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Should My College Student Take Naltrexone For Alcohol Use?

Does binge drinking have to a part of the college experience?

When you drop your child off at college for the first time, you probably have a long list of instructions to give them. Yet, there is a short list of important, even life-saving, points that are so important, you want to make certain that you have your child’s full attention.

One of those key instructions that you want to make very clear is to not drink alcohol. You stop what you are doing, look your child in the eye, and say, “I don’t want you drinking alcohol. But, since I know that college kids like to drink, I want you to be careful. Do not drink too much. Avoid dangerous activities such as hazing or drinking games.”

Then, you may remind them of some horror stories that have been in the headlines. Fraternity hazing activities with male students gone wrong. A university student gets locked in the trunk of a car and told he cannot get out until he finishes the alcohol they locked in with him. He is then found lifeless the next day. Cause of death: alcohol poisoning.

Or, you may tell one of the stories of a college girl who was the victim of sexual assault after drinking too much alcohol and passing out at a party. College campuses today do what they can to control heavy drinking and alcohol abuse on campus, but they have one major obstacle. The typical college student is a legal adult.

Is any amount of alcohol consumption safe for college students?

While the legal drinking age in the United States is 21, underage drinking is still common on college campuses. Student drinking occurs for students of all ages.

Is it safe for a 21 or 22-year-old college student to engage in heavy drinking? As we know now, there is no safe amount of alcohol. And, alcohol is one of the deadliest drugs of abuse. Drug deaths from opioids and alcohol dwarf the rate of deaths from any other drug.

Even terrifying street drugs, such as crack and meth, do not cause death at such as high rate as alcohol. In fact, alcohol may be as much as ten times deadlier than those highly illegal and addictive street drugs.

The American Cancer Society has determined that there is no safe amount of alcohol. The ideal amount of alcohol for adults to consume is no alcohol. Cancer, of course, is not the only concern when it comes to drinking, and will probably not scare a college kid.

Alcohol related mortality will probably not mean much to a college undergraduate.

The central nervous system does not fully develop until around the age of 25. The process of myelination, which is the full insulation of neurons in the brain, is not complete until that time.

The state of partial myelination of the brain, during natural development in the late teens and early twenties, puts college students at risk for making dangerous decisions without fully considering the consequences.

Young adults have a sense of immortality and invincibility that is partly due to the underdeveloped nature of their brains. It can be difficult to impart to a college student the dangers of alcohol consumption, especially when it gets out of control.

According to the NIAAA, there is an emerging trend of high intensity drinking among adult men and women, 18 years-old and older, related to excessive drinking. The high rate of binge drinking, according to a recent college alcohol study, is leading to significant increases in alcohol overdose and ER visits.

Why do college campuses hand out condoms to students?

On many campuses, there are educational events to warn students of the dangers of risky behavior. While students may have been educated on topics such as safe sex in high school, universities want to do their part in providing this essential information.

Of course, it would be ideal to ask college students to be abstinent from sex and from drinking. Wouldn’t it be great if the deans or college presidents of universities could inform students at a substance abuse and alcohol education event that while they are still under the care of their parents, they must not engage in risky adult behavior with negative consequences? One brief lecture from the dean, and all the students nod their heads and agree not to have sex, drink alcohol, or use drugs.

Unfortunately, the world does not work that way. What experts have come to understand is that harm reduction is the best solution to addressing dangerous behavior in many cases. Harm reduction means to meet a person where they are at and give them tools to reduce the dangers of these inevitable activities.

So, in educating students on safe sex and the dangers of sexually transmitted infections and unplanned pregnancy, universities may make condoms available to the students. This is as if to say, “we would rather you not have sex, but we know that some of you will do so anyway, so here is a tool that will help to keep you safe and here is how to use it.”

Should universities provide naltrexone to students? What does naltrexone have to do with alcohol consumption?

