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Naltrexone is a medication for alcohol use disorder that helps reduce cravings and maintain recovery. It does not treat acute withdrawal symptoms. However, it plays an important role in long term relapse prevention.
In this article, you’ll learn how naltrexone works in the brain, when it is prescribed and what benefits it offers during alcohol use disorder treatment. We’ll also cover how it differs from alcohol withdrawal medications and what to expect if you or a loved one begins treatment with naltrexone.
Key Facts
- Alcohol withdrawal happens within hours after stopping heavy use, peaking at 24–72 hours and resolving in about a week.
- Naltrexone does not address acute withdrawal but supports recovery after detox.
- This medication blocks opioid receptors to reduce cravings and relapse risk.
- Safe use requires being opioid free, having stable liver function and completing detox.
- Oral (daily pill) and injectable (monthly shot) forms allow flexible treatment planning.
- Benzodiazepines and phenobarbital, not naltrexone, treat the acute withdrawal phase.
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The Role Naltrexone Plays in Alcohol Withdrawal
Naltrexone plays an important role in alcohol use disorder treatment, but not in the way you may assume. The main purpose is to support long term recovery by lowering cravings and reducing the risk of relapse.
Alcohol Withdrawal 101
Alcohol withdrawal happens when your body reacts to the sudden absence of alcohol after heavy or prolonged use. Symptoms of withdrawal usually begin within 6 to 24 hours, peaking around 24 to 72 hours and resolving within 3 to 7 days.
Symptoms may range from mild anxiety and tremors to more severe complications like seizures or delirium tremens (DTs).
Certain warning signs require urgent medical attention. These red flags include confusion, hallucinations, high fever, uncontrolled vomiting and severe tremors. If any of these occur, immediate medical care is critical for your safety.
Why Naltrexone Isn’t for Acute Withdrawal & Where It Fits After Detox
Naltrexone does not manage the immediate dangers of alcohol withdrawal. These include autonomic hyperactivity, seizures or other acute symptoms. These are commonly treated with medications like benzodiazepines or phenobarbital under medical supervision.
Using naltrexone in the early stage of alcohol withdrawal does not provide the necessary protection against serious risks. However, naltrexone plays a crucial role after detox, when the focus shifts from short term stabilization to long term recovery.
Naltrexone helps reduce cravings, lowers the number of heavy drinking days and supports ongoing sobriety. This makes it a valuable tool in relapse prevention and sustained recovery in alcohol use disorder treatment.
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How Naltrexone Works and When to Start
Naltrexone can be started at different points in treatment, depending on your goals and clinical situation. Some people begin naltrexone after completing detox, while others start it during or shortly after withdrawal, or while working to reduce their alcohol use. The timing should be individualized based on withdrawal symptoms, treatment goals, and other medical factors.
Mechanism & Expected Benefits
Naltrexone works as a mu opioid receptor antagonist. They block your brain’s reward pathways that are normally activated by alcohol. By reducing the pleasurable effects of drinking, it helps weaken the urge to drink in response to triggers or environmental cues.
The benefits of this approach include fewer heavy drinking days, longer periods before relapse and improved outcomes when combined with counseling or structured therapy. Together, these effects make naltrexone a valuable tool in your long term recovery.
When to Start Naltrexone After Detox and Pre-Start Checklist
Naltrexone can be started at different points in recovery, including during or after withdrawal. The best timing depends on a person’s symptoms, treatment goals, and overall medical condition.
Several criteria must be considered before beginning naltrexone, including:
- Confirmed opioid free to avoid severe withdrawal
- Thorough review of current medications and allergies
- Baseline liver function tests
- Comprehensive education to ensure safe and effective use
Options, Dosing and Choosing the Right Formulation
Naltrexone is available in oral and injectable forms. This allows you and your providers flexibility in customizing your treatment plan.
The appropriate option depends on factors like lifestyle, adherence and medical history. This highlights the need to consider common dosing approaches and key considerations to select the most effective formulation.
