Trying to Drink Less? How Naltrexone Can Help Change the Pattern

You planned on two drinks. The evening ended at five. By morning, the workout you had lined up felt considerably less appealing.

Maybe it happened once. Maybe you’ve made the same promise to yourself several weekends running. Either way, you don’t have to wait for a crisis to ask for help.

“I think the biggest misconception is that medication for alcohol is reserved for someone whose life has completely fallen apart,” says Daniel Montville, M.D., a psychiatrist and chief medical officer of Choose Your Horizon, a telehealth company offering alcohol treatment.

For some people, that conversation can include naltrexone, an FDA-approved prescription medication for alcohol dependence. It can also clarify something more personal: whether drinking less is a reasonable goal, or whether stopping would be safer.

Drinking less can be a meaningful treatment goal

“Moderation can absolutely be a medically reasonable treatment goal for some people,” Montville says.

He looks at whether someone can reduce heavy drinking, regain control and improve daily life. The goal needs to fit the person’s health and circumstances, with room to change if moderation isn’t working.

In 2025, the FDA qualified a substantial reduction in drinking-risk levels as an acceptable primary endpoint in medication trials for adults with moderate to severe alcohol use disorder. Specifically, it recognized a two-level reduction on the World Health Organization’s risk-drinking scale as clinically meaningful.

That recognizes improvement without requiring abstinence in every case. It does not make continued drinking risk-free.

Montville is more cautious when someone has severe alcohol use disorder, physical dependence, repeated difficulty controlling drinking or serious alcohol-related medical complications. Abstinence, supervised withdrawal or more intensive treatment may be appropriate.

“The goal is not moderation at all costs. The goal is reducing harm,” he says.

What naltrexone actually does

Naltrexone blocks opioid receptors involved in alcohol’s rewarding effects. That can make alcohol feel less compelling and help reduce cravings. Describing it as simply “blocking dopamine,” as some marketing does, misses the mechanism.

“Naltrexone is not an aversion medication, and it does not make someone physically incapable of drinking,” Montville says.

You can still become intoxicated while taking it; it does not make driving after drinking safe.

The evidence extends beyond maintaining abstinence. A 2023 JAMA systematic review found that oral naltrexone at 50 milligrams daily reduced the likelihood of returning to heavy drinking compared with placebo. That analysis included 19 trials and 2,875 participants.

About 11 people needed treatment for one additional person to avoid a return to heavy drinking over the studies’ follow-up periods. Most trials in the broader medication review also included counseling or another nonmedication intervention.

That is a meaningful benefit, with individual responses that vary.

Montville generally begins with daily treatment, the better-established approach. Clinician-directed use before anticipated drinking has randomized evidence too, but a smaller evidence base; it differs from the labeled daily regimen.

He assesses progress over several weeks rather than one evening: fewer heavy drinking days, fewer drinks when someone drinks and less mental energy spent negotiating with cravings.

A medical review comes before a prescription

“Access should be straightforward, but there should still be a real medical evaluation,” Montville says.

Common naltrexone side effects include nausea, headache, dizziness, fatigue and vomiting. A clinician should also review liver health and other medications.

Opioid use is especially important. Naltrexone’s prescribing information contraindicates its use in people receiving opioid painkillers, those with opioid dependence and those in acute opioid withdrawal. It can precipitate severe opioid withdrawal and interfere with opioid pain relief.

Tell medical and dental teams that you take it, including before surgery. Trying to overcome the blockade with larger opioid doses can cause a fatal overdose; reduced opioid tolerance after stopping treatment also matters.

Alcohol withdrawal is a separate concern. If you drink heavily every day, need a morning drink to feel normal or become shaky, sweaty or unwell when alcohol wears off, seek medical advice before abruptly stopping or sharply reducing your intake. A history of withdrawal seizures is particularly important to disclose.

Alcohol withdrawal can be life-threatening, and naltrexone does not treat it.

The payoff may start with getting your mornings back

Ask Montville what patients notice after substantially reducing their drinking, and he starts with everyday life.

“They wake up feeling better. Their mornings become more predictable. They miss fewer workouts,” he says.

