People in Moderation Management share experiences of naltrexone use

A physician in recovery, suddenly alone in an office well stocked with opiates and sedatives, found himself on the ropes. His experience with naltrexone, circa 11/2000:

I was a very heavy drinker from about the age of 18 till about age 31 when I first joined AA. I was also an IV cocaine addict for the 8 years leading up to this event on a pretty fixed binge cycle of 3X/week. Horrible, horrible.

I did AA all-the-way: 5'ish meetings a week for years (this is now 1986-89), read all the books (and liked much of what was in many of them), had several sponsors, was a sponsor to several... 'the whole 9 yards' as we say in the States.

However, the cravings never really left me, and after starting and stopping Antabuse several times, I just decided to stay on it for life. Got remarried 3 yrs ago, and my wife gives it to me every night, and I say "thank you."

After leaving a position in a substance abuse treatment center that I had held for over a decade, I was contacted, two weeks later, by an old friend and mentor who asked me to take cover his solo Manhattan practice as he was very ill. So, with my characteristic impulsivity, I suddenly found myself in a solo addiction medicine with absolutely no background in running a business or in the solo practice of medicine.

OK, finally, here's where the naltrexone comes in. In this office, where I was often entirely alone, there were all sorts of drugs in drawers, falling out of closets, and in our "locked box" (filing cabinet). Really interesting stuff like morphine sulphate 25mg/cc in multiple dose bottles and lots of buprenorphine. Other stuff also, benzodiazepines and the like, but it was the morphine I kept thinking about. But I knew I couldn't take it, and I didn't, but I found myself becoming more and more irritable. I was doing a lot of pain work and outpatient detoxification which involves counting oxy-contin, dilaudid, and the like, and I found myself exerting conscious effort not to snatch a few for myself. I found myself becoming irritable whenever I was in the office.

I finally realized how dopey this was, and added naltrexone to my nightly supervised Antabuse regimen.

And my experience was truly amazing. Within days, I was no longer irritable around the office. I knew the morphine was still there, and I knew I still couldn't have it, but it no longer bothered me AT ALL. The drugs no longer had any salience for me and I was able to work happily with my detox and pain patients without any inner struggle.

Way cool, huh? I've also found that since I've been on naltrexone I've lost all desire for the two or three cigarettes I've held onto for all these years, and have let them go.

So while moderation is not an option for me, personally, I do see how it can play a role for problem drinkers who have a goal of moderate drinking. I think that for those having trouble completing MM's Step 2 - a 30 day period of abstinence, that naltrexone might provide the extra help you need to learn what it feels like to be sober without struggling. For another group of moderators, naltrexone might give you the experience of what it feels like to stop after one or two drinks without feeling cranky or irritable. And, if you are getting the full effect of naltrexone which to me includes this experience of 'decreased salience for the drug or drugs of abuse' on 50 mgs it would be reasonable to test a higher dose of 100mg daily for 2-3 weeks.

If you are in MM, and trying to work the program, and are having difficulty sticking with it, I strongly urge you to discuss naltrexone with your physician, and give it a try. It just might be the ingredient you've been missing.