Naltrexone gets to work fast. A pill hits its peak level within about an hour, and the monthly Vivitrol shot within a few hours.
Quieter alcohol cravings, the part most people care about, take a little longer. When the medication is paired with therapy, CMAR addiction specialist James Jackman says “patients usually see rapid results within the first couple of weeks.”
James is a Certified Addiction Specialist who has worked in addiction treatment in Colorado since 2015. Everything he says below comes from our October interview with him.
Naltrexone starts working on the first day. A pill reaches its peak level within about an hour, and the monthly Vivitrol shot peaks about 2 hours after the injection. The effect on cravings builds more slowly: most people notice quieter cravings within the first couple of weeks, especially with therapy.
Here is the timeline from the naltrexone tablet prescribing information and the Vivitrol prescribing information:
A naltrexone pill reaches its peak level within one hour. A 50 mg dose blocks the effects of opioids for up to 24 hours, which is why the usual alcohol dose is one pill a day.
With Vivitrol, the first peak comes about 2 hours after the shot and a second one 2 to 3 days later. From there, the medication stays in your system for more than a month.
This is when most people notice the difference: cravings get quieter, and drinking feels less rewarding.
Naltrexone blocks the opioid receptors in the brain, which seems to take some of the reward out of drinking. People notice “a moderate to significant decrease in craving,” James says, and if they do drink, alcohol “is not as rewarding for them as it was before.”
Even the label admits the exact mechanism for alcohol “is not understood.” Naltrexone is also nonaddictive, according to NIAAA, and the label notes it does not lead to physical or psychological dependence.
Most people describe the first weeks as quieter rather than dramatic: fewer cravings, less mental noise around alcohol and mild side effects that fade. Patients often put it this way:
Side effects tend to be mild. On the pill, the most common are nausea, headache, dizziness and tiredness. With Vivitrol, nausea and soreness or swelling where the shot was given are most common, and James says these “decrease over time, and they’re manageable, they are tolerable.”
Naltrexone also does not make you sick if you drink, unlike Antabuse. Our guide to drinking while taking naltrexone explains why that still isn’t a green light.
Both forms contain the