10/13/2019
A patient perspective of his experience with Naltrexone.
"NALTREXONE – THE EFFECTIVE MEDICAL OPTION TO TREAT ALCOHOL ADDICTION
(that hardly anyone knows about) – copyright 2018
Mark A. Greenman (612) 388-7260 [email protected]
“WOW! What can I say? That Naltrexone is great! It took away my cravings and let me get a leg up on my drinking problem. Everybody should try it.” -Jay M. San Diego, CA
I. NALTREXONE – WHAT IT IS AND HOW IT WORKS
Naltrexone is a non-addictive op**te blocking medication that is taken in pill form. Naltrexone was first developed for the treatment of opioid addiction and it was later discovered that Naltrexone was also effective for treating alcohol addiction. Naltrexone was approved by the FDA for the treatment of alcohol addiction in 1994. FDA approval means that the agency has decided that the benefits of the drug outweigh the potential risks for the drug’s planned use. Although the drug is approved by the U.S. federal government, it is not commonly used in this country. In fact, even most American doctors are unfamiliar with Naltrexone.
A. Naltrexone as an Anti-Intoxication Medication - the Science
Opioid receptors are molecules within a person’s brain that are activated (opened) by opioid substances. A receptor is like a lock on the surface of a cell. When the receptor is “unlocked” by opioids contained in alcohol, endorphins (“happy hormones”) are released which stimulate the Ventral Striatum (hereafter “VS”) part of the brain, the technical name for the pleasure center of the brain (remember this for later). This produces feelings of pleasure and well-being. We become buzzed. Naltrexone keeps the opioid receptors “locked” and prevents the endorphins from being released. With no endorphins to stimulate the Ventral Striatum, a person gets no feelings of intoxication.
What this boils down to is Naltrexone works by blocking the normal reaction of the part of the brain that causes the feeling of pleasure when drinking alcohol.
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In other words, when you drink you don’t get buzzed/drunk. If you don’t get buzzed/drunk when you drink, you likely will not drink. What’s the point? Eventually, thoughts of drinking will naturally dissipate (see infra, pp. 5-6).
Naltrexone is known to be very effective. According to the Naltrexone Implant Center, in clinical trials undertaken in Australia, more than 60% of alcoholics taking Naltrexone were not drinking at all after 6 months. The remainder were drinking only one or two drinks at a sitting (see the Sinclair Method, infra, pp 4-6). The Center observed that these results are dramatically better than those achieved by any other protocol available in the United States.
So, what keeps you motivated to keep taking the Naltrexone every day? Why can’t you cheat? That would be easy. As will be explained in the next subsection, the answer is that you stay compliant taking the Naltrexone and won’t cheat because alcohol will stop being attractive and you will not want to drink.
B. Naltrexone an Anti-Craving Medication – the Theory
In addition to preventing intoxication, and perhaps more importantly, for reasons that are not yet fully known, Naltrexone also independently serves to eliminate the desire for alcohol. So in addition to being an anti-intoxicant, Naltrexone also serves as an anti-craving medication. With no cravings, there is usually no desire to drink. Cravings are what makes us drink. To illustrate, let’s say you really love cheesecake and you really enjoy eating a slice of it every night before bed. You crave it. Suddenly, your beloved cheesecake stopped tasting good. It was tasted neutral – neither good nor bad. You would most likely stop craving it and it will no longer be something you feel like you need every night. Thoughts of cheesecake will eventually cease. Just like with this cheesecake illustration, alcohol ceases to be pleasurable when taking Naltrexone and thoughts of drinking eventually cease.
So how does Naltrexone eliminate the cravings? No one knows for certain, but one theory is that Naltrexone interrupts good memories associated with alcohol. It has been known for a long time that alcoholics get cravings when they are exposed to triggers. These triggers can include small amounts of alcohol as well as pictures or other memories associated with their alcohol use. According to the Coleman institute, when alcoholics get these triggers and memories, the VS (pleasure center part of their brain – remember?) is activated just like when they are drinking. It appears that Naltrexone can work on a person’s memory systems by blocking pleasant memories of alcohol use thus preventing the stimulation of
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the VS. This lack of stimulation results in the lack of cravings. The lack of cravings, in turn, results in the lack of drinking. Similarly, in research conducted by Dr. Hugh Myrick, animal research indicates that Naltrexone may exert a lot of its effect by reducing what is called “cue-induced reinforcement” – a fancy term meaning that if alcoholics have triggers – pictures or other memories - they will have cravings. Myrick wanted to see if Naltrexone would work the same way in humans. He conducted an experiment involving 90 alcoholics and 17 social drinkers. He gave both groups a taste of alcohol and showed them alcohol-related pictures. The results were exactly as he had predicted. After a taste of alcohol or after seeing alcohol-related pictures, the social drinkers had no cravings and no activation of their VS. When the alcoholics, on the other hand, had either a small drink or saw a pictures involving alcohol, they had an increase in cravings and they had an increase in activity in their VS. The alcoholic subjects were then put on Naltrexone. After seven days, the experiment was repeated. As he anticipated, the alcoholics had significantly less craving and significantly less activation of their VS following a drink of alcohol or after being shown triggering pictures. Dr. Myrick concluded that it seems pretty clear that one of the major ways Naltrexone works is to interrupt the memory pathways so triggers do not induce cravings. He characterized the results of his experiment as “dramatic”.
