Category: Ambulatory Detox

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.

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

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