Oral Naltrexone (Typically 50 mg Daily)
Oral naltrexone is most often prescribed at 50 mg per day. However, administration can begin with a 25 mg test dose before titrating up. Taking naltrexone with food can help reduce gastrointestinal discomfort.
This option is well suited as a first line trial since it is easy to start, stop or adjust the dosage as needed. However, it is critical that you consistently adhere to treatment since missed doses can limit the effectiveness and reduce the medication’s ability to curb cravings.
Extended Release Naltrexone (380 mg IM Monthly)
Extended release naltrexone is given as a 380 mg intramuscular injection once a month. This is a convenient alternative when you struggle with daily pill taking or prefer a long acting option. This formulation helps ensure steady medication levels and consistent support against cravings.
Before beginning treatment, your provider takes several precautions to reduce complications and make treatment more effective. These steps include:
- Screening for potential injection site concerns
- Confirming you are opioid free for an adequate period
- Reviewing full medical history
- Checking baseline liver function
- Education on what to expect during treatment
Choosing Oral vs. Injection
Deciding between oral and injectable naltrexone depends on several factors. These include adherence, access to care, insurance coverage, side effect tolerance and personal preference. The best choice varies by individual needs.
It’s important to consider logistics such as the ability to attend monthly clinic visits for injections. As well you should have plans for managing missed doses and whether transitioning between formulations might be helpful over time. A collaborative discussion with a provider ensures the most practical and effective approach.
Alcohol withdrawal medications comparison
| Medication | Primary Use in Alcohol Care | Typical Course | Common Side Effects |
|---|---|---|---|
| Librium (chlordiazepoxide) | First-line treatment for moderate-to-severe withdrawal; prevents seizures and delirium tremens | 3 to 7 days, tapered | Drowsiness, dizziness, coordination issues |
| Gabapentin | Mild-to-moderate withdrawal; reduces anxiety and cravings | 5 to 7 days, tapered | Dizziness, fatigue, swelling |
| Clonidine | Adjunct medication for high blood pressure, sweating, and anxiety; does not prevent seizures | 3 to 5 days | Low blood pressure, dry mouth, drowsiness |
| Naltrexone (oral or Vivitrol injection) | Post-detox craving and reward reduction | Daily oral or monthly injection; often long-term | Nausea, headache, fatigue |
| Thiamine (Vitamin B1) | Prevents Wernicke-Korsakoff syndrome; routinely given during alcohol detox | Daily during detox, often parenteral | Generally well tolerated |
For reference only. Medication decisions belong with a licensed clinician.
Safety and Special Situations
Naltrexone is generally safe and well tolerated. However, certain health conditions and circumstances require extra caution. This section outlines key safety considerations and special situations where careful monitoring or alternative approaches may be needed.
Liver Safety & Monitoring
Naltrexone should not be used if you have acute hepatitis or liver failure. Baseline liver function tests (LFTs) are recommended before starting treatment. Periodic monitoring helps ensure continued safety during use.
Providers carefully weigh the risks and benefits when you have mild to moderate enzyme elevations. They educate you about the warning signs of hepatitis, such as jaundice, dark urine or abdominal pain. This proactive approach supports both safety and effective treatment.
Opioid Free Status & Pain Management Planning
Before starting naltrexone, individuals must be completely opioid free to avoid precipitated withdrawal. Once on treatment, the medication blocks opioid receptors, making opioid based pain relief ineffective.
For surgeries or procedures, advanced planning is essential. Non opioid pain management strategies should be prioritized. If opioids are absolutely required, coordination with specialists helps ensure safe and effective care.
What Treats Alcohol Withdrawal
Alcohol withdrawal requires medications that directly calm the nervous system and prevent dangerous complications as the body detoxifies. These are first line medications that work differently from naltrexone, but are critical to recovery.
First Line Medications & When Inpatient Care Is Needed
The mainstay of alcohol withdrawal treatment is benzodiazepines, given either on a symptom triggered schedule or as fixed doses. A customized treatment plan based on evidence based measurement tools helps providers make accurate decisions about how medications are administered.