C. Proviso
Just as diabetics must take medication every day to control their diabetes, we must take Naltrexone every day as well. Otherwise, endorphins are not blocked when we drink – causing us to feel intoxicated. This can lead to more “unprotected” drinking. You know where this leads.
II. VIVITROL
Vivitrol is an FDA-approved (2006), long-acting (30 days) injectable form of Naltrexone that is received in the gluteal (buttock) muscle once a month. During that one-month period, Naltrexone is slowly released into the bloodstream. According to EnterHealth Addiction Center, Vivitrol basically helps to prevent relapse by causing three (3) things to occur:
- It decreases cravings for alcohol by up to 90%;
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- If a person does drink alcohol, Vivitrol blocks the euphoria or the “high”. On the downside, (s)he will still have the other symptoms of intoxication such as poor driving or unstable walking. (S)he will not, however, benefit from any of the upside (pleasant) effects of alcohol;
- Vivitrol prevents the first drink from “priming the pump” for more alcohol. Unlike alcohol without Vivitrol, in which someone will have one beer which then seems to set off a cascading compulsion to have eight to ten more beers in that sitting. Vivitrol blocks that “priming” effect and the patient may have only one beer or less in total.
The downside to Vivitrol is that it is very expensive ($1400 per month) compared to Naltrexone ($32 per month). Insurance may cover Vivitrol however.
III. NALTREXONE & ME
I am passionate about Vivitrol (30-day Naltrexone). I rave about this drug to anyone who will listen. Vivitrol has dramatically changed my life for the better and has completely eliminate any desire to drink. I just never think about it.
My story briefly - I drank heavily for many, many years. During the latter part of these years I suffered many negative consequences because of alcohol. These consequences include my marriage falling apart, being arrested three times for DUI in a car (convicted once) and three times for DUI on a SEGWAY (yes, a Segway – Google Greenman Segway DUI Minnesota). My law license was suspended for missing hearings and deadlines among other things. I suffered from severe, debilitating alcohol-induced depression that could only be relieved by drinking. It got so bad I decided I could live like this no longer and I needed help to stop drinking.
I tried treatment (rehab) four (4) times unsuccessfully prior to my last treatment at Aton Center (March 5 to in April 4, 2017) where I started on Vivitrol. I first went to Hazelden - a 12-step based program. The 12-steps were not for me. I tried Passage Ventura, a holistic treatment program, twice. I then tried Sharp McDonald Center. During my brief periods of sobriety, I tried SMART Recovery. Although I liked SMART, I could not stay sober.
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Despite four inpatient treatments and many meetings, I could not ultimately rid myself of the compulsion to drink no matter how hard I tried. THAT was the problem. The longest I remained sober was six months.
While at Aton Center, I thankfully learned about Vivitrol from Aton’s doctor. I had my first shot of Vivitrol on my last day of treatment and have gotten a shot every month since. My desire to drink is GONE. I now view alcohol like I view tomato juice. It is just something I don’t care to drink. I feel the same regardless of my environment. Thus I go to bars regularly to watch sports and love to perform at open mics in bars. All the while I drink Coke. Such things are virtually unheard of in connection with traditional treatment methods.
I am petitioning to have my law license reinstated and I am optimistic. I have been eligible for reinstatement for 2 1⁄2 years. I did not want to attempt reinstatement until I had a real handle on my sobriety. It would not be viewed favorably if I petitioned for reinstatement and then relapsed. I now have that handle and can proceed with confidence.
IV. SIDE EFFECTS
Like with any drug, there are potential side effects (see www.mayoclinic.org/.../naltrexone-oral-route/side-effects/DRG-20068408).
There is some criticism that Naltrexone may block endorphins associated with pleasurable things that do not involve alcohol. I have found this to be the case with respect to substances but not with activities. For instance, I stopped (not quit) smoking without trying. I lost all interest in ci******es.
There is one targeted side effect of the drug. Naltrexone coupled with Wellbutrin (an anti-depressant that I take independently) is sold as a prescription appetite suppressant called “Contrave”. This certainly seems to work. I rarely think about food and only eat once a day. I lost considerable weight from 225 lbs. in May 2017 to 175 lbs. today.
