Vivitrol is a once-monthly injection of naltrexone that reduces alcohol cravings and blocks much of the reward drinking produces. It is not addictive; it does not make you sick if you drink, and it is one of the most evidence-backed medications for alcohol use disorder.
It is also widely misunderstood, which is why so many people spend months researching it without ever making a call.
In this article, Michael Damioli, MSW, CSAT, Chief Clinical Officer at Colorado Medication Assisted Recovery, walks through what he wants every patient to know before the first appointment: who Vivitrol is for, what the first injection involves, and what the first 30 days feel like.
If you are comparing treatment options for drinking right now, this is the conversation you would have if you called us.
What Is Vivitrol and How Does It Work for Alcohol?
Vivitrol is the extended-release, injectable form of naltrexone. One shot from a medical provider lasts about four weeks, which removes the daily decision of whether to take a pill.
Naltrexone is an opioid blocker. That sounds strange for an alcohol medication until you know how drinking works in the brain: alcohol triggers a release of natural endorphins, and those endorphins land on opioid receptors to produce the warm, rewarding part of being buzzed. Vivitrol sits on those receptors and blocks them. According to SAMHSA, the result is reduced craving and reduced reward, which is exactly the combination that helps people stop.
| What Vivitrol does | What Vivitrol does not do |
| Reduces alcohol cravings | Does not make you sick if you drink (that is Antabuse) |
| Blocks most of the euphoric reward of drinking | Does not prevent intoxication or impairment |
| If a relapse happens, tends to shorten it and reduce how much is drunk | Does not create dependence, a high, or abuse potential |
| One shot covers about four weeks | Does not work as a standalone cure without counseling |
That third row on the left is the part Damioli highlights most with patients. In his words, if somebody does relapse on Vivitrol, the drinking tends to be shorter and lighter, because the payoff is not there, and people come back to treatment sooner. The medication does not just help prevent the slip. It shrinks the slip.
The evidence backs the approach: in the clinical trial behind Vivitrol’s FDA approval, patients receiving Vivitrol with counseling had 25 percent fewer heavy drinking days per month than patients receiving placebo with counseling.
Who Is a Good Candidate for Vivitrol?
In our assessments, the patients who tend to do well share a few things:
- They have decided they want to stop or seriously reduce drinking, and cravings are the thing sabotaging that decision
- They can get through a short alcohol-free window before the first shot
- They prefer a monthly appointment over remembering a daily pill, or they know from experience that they stop taking daily medications
- They are willing to pair the medication with counseling, because the shot handles cravings, not the reasons behind the drinking
There are two hard medical requirements. First, you need to stop drinking before starting: the FDA approved Vivitrol for people who are alcohol-free at the start of treatment, typically about a week.
If you are still drinking daily, that window can feel impossible, and this is where CMAR is different from a standalone Vivitrol clinic: our outpatient detox program can manage alcohol withdrawal medically, with daily monitoring and comfort medications tapered over several days, so the path from drinking to first injection is supervised rather than white-knuckled. If you are wondering what that gap looks like, we break down the timeline in how long does alcohol withdrawal last.
Second, you must be fully opioid-free, usually 7 to 14 days, including painkillers. Because Vivitrol blocks opioid receptors, starting it with opioids in your system triggers immediate, severe withdrawal. This is screened carefully at intake.
One more caution from the transcript of our clinical conversations: anyone with existing liver damage needs clearance from their liver specialist first, since naltrexone is processed by the liver. Outside of that, Damioli is direct: most people tolerate Vivitrol very well, and we encourage most patients with alcohol use disorder to at least consider it, following an assessment with our medical provider.
Wondering whether you would clear those requirements? That is a ten-minute phone conversation, not a research project. Call CMAR at (833) 448-0127 and ask. No commitment comes with the question.
Is Vivitrol Just Trading One Drug for Another?
This is the concern Damioli hears most, and his answer starts with a distinction: dependence is not addiction.
“A diabetic is dependent on insulin, but nobody says they’re addicted to it. There’s a difference between a drug that’s causing issues in your life and a medication that’s helping you be more functional in your life.” Michael Damioli, MSW, CSAT
With Vivitrol the concern dissolves even further, because there is nothing to trade to. Naltrexone is a blocker, not an activator. It produces no high, no euphoria, no withdrawal when you stop, and no street value. It is not a controlled substance. You cannot become addicted to a medication whose entire job is to keep receptors quiet.
You can become a person whose cravings no longer run the schedule. That is the trade.
What Happens the Day of the First Injection?
Patients are often surprised by how ordinary the first day is. At CMAR, it looks like this:
- Intake and assessment. You meet our medical provider for a full assessment and physical workup, including your drinking history, medications, and liver health. Labs are drawn if needed.
- Opioid screening. We confirm you are opioid-free before the shot is cleared, because safety here is non-negotiable.
- The injection itself. Vivitrol is a single intramuscular shot in the upper buttock, given by our medical team. It takes a few minutes.
- The plan for the month. Before you leave, your counseling and group schedule is set, because the medication is one half of the treatment, not the whole of it.
Soreness at the injection site for a few days is the most common complaint. Some people have nausea or stomach upset in the first days, which typically settles. You come back in about four weeks for the next shot, and our team checks in well before then.