In some experienced settings, phenobarbital may be added for additional control. Supportive care is equally important. This includes thiamine before glucose, fluids and electrolytes and close monitoring of vital signs.
Inpatient care becomes necessary when there is a high risk of severe alcohol withdrawal symptoms.
Admission is recommended when there is a history of:
- Severe withdrawal
- Seizures
- Delirium tremens
- Unstable vital signs
- Pregnancy
- Limited support at home
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Naltrexone Frequently Asked Questions
No, naltrexone does not manage tremors, agitation, blood pressure spikes or seizures.
These symptoms require evidence based withdrawal protocols, often with benzodiazepines or phenobarbital. Naltrexone is introduced during or after detox and stabilization to support long term recovery and reduce cravings.
Naltrexone is often started once acute withdrawal symptoms are resolved. This commonly occurs between 3 to 7 days of abstinence. In some cases it is started sooner.
Before beginning, your provider confirms you are opioid free and have acceptable liver function tests. Follow up visits help monitor your response and ensure the medication is well tolerated.
Always inform your care team that you’re taking naltrexone. For elective procedures, planning is essential.
Non opioid pain control is preferred. However, if opioids are necessary, they must be managed carefully by specialists. Naltrexone can be safely restarted once opioids are no longer required.
Find Treatment Near You
Finding the right treatment program for alcohol withdrawal is crucial to your long term success. Naltrexone plays a unique role in supporting sustainable recovery.
Use the treatment directory at Rehab.com to search for centers that match your needs. You can filter by location, level of care, accepted insurance and special programs to find the right fit.
Not sure where to start? Call today
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Top Rated Centers for Alcohol Addiction Treatment
| Name / Address / Rating | Description | Treatments / Payments / Programs | Review / Contact | Images | |
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Avenues Recovery Center at ClarksvilleAd This is an ad and Avenues Recovery Center at Clarksville is a paid advertiser. Paid advertisers may be listed first in search results. This ad may contain content provided by the advertiser. Rehab.com does not verify ad content or any reviews that are displayed. Learn More Clarksville, IN  Claimed | Avenues Recovery Center in Clarksville, Indiana, is an inpatient drug and alcohol detox and rehab center. They strive to provide individuals receiving treatment with a loving environment and attentive medical care. You’ll be away from toxic environments and triggers and have the opportunity to focus on developing life skills that will support you | Treatments Programs Payment Options  Alcoholism Mental Health And Substance Abuse Drug Addiction Opioid Addiction Substance Abuse Dual DiagnosisMental Health  Adult Program Young Adult Program LGBTQ Program Military Program  Private Insurance Self-Pay Options Medicaid Military Insurance | View Website (930) 203-1947 | 
Avenues Recovery center is a very good place love the staff love the facilitators love the case managers there’s a lot of good help here I am still involved with the alumi meetings I just love how were family love you avenues recovery center
Joshua Levi Johnson
1 day ago
Avenue staff was exceptionally considerate to all of my needs. Highly recommend if your truly searching for recovery.
Janezee Leezy
1 day ago
Really good place to go to
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9.67 / 10 Claimed | All In Solutions Wellness Center is a treatment facility located in West Palm Beach, Florida. This facility specializes in treating adults who are struggling with co-occurring disorders and addiction. The levels of care offered here are detox, residential, and aftercare programs. As one of the best-rated detox centers in Florida, All In Solutions | Treatments Programs Payment Options AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis Adult Program Program For Men Program For WomenYoung Adult Program Private InsuranceSelf-Pay Options | 
My experience at All In Solutions exceeded my expectations. I was treated with respect, honor and dignity. I was kept comfortable while detoxing.
Timothy Snow
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My wife completed residential treatment here for alcohol addiction and the change has been remarkable. Family therapy sessions helped all of us understand how to support her moving forward.