Naltrexone is an opioid-receptor-blocking medication. It is a 50 mg pill that can be taking by mouth once daily. It is also available in a monthly injection that provides about the same effect as taking the pill every day.

Naltrexone was first identified and patented in the 1960s. In the 80s, it was approved by the FDA for treating opioid addiction. By blocking the opioid receptors, the patient found that they could not get high, and they also had fewer cravings for opioids.

In studying the drug, doctors and researchers learned that people who took naltrexone also had fewer cravings for alcohol. In the 90s, the FDA gave approval to the drug for treating alcohol use disorder. Alcoholics who went through detox and rehab could ask their doctor for a naltrexone prescription to support their recovery.

What is TSM?

Unfortunately, naltrexone was not especially well-received. Doctors did not prescribe it very often and patients did not ask for it. Maybe it was a failure in marketing, or possibly, naltrexone was not prescribed in the most effective way possible.

While US doctors were not excited about helping alcoholics to stay sober with naltrexone, a different kind of research was being done outside the United States. A protocol for using naltrexone for alcoholism was developed and given the name, The Sinclair Method (TSM), named after a Dr. Sinclair, who did much of the early research.

Dr. Sinclair had the idea that naltrexone might be used with alcohol consumption to help reduce the patient’s level of drinking. Following TSM is fairly easy. Patients are instructed to take a naltrexone tablet one hour before drinking.

Why is TSM unpopular in the United States?

Why is The Sinclair Method not used more often? Why do most US doctors not even know about it? If it works, shouldn’t addiction doctors and rehabs be talking about it to all of their patients with alcohol problems?

To better understand the problem, imagine if the United States government was run by the Catholic Church. Of course, there is nothing wrong with the Catholic Church, but there are good reasons why one of the founding principles of our government is the separation of church and state.

If the church had control over our laws and rules at all levels of government, sex education would be very different in schools. There would likely be no talk of birth control. Universities would not talk about safe sex, they would only insist on no sex. There would be no condoms handed out to college students. Condoms might not even be legal.

We have a similar issue when it comes to addiction treatment. The program of Alcoholics Anonymous (AA) is tightly bound to medical addiction treatment in the United States.

AA is a spiritual program that recommends a program of abstinence from alcohol.

While the program does insist on the belief in a higher power, referred to as God, members of the program may define their own higher power in any way they wish. The program is inclusive to people of all faiths.

Is AA a church? If you were to ask any AA member this question, they would point out that it is a spiritual, not religious program. They would claim that AA is certainly not a church. However, prayer and the belief in a higher power is an essential part of the program, and the larger organization has the legal tax structure of a church.

Alcoholics Anonymous is unique in its influence during the 20th century on government and its involvement in all levels of addiction treatment. The founder of AA, Bill Wilson, and his colleagues were highly effective in promoting the program and gaining the support of highly influential people.

It is only in recent years that rehabs are starting to offer AA alternatives. Some rehabs are also providing medical treatment for alcohol use disorder and other addictions instead of insisting on full abstinence in accordance with the principles of AA.

What does a naltrexone tablet have in common with a condom?

Universities provide condoms to students for the purpose of harm reduction. They are not giving them out to encourage students to have sex. They want students to behave responsibly, and condoms can help to prevent pregnancy and the spread of disease.

Naltrexone, when used with The Sinclair Method protocol, can be seen similarly as a form of harm reduction. Just like a person who is sexually active carries a condom with them just in case they need it, a person who drinks alcohol can carry a naltrexone tablet with them. If that person is in a situation where they know they will be drinking, they take the tablet one hour before drinking starts.

The naltrexone will help the person who drinks to control their drinking and drink less. There will be less craving, less obsession, and less compulsion to continue drinking after the first drink. Naltrexone helps to curb drinking.

What if universities could give students naltrexone? For now, naltrexone is a prescription drug and can only be obtained with a doctor’s prescription. However, universities do have health centers that employ doctors, physician assistants, and nurse practitioners. It would be possible to make naltrexone available to students.