What Do the First 30 Days Feel Like?
For most people: quieter. The background noise of craving turns down, sometimes dramatically, and the evening hours stop being a negotiation.
Some patients describe the first few weeks as flat, like nothing is quite as enjoyable. Damioli takes that seriously rather than waving it off. Part of it can be the medication settling in, and part of it is early recovery itself: a brain that has leaned on alcohol for reward needs time to remember how to generate its own. Either way, it is usually temporary; it is worth telling your provider about, and it is exactly the stretch where group support carries people, because everyone in the room has felt some version of it.
The first 30 days are also where counseling stops being a formality. Vivitrol handles the chemistry of craving. It does nothing about the stress, the habits, the 6 p.m. trigger, or the relationships around the drinking. That is what the therapy is for, and it is why the manufacturer itself states the medication must be paired with a recovery program to work.
If the flat stretch, the trigger hours, or the first month in general is what worries you, that is a good sign you are taking this seriously. Talk it through with our team before you decide anything: (833) 448-0127, or start with our Vivitrol program page.
What Does Success Look Like at 90 Days?
Not just a sobriety streak. Abstinence, or a major reduction in drinking, is the first indicator we look for, but Damioli calls it the simple one. The markers that tell us Vivitrol and treatment are actually working are broader:
- Fewer and weaker cravings, and less mental energy spent fighting them
- Better sleep, better physical health, more energy
- Relationships at home improving
- Showing up more consistently at work
- Engagement with the recovery community, in whatever form fits
There is a moment Damioli describes seeing over and over, where the lights come on for somebody: they walk in one day and you can tell something changed in how they meet the world. Recovery takes time, the brain takes time to heal, and new habits take time to form.
But when the cravings are chemically quieted while that healing happens, people get to that moment more often, and sooner.
How CMAR Builds Treatment Around Vivitrol in Denver
Colorado Medication Assisted Recovery is built on a simple position: medication and therapy are two sides of the same coin, and using both increases your odds. As a dedicated provider of medication-assisted treatment in Denver, we combine:
- Medical care: assessment, the monthly Vivitrol injection, and outpatient detox when you need medical support to get alcohol-free before starting
- Therapy and groups: structure, accountability, and support, the core of how we treat, with individual counseling addressing what drives the drinking
- Practical help: insurance verification on the first call, and case management for the real-life barriers that derail treatment
Most people researching Vivitrol have already decided something needs to change. The medication question is really a fit question, and fit is determined in an assessment, not a search bar.
Ask a Clinician: Michael Damioli on Vivitrol for Alcohol
When someone comes in interested in Vivitrol, what do you want them to know before they walk in the door?
“That it’s appropriate for most people. Most people tolerate it very well and have minimal side effects, such as some GI distress in the first few days. The main exceptions are anybody currently on opioids, and anybody with existing liver damage, who needs to work with their hepatologist first. Outside of those situations, we really encourage most people to consider it, following an assessment with our medical provider.”
How do you answer someone who says Vivitrol is just replacing one addiction with another?
“I explain the difference between dependence and addiction. A diabetic is dependent on insulin, but that doesn’t mean they’re addicted to it. There’s a difference between a drug that’s causing issues with your family and your life, and a medication that’s helping you be more functional in your life. And with Vivitrol specifically, there’s no high in it at all. There’s nothing there to be addicted to.”
What actually makes it work for alcohol?
“It reduces cravings, and if somebody does have a relapse, it reduces the amount they drink and how long they drink, because it blocks a lot of the euphoric experience they’re looking for. So people come back to treatment and back to recovery sooner. It takes the power out of the slip.”
What does the treatment around the shot look like at CMAR?
“The medication is one pathway, and we want people using as many pathways as possible, because that’s what increases the odds. So at CMAR, Vivitrol sits inside the full program: our medical provider handles the injection and monitoring, outpatient detox gets someone safely alcohol-free first if they need it, and our counseling and groups do the work the medication can’t, the coping skills, the triggers, the life around the drinking. Medication and treatment are two sides of the same coin. We don’t hand out one side.”
Frequently Asked Questions
You will not get sick, and you can still become impaired, but most of the pleasurable reward of drinking is blocked. Many people find drinking simply feels pointless. Continued heavy drinking on Vivitrol is a signal to adjust the treatment plan, and it adds strain on the liver, so tell your provider.
For alcohol, you should be alcohol-free when treatment starts, typically about a week. You must also be fully opioid-free, usually 7 to 14 days, or the shot can trigger severe withdrawal. CMAR’s outpatient detox can bridge that window with medical supervision instead of willpower.
About four weeks. The extended-release injection maintains a steady level of naltrexone throughout the month, and then you return for the next shot. That monthly rhythm is the main advantage over daily naltrexone pills, which only work on the days you remember and choose to take them.
No. Naltrexone is an opioid blocker, not an activator. It produces no euphoria, no high, and no withdrawal when stopped, and it is not a controlled substance. It carries none of the trade-offs people worry about with other medications used in addiction treatment.
Some patients describe the first weeks as emotionally muted. Part of that can be the medication, and part is early recovery itself, as the brain relearns to produce reward without alcohol. It is usually temporary and worth reporting to your provider; it is also one reason group support matters most in the first month.
