Targeted opioid receptor antagonist therapy (TORAT)/ targeted naltrexone therapy is an approximately 78% effective treatment to control drinking problems and alcohol dependence (alcohol use disorder/ alcohol addiction/ alcoholism). An opioid receptor antagonist (ORA) is taken one hour before consuming alcohol every time there is a risk of consuming alcohol anticipated. Naltrexone is the most commonly prescribed ORA.
The ORA binds to opioid receptors in the brain. Endorphins that are released in response to drinking alcohol are then blocked from binding to these receptors. Over time, pharmacological extinction of the long term reinforcement effect of endorphin release following alcohol consumption, is achieved. Alcohol cravings are reduced to pre-addiction levels in approximately 3 - 4 months. The reinforcement that progresses addiction is prevented. The nervous system reacts by weakening the neural connections that cause craving and drinking. It is realistic to expect drinking to be controlled to within recommended limits, and maintained, after pharmacological extinction has been achieved. TORAT is a lifelong treatment.
Around one quarter of those on TORAT become 100% abstinent. As with all medical treatments, individual results may vary and will not be completely effective for everyone. Changes in medication dosage should be discussed with your health practitioner.
Naltrexone may be prescribed to be taken as needed/targeted at times of higher risk in the first instance. This approach may be more effective than daily naltrexone/injectable naltrexone in many people and can reduce the exposure to side effects experienced on naltrexone. For others, daily naltrexone may be the preferred option if compliance in taking targeted naltrexone when required cannot be achieved over time.