Of course, we would rather that our students not drink alcohol, but if they are going to have a drink, we want them to drink safely. An important part of safe alcohol consumption is to stop before becoming intoxicated.

Does naltrexone make campus drinking safe?

Unfortunately, naltrexone is not a magic pill. It will not prevent all drunk driving and motor vehicle crashes. Naltrexone will not put an end to academic consequences of alcohol misuse and it will not stop all alcohol related sexual assault.

There is still a need for ongoing alcohol use education and access to counseling and therapy for all college students. Maintaining the mental health of college students is critically important. College life can be stressful and many students will turn to drinking as a form of stress relief.

Yet, naltrexone can help to make a difference. A person who uses naltrexone to curb drinking early on will likely have less of a risk of developing serious alcohol dependence later in life. By providing a mechanism for pharmacological extinction of the development of alcohol addiction in the brain, healthy drinking habits can be formed early on before a young adult at risk develops full-blown alcohol use disorder.

Is gray area drinking a serious problem on college campuses?

A new term has come into use in the past few years to describe a particular type of alcohol drinker that may represent the typical college student. The gray area drinker does not drink alcohol every day of the week. They do not consider themselves to be an alcoholic or to have a drinking problem.

However, the gray area drinker does tend to get out of control when they do drink. On the weekends, when going out to parties or other social events where alcohol is served, they tend to engage in heavy drinking. They are often binge drinkers, but maybe only 1-3 days per week.

A college student may function very well in school and have high grades, yet they may also be a gray area drinker. College drinking traditions often encourage binge drinking. The problem with gray area drinking is that it puts a person at higher risk for a tragic event, such as alcohol poisoning, date rape, motor vehicle crashes, or other alcohol related unintentional injuries or alcohol related mortality.

When a person is pulled over by the police for DUI or DWI, the authorities are concerned with intoxication at that moment and with blood alcohol concentration. They do not care if a person is an alcoholic or a gray area drinker. At that moment, they are confronted with a person who poses a serious risk to themselves and others.

Naltrexone works very well for many gray area drinkers.

In my experience, I have seen gray area drinkers do very well with naltrexone to help them reduce their alcohol intake. Once we change our mindset with respect to the medical treatment of alcohol use, we open up a whole new world of possibilities.

The old model of addressing non-addictive drinking was that individuals had a responsibility to use willpower and self-control to manage their drinking. Experts preached to young people and adults about the dangers of excess and the importance of not giving in to peer pressure.

By seeing alcohol use in a new light and applying our better understanding of how the brain works, we can help people to manage their drinking with a combination of tools. Treating alcohol use disorder with rehab and medications, such as naltrexone is a great way to help an alcoholic to recover.

What if we started much earlier in the process, helping people at risk for alcoholism to not progress to the point where they have an alcohol problem? We have the tools to help young adults in college to prevent alcohol dependence. The challenge is to move forward in making these tools more readily available.

When a college student begins to move towards becoming a gray area drinker, we have an opportunity to help them. We can help them to avoid the consequences of excess drinking and to avoid developing alcohol use disorder.

Prevention is the best medicine when it comes to treating alcohol misuse.

There is a saying in the world of recovery that once a cucumber becomes a pickle, it can never go back to being a cucumber again. An alcoholic must always be careful to avoid slipping back into old habits that might lead to heavy, uncontrolled drinking again.

It may be possible to prevent the development of alcoholism by addressing the issue at an early age. Education and counseling are excellent tools, but they may not be enough.

Naltrexone is a relatively safe drug. It has been in use for decades and has few risks associated with it. There has been a movement to push for the approval of naltrexone as an over-the-counter drug. It may be possible one day to obtain naltrexone as easily as Advil, Motrin, or skin cream.

While it is not a perfect solution to end all alcohol-related problems on college and university campuses, it could make a significant improvement in helping students to control excess alcohol consumption. It is all about harm reduction and keeping our children safe.

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