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9.64 / 10 | Recovery Unplugged Nashville Drug & Alcohol Rehab is a private luxury addiction treatment center located just south of Nashville, in Brentwood, Tennessee. They offer several levels of care, including medication assisted treatment (MAT), residential treatment and behavioral telehealth. Adults with dual diagnoses and substance use disorders are welco | Treatments Programs Payment Options Substance AbuseAlcoholismDrug AddictionDual Diagnosis Adult Program Private InsuranceSelf-Pay Options MedicareMedicaidMilitary Insurance | 
This place helped me save my own life. I couldn’t recommend a company more.. especially in a dire situation. They are family.
Michelle Aspen
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What an amazing place to save your life!
Rich Stadtlander
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Help my family out wonders!
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Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center’s quality right now.
9.61 / 10 Claimed | All In Solutions Detox in Simi Valley is one of the best ranked inpatient detox facilities in California providing safe, medically supervised care for individuals beginning their recovery from drug or alcohol addiction. As part of the All In Solutions Behavioral Health network, this facility serves as the first step in a full continuum of care. Cli | Treatments Programs Payment Options AlcoholismDrug AddictionMental Health And Substance AbuseOpioid AddictionSubstance AbuseDual Diagnosis Adult ProgramYoung Adult ProgramProgram For MenProgram For Women Private InsuranceSelf-Pay Options | 
This facility has been amazing. The staff is great and the program is also great
Michael Miller
2 days ago
Awesome staff and great facilities. All my needs were met and they got me on the road to recovery.
Brian Mckinney
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Everything here was really great. The stars and medical team was very helpful. I left here with a new life
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Avenues Recovery Center at Lake ArielAd This is an ad and Avenues Recovery Center at Lake Ariel is a paid advertiser. Paid advertisers may be listed first in search results. This ad may contain content provided by the advertiser. Rehab.com does not verify ad content or any reviews that are displayed. Learn More Lake Ariel, PA Claimed | Clients seeking treatment for alcohol addiction may be required to undergo detox first. As one of the best detox facilities in Pennsylvania, the process at Avenues Recovery Center ensures any abused substances are out of a client’s system and that they are in a healthy frame of mind when they enter residential treatment. Detox is overseen and | Treatments Programs Payment Options Substance AbuseAlcoholismDrug AddictionMental Health And Substance AbuseDual Diagnosis Adult Program Private InsuranceSelf-Pay OptionsMilitary Insurance | View Website (570) 354-6060 | 
Amazing place! Totally worth it!
Megann
1 week ago
Excellent facility fabulous staff!
amy knorr
1 week ago
This is truly an amazing facility! Every single person I’ve encountered is absolutely wonderful. The staff are incredibly kind, caring, and knowledgeable, groups are fun & informative, and the housing and food are excellent. There’s an amazing sense of community and I 1000% recommend.
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9.45 / 10 | Recovery Unplugged offers a full suite of outpatient substance use recovery for adults and adolescents in the DC Metro area of Annandale, Virginia. They offer general outpatient and top-rated intensive outpatient care (IOP) alongside partial hospitalization programs (PHP). Each of these levels of care may incorporate medication-assisted treatment ( | Treatments Programs Payment Options Substance AbuseAlcoholismDrug AddictionDual Diagnosis Adult ProgramYoung Adult ProgramLGBTQ Program Teen Program Private InsuranceSelf-Pay OptionsMedicareMedicaid | 
I have been in and out of treatment for 15 years, and this is by far the best recovery center I have ever been to. The staff genuinely care about every client and their well-being. They aren’t just out for money or treating people like another number—they truly want to see you heal, grow, and succeed. I have felt supported, understood, and cared for throughout my time here. Recovery is not easy, but this center has given me hope and the tools I need to build a better life. I’m incredibly grateful for this place and would recommend it to anyone who is ready to make a change.
Tara R.
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I would not be where I am today without the help of Recovery Unplugged. I had two 30 day visits with them back in 2019 before moving on to a 90 program in Arizona. Everyone was friendly and you felt like you actually mattered. The musical component of it all was life changing and is still a huge support in my life today. It’s outside of the box recovery and if you are looking for a place to start, this is it. I’m coming on six years of sustained recovery and now hold a masters in divinity while thriving in Tucson. AZ. None of this would have been possible without Recovery Unplugged and I could not be more grateful for all they provided in early recovery.
