naltrexone often go from consuming 4 to 5 or more drinks to stopping after 1 to 2. Some people describe alcohol as becoming "less interesting" or "not worth it."

Week 3 through 4 - By the end of the first month, many people report a noticeable decrease in how often they think about drinking. The automatic urge weakens because the reward pathway has been consistently disrupted.

Months 2 and beyond - The effects tend to build over time. The longer you take naltrexone consistently, the more the learned craving response weakens. Many people describe reaching a point where they simply don't think about alcohol the way they used to. The mental space that drinking used to occupy becomes available for other things.

Something to consider is that individual experiences vary. Some people notice changes quickly, while others take longer. Consistency with the medication is important for best results.

Standard Dosage and How to Take Naltrexone

Naltrexone for alcohol cravings comes in tablet form at three dosage levels:

• 25mg

• 50mg

• 100mg

The standard daily dose is 50mg. Some patients start at 25mg during the first few days to reduce the likelihood of side effects, then increase to the full dose. Medical professionals typically avoid starting at higher doses because side effects become more likely.

A single 50mg dose of naltrexone stays active in your system for about 20 to 24 hours. The medication has a half-life of approximately four hours, but it remains effective longer because the liver converts it into a metabolite called 6-beta-naltrexol. This metabolite has a half-life of about 13 hours and continues providing blocking effects.

Daily use means taking naltrexone once a day at the same time, ensuring continuous coverage. This approach is straightforward and ensures you're protected if you drink unexpectedly. All it takes is one time drinking without naltrexone for the reward response to reinforce the craving pattern.

As-needed use means taking naltrexone only when you plan to drink. If you use this approach, you need to take the medication at least one hour before your first drink to give it time to start working. A good example of when this works well is before a work happy hour or a wedding reception where you know alcohol will be served.

For that reason, many medical professionals recommend daily use for people who want to reduce their drinking consistently. You don't have to plan ahead or risk drinking without coverage.

Something to consider is that research has examined combining both approaches. One study found that taking a daily 25mg dose plus an additional 25mg as needed before drinking occasions was more effective at reducing heavy drinking days than a single daily 50mg dose.

For more on dosing options, see our article on getting the right naltrexone dose.

Side Effects and Safety

Most people tolerate naltrexone well, but side effects can occur, especially during the first week.

Common side effects include:

• Nausea - The most frequently reported. Usually mild and improves within a few days. Taking medication with food helps.

• Headache - Can occur during the first few days. Typically resolves on its own.

• Dizziness - Some people feel lightheaded initially.

• Fatigue - Feeling tired is common in the first week. Most people adjust within 7 to 10 days.

• Decreased appetite - Some people notice less interest in food. Usually normalizes.

These side effects are generally mild and temporary. If side effects persist beyond two weeks or are severe, contact your prescribing physician. Adjusting the dosage or timing can sometimes help.

Important safety considerations:

• Opioid interactions - Naltrexone blocks opioid receptors. You should not take naltrexone if you are currently using opioid medications or have used opioids in the past 7 to 10 days. Taking naltrexone while opioids are in your system can trigger severe withdrawal symptoms.

• Liver function - Naltrexone is processed by the liver. If you have existing liver conditions, your medical provider will want to monitor liver function. Naltrexone is generally safe for people with mild liver issues, but severe liver disease may be a contraindication.

Who Benefits Most From Craving Medication

Medication that helps with alcohol cravings can benefit a wide range of people. You don't need to have severe alcoholism to benefit.

Good candidates for naltrexone typically include:

• People who drink more than they intend to and want to regain control

• People who have tried cutting back using willpower but struggle with cravings

• People who want a private, discreet treatment option

• People who prefer medication-based approaches to group programs

• People who want to reduce binge drinking episodes

One common misconception is that you have to hit rock bottom before medication makes sense. This isn't accurate. Many people benefit from craving medication while still functioning in their daily lives. Addressing cravings earlier tends to be easier than waiting until drinking has caused serious problems.

All that said, naltrexone works best for people who are motivated to change their drinking. The medication makes it easier to drink less, but it doesn't force you to stop. Having a clear goal and some form of support improves outcomes.

How to Access Medication for Alcohol Cravings

Naltrexone is a prescription medication, which means you need to see a medical professional to get it. However, accessing this medication has become significantly easier through telehealth.

Traditional route - You can ask your primary care doctor about naltrexone. Many general practitioners can prescribe it, though some may refer you to a specialist.

Telehealth route - You can complete an assessment online, meet with a licensed physician via video call, and have your prescription sent to a pharmacy or delivered to your home. This approach is more convenient and private than in-person appointments.

Choose Your Horizon offers a telehealth program that combines naltrexone with coaching support. The process starts with an online Alcohol Use Assessment that takes just a few minutes. Based on your responses, you'll be matched with a physician who can evaluate whether naltrexone is appropriate.

The cost of naltrexone varies but is generally affordable. Generic versions are widely available at most pharmacies.

Our article on how naltrexone helps you regain control explains the medication and program in more detail.

Taking the Next Step

Medication that helps with alcohol cravings offers a practical tool for people who want to change their drinking. Naltrexone has been used safely for decades and works by targeting the brain chemistry that drives cravings. It doesn't require complete abstinence and can make the process of drinking less significantly easier.

If you've been struggling with cravings and want to explore your options, take the online Alcohol Use Assessment to see if naltrexone could be a good fit.