These are his clinical observations, not guaranteed results. But the practical value is easy to understand: following through on training plans, eating more consistently and spending fewer mornings recovering from the night before.

There is evidence for measurable health improvements, too. An analysis of 1,142 participants in the COMBINE alcohol-treatment study associated reductions in drinking-risk levels with improvements in systolic blood pressure, liver enzymes and quality of life.

Montville avoids promising a particular physique or hormonal response.

“So I would not tell a man that cutting back on alcohol guarantees higher testosterone, a lower body-fat percentage, or more muscle,” he says.

For someone whose drinking repeatedly interrupts training, greater consistency is a useful place to start measuring progress.

Support needs to fit the life you have

Medication can help with cravings, but it doesn’t automatically change the routines surrounding alcohol: the after-work drink, the social pressure, the habit of opening another bottle.

“I consider support critically important. What I do not think is critical is any single form of support,” Montville says.

He describes options including therapy, coaching, recovery groups, peer support and clinician check-ins. Some can happen virtually, making participation easier around work and family.

Choose Your Horizon combines medical care with tools such as coaching and progress tracking. Montville’s broader point applies beyond any platform: support should be something a person can realistically use.

“Accessibility matters because the theoretical best treatment is not the best treatment if the patient cannot realistically participate in it.”

GLP-1 research is promising, with important limits

GLP-1 medications have attracted interest for effects that may extend beyond appetite and weight. Human trials now offer evidence that semaglutide can influence some alcohol-related outcomes.

A 2026 Lancet trial enrolled 108 adults with moderate to severe alcohol use disorder and obesity. Over 26 weeks, semaglutide injections produced a greater reduction in the percentage of heavy drinking days than placebo; both groups also received cognitive behavioral therapy. The estimated difference was 13.7 percentage points.

The participants’ obesity matters when considering how broadly those findings apply.

A separate eight-week trial of oral semaglutide in 50 adults found fewer heavy drinking days, but no significant benefit on its primary laboratory craving measure or average drinks per day. The results support further research rather than a blanket promise.

GLP-1 medications are not FDA-approved for alcohol use disorder. Prescribing an approved product specifically for alcohol reduction is off-label.

Combining one with naltrexone raises another question: does the combination add benefit beyond either treatment alone?

“That is a hypothesis. It is not yet a proven fact,” Montville says.

He describes Choose Your Horizon’s internal outcomes as preliminary and acknowledges that routine care cannot fully separate medication effects from coaching, weight loss and other behavior changes.

The formulation matters, too. The company’s GLP-1 program advertises compounded semaglutide drops taken under the tongue. The trials above studied injections or tablets, so they do not establish those drops’ effectiveness. Compounded drugs are not FDA-approved and do not undergo FDA premarket review for safety, effectiveness and quality.

Adding a medication also means assessing its risks. Both treatments can cause gastrointestinal symptoms; GLP-1 suitability requires a separate medical review.

Start with what’s actually in your glass

Montville’s first step is simple: “Start with measurement, not labels.”

Track how much you drink, how often and what happens afterward. Include serving sizes and alcohol strength.

A U.S. standard drink contains 14 grams of alcohol: roughly 12 ounces of 5% beer, 5 ounces of 12% wine or 1.5 ounces of 40% spirits. A strong beer or generous pour can contain more than one.

Notice the gap between what you intended to drink and what you actually drank. Consider missed workouts, mood, sleep, work and relationships.

A clinician can assess alcohol use disorder, withdrawal risk and treatment options. You can have that conversation before deciding whether medication belongs in your plan.

“Ask whether alcohol is taking more from your health, performance, relationships, or life than you want to give it,” Montville says. “If the answer is yes, that is enough reason to have the conversation.”

This article is for general education and is not a substitute for individualized medical advice, diagnosis or treatment. Medication selection and drinking goals require a licensed clinician’s assessment. Do not start, stop or combine medications without medical guidance. People with possible alcohol dependence should seek medical advice before abruptly stopping or sharply reducing drinking. Seizures, hallucinations or severe confusion require emergency medical care.

This story was originally published by Men’s Fitness on Oct 26, 2026, where it first appeared in the Nutrition section. Add Men’s Fitness as a Preferred Source by clicking here.