With respect to diminished pleasure when engaging in positive activities, I have not experienced that at all. In fact, I am enjoying two of my favorite activities (golf and playing the guitar) more than ever.
Based on my experience with Naltrexone’s side effects, I facetiously tell people that if you want to stop drinking, stop smoking and lose weight, take Naltrexone.
V. THE BOTTOM LINE
I so thankfully have been sober for a year. Based on past experience, it is extremely likely that I would have relapsed by now if not for Vivitrol. Not only have I not relapsed, I am supremely confident that I will remain sober for the long-term so long as I continue to take Vivitrol until such time that my doctor and I decide I no longer need it.
I wrote this paper for one reason; I want to help people. I intend to share this paper and my experience with others with alcohol problems with the hope that they will become educated about Naltrexone. They will then be in a position to make informed decisions concerning all available options.
EDITORIAL
I went to three (3) different treatment centers prior to Aton Center and not one of them told me about Naltrexone. This is wrong. I could have gotten sober in 2013. One would think that when a person checks into a drug and alcohol treatment center for treatment of alcohol addiction, the treatment center would provide at least a cursory review of an effective FDA-approved drug that is used for the treatment of alcohol addiction. Maybe doing so would cut into repeat business.
NOTE: I have no financial incentive for writing this paper. I do not work for, nor am I being paid by, any drug company, distributer, marketing agency or sales agency. MG 4/4/18
ADDENDUM
Now that you know everything there is to know about Naltrexone, I want to share some additional practical information (and a little opinion) that you may find helpful.
Should You Take Naltrexone?
If you are sober, Naltrexone will likely help keep you sober. If you are struggling, Naltrexone will likely help you get and stay sober. From my standpoint, you have absolutely nothing to lose and absolutely everything to gain from taking Naltrexone. If you do not have negative side effects, how easy is it to take a pill every day? Very. If Naltrexone works for you like it has worked for me, you can rid yourself of any desire to drink and finally be liberated from alcohol.
It is also my firm belief that if you have a drinking problem and are sober now, you should continue doing whatever it is that you are doing, no matter what it is - whether it’s AA, SMART, Refuge or Equine Therapy. I do not advocate
Naltrexone instead of what you are doing. I advocated taking Naltrexone in addition to whatever it is you do to stay sober. When you eventually lose that compulsion to drink after taking Naltrexone for awhile, you will go to AA or SMART because you want to and not because you think you have to.
Do You Need a Doctor?
Naltrexone is a prescription medication although it shouldn’t be. It is available in other countries over the counter. There is no reason that Naltrexone should not be available over the counter in the United States, too. It is not addictive and it can’t be abused. But, because Naltrexone is a prescription medication, you need a doctor’s prescription to get it in this country.
You may already have a doctor you like and trust and that is great. There is a decent chance, however, that (s)he may have never heard of Naltrexone. Most doctors have not. If your doctor is not familiar with Naltrexone, be advised that there are doctors who are reluctant to prescribe medications they don’t know about. Even if he is familiar with Naltrexone, he may not prescribe it for whatever reason. This happened with a family member of mine.
I choose to have a separate addiction doctor for all things related to my “AUD” (Alcohol Use Disorder – apparently the new term used to categorize us). I use my regular doctor for everything else. My doctor is Dr. Phillip Milgram. I chose Dr. Milgram because I wanted a doctor who is an expert in the field regarding addiction, Naltrexone and Vivitrol. Dr. Milgram is also one of the very few Vivitrol doctors in San Diego County.
I have confidence in Dr. Milgram. He has 28 years of experience treating patients with drug and alcohol addiction. He has many Vivitrol patients and many Naltrexone patients. Dr. Milgram is one of us and he welcomes new addiction patients. Dr. Milgram’s phone number and email are (760)736-4444, [email protected]. Dr. Milgram’s office will run your insurance to check for coverage for both Naltrexone and Vivitrol.
Should You Go With Naltrexone or Vivitrol?
I believe it is best to start with Vivitrol. With Vivitrol, you get your shot and then you forget about it for a month. The only problem with Naltrexone is that you have to take it. The biggest reason that Naltrexone fails for a person is not the failure of the drug, but the failure to take it as daily as prescribed. Early on it might be tempting to stop taking Naltrexone for a day when you want to party.
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You then say that you will resume taking Naltrexone the next day. That is fine and it would probably work, but I don’t think you can achieve long-term sobriety that way. With Vivitrol, you cannot take a day off.
If your insurance does not cover Vivitrol, then by all means go with Naltrexone.
If you are truly motivated to stay sober, you will take your little Naltrexone pill every morning.
Story with Aton One Little Pill Me and the Sinclair method"
