Kate Carbonari has been drinking since she was 15 years old. By her early 60s, she began to rethink her relationship with alcohol. “I’ve gone through a lot of different drinking cycles in my life, and I feel like now, finally, as a society, we’re starting to say, ‘What are we doing with this alcohol here? This is so not good for us,’” she says.
Her first step was tracking her intake with an app. On average, she was drinking about 28 drinks a week—an amount her doctor said raised her risk for several health conditions. A few months later, the company behind the app reached out to ask whether she’d be interested in trying naltrexone, a prescription medication that reduces alcohol’s rewarding effects in the brain. Her doctor agreed that the medication could be worth a try—and it was. Today, she’s drinking a max of seven drinks per week and taking at least three full days off per week.
Using naltrexone to cut back on drinking isn’t new, says Sarah Wakeman, a senior medical director for substance use disorder at Mass General Brigham. The approach dates back to the 1980s with the Sinclair method, which pairs drinking with naltrexone to blunt alcohol’s pleasurable effects. In parts of Europe, Wakeman adds, people have long used a “pill-in-the-pocket” strategy, taking the medication only when they anticipate drinking.
In the United States, however, naltrexone remains underused—even among people with alcohol use disorder. “It’s in the single-digit percent of people with alcohol use disorder who take it,” Wakeman says. Still, clinicians are beginning to see growing interest among people who don’t meet the criteria for alcohol use disorder but regularly drink above recommended limits—more than 14 drinks per week for men and more than seven drinks per week for women. Direct-to-consumer companies are helping drive that shift by adding naltrexone prescriptions to their offerings.
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