Jay Newman
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The program and support is great, but once you finish no resources are provided. No follow-up with patients. They are all about profit. The providers can’t even provide outside resources. This should be a warning sign they are out to make money.
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9.41 / 10 Claimed | All In Solutions Counseling Center is a mental health and addiction clinic in Cherry Hill, New Jersey. They provide outpatient addiction treatment and mental health care. They offer options like an intensive outpatient program, a partial hospitalization program, and medication-assisted treatment. All In Solutions Cherry Hill Drug & Alcohol Reha | Treatments Programs Payment Options AlcoholismDrug AddictionDual DiagnosisOpioid AddictionSubstance AbuseMental Health And Substance Abuse Adult ProgramYoung Adult ProgramProgram For MenProgram For Women Private insuranceSelf-Pay Options | 
The clinical building being separate from the housing is a detail that sounds small but makes a big practical difference. You go there to work, and you come back to somewhere calmer when the day is done. That separation gave the whole experience a clearer shape.
Brian Saunders
2 weeks ago
Friday afternoons they bring in alumni speakers. Sitting in a room listening to someone who’s been through it and come out the other side is different from any group session with a counselor. It was one of the parts of the week I genuinely looked forward to.
Thomas Navarro
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The weekly family group, held online so family can join from wherever, is something I wasn’t expecting. My family had been through a lot and being able to include them in the process, even from a distance, changed how I felt about what I was doing here. Recovery doesn’t happen in a bubble and a program that actually acknowledges that is worth noting.
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Top 10 Rehab in TX
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9.39 / 10 | Symetria – Hurst Outpatient Rehab and Suboxone Clinic in Hurst, Texas, is a private drug rehabilitation clinic for adults. One of the best outpatient rehab centers in Texas, Symetria offers various withdrawal medications to help clients get started with their recovery journey. You’ll also have access to treatments such as the intensive outp | Treatments Programs Payment Options Substance AbuseAlcoholismOpioid Addiction Adult ProgramYoung Adult Program Private InsuranceSelf-Pay OptionsMedicareMilitary Insurance | 
Symetria is like a second family for me now and Mrs. Debrah , who runs the center is always awesome and also Mrs. Callie is my counselor and a great one at that! Come to Symetria if you need help you’re not alone they will treat you like your one of them. And the front desk lady Michelle is so sweet that she won’t let you miss a does so she calls every patient everyday in case you forgot so u don’t suffer!
Krystina Hubbell
2 weeks ago
I have been in the DARKEST place for so long. Symetria was my saving grace. My counselor Callie (my saving grace) showed me that I actually really do matter and gave me a sense of belonging for the FIRST time in my life! She truly cares and has helped me in so many ways that I can’t thank her enough. If it weren’t for her, I’m not sure where I’d be in life right now without her. Ms Callie, if you see this, thank you again. To all of the concerned mothers/fathers out there, I promise you, this is the best methadone clinic in the United States. Thank you for taking the time to read my comment, I promise I wouldn’t steer you the wrong direction. <3 Please take into consideration coming to Symetria. I finally have hope.
Madi Murphy
1 month ago
This place is great. The entire staff had always been excellent
bryan harris
2 months ago
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Top 10 Rehab in NY
Rehab Score
Our Rehab Score is designed to make it easier for you to find the best treatment centers. We combine overall ratings with recent feedback to create a score that reflects a center’s quality right now.
9.39 / 10 | This facility offers leading outpatient addiction treatment, recovery coaching, and medication-assisted treatment for adults. Through an intensive outpatient program or an outpatient program, participants engage in individual and group therapy that helps get to the root of addiction and relapse prevention skills. Outpatient support groups allow you | Treatments Programs Payment Options AlcoholismDrug AddictionSubstance AbuseOpioid Addiction Adult ProgramYoung Adult ProgramLGBTQ ProgramTeen Program Private InsuranceSelf-Pay Options Sliding Scale Payment Assistance Financing | 
As a family member, I cannot say enough wonderful things about Mountainside Treatment Center in Huntington. From the very beginning, the staff treated both our loved one and our family with compassion, respect, and genuine care during an incredibly difficult time.
The communication throughout the process was thoughtful and professional, and it was clear that everyone involved truly wanted the best possible outcome. Mountainside provides best-in-class treatment in a safe, supportive, and welcoming environment. Knowing our loved one was in such caring and capable hands gave us comfort and hope when we needed it most.
We are deeply grateful for the support, guidance, and dedication of the entire team. Highly recommend.
Adriana Popa
4 months ago
Going to Mountainside in Huntington was a life changing experience. I could not recommend it more!
Violet White
1 year ago
As a clinical social worker running a local group practice, I regularly collaborate and refer clients to Mountainside Treatment Center. Their staff has always been exceptional, especially Courtney Hulse and Dan Sexton, who go above and beyond in tailoring their treatment plans for each client and family. Mountainside serves as a tremendous resource, providing quality substance abuse treatment that is critically needed here on Long Island. We are enthusiastic about continuing to work with Mountainside to best serve our community and families. Thank you for all you do Mountainside. Highly recommend!
Gordon Gooding
2 years ago
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4 
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1
Top 10 Rehab in MD
Rehab Score
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9.38 / 10 | Bracebridge Hall is an inpatient facility located in Earleville, Maryland under the umbrella of Recovery Centers of America. It’s on 560 acres with a view of the Sassafras River. They offer substance use disorder (SUD) treatment and mental health treatment for co-occurring disorders. They accept and are in network with most major insurance plan | Treatments Programs Payment Options AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionSubstance Abuse Adult ProgramMilitary ProgramYoung Adult ProgramLGBTQ Program Private insuranceSelf-Pay Options Financial AidSliding Scale Payment AssistanceMilitary InsurancePrivate InsuranceMedicaidMedicare+1 | 
RCA and its facilitors were exceptional. Intake and discharge was streamlined and efficient. A variety of flexible groups and speakers were scheduled weekly. Educational classes regarding medications and planning for discharge are also available. The facility provides lesiure activities such as fishing, recovery walks, and a gym. Facility was well maintained and clean. A variety of meals are offered for breakfast, lunch, dinner, and a night snack. Substitute protein options are also available. RCA will meet and exceed expectations and provide all one needs for a successful recovery.
Juan Najera
1 day ago
My stay at RCA Bracebridge was truly life-changing. This was my first experience in rehab, and I honestly didn’t know what to expect, but it exceeded everything I could have imagined.
The groups were both educational and life-changing, providing valuable knowledge and tools that I can carry with me throughout my recovery. The staff were exceptionally supportive, caring, and informative. It was comforting to know that someone was always there whenever I needed help or support.
My therapist, Jessica V., is amazing, and I will never forget her. Mr. Dan, Mike H., Mrs. Jessie, and Mrs. Amber were also incredibly supportive and generously shared their knowledge and experience, which made a meaningful difference in my recovery.
The RSS staff were outstanding, and words cannot fully express my gratitude for everything they did. The kitchen staff, especially Eric, went above and beyond to make sure we were comfortable and had what we needed. That support allowed us to focus on what mattered most—our recovery.
Mr. Tariq always listened and showed genuine care and compassion toward the clients. His kindness and willingness to be there for us meant a lot.
I will forever be grateful to RCA Bracebridge for helping save my life and giving me the coping skills and tools I need to continue recovering one day at a time. I am leaving with gratitude, hope, and a renewed commitment to my recovery. Thank you to everyone who played a part in this journey
Shawnda
1 day ago
RCA gave me the confidence and tools to live the life of sobriety. Im truly grateful for everyone involved in my treatment there and the compassion and understanding of my treatment. I cant truly describe the gratefulness I have for this facility that has changed my life.
Jerry Chandler
2 days ago
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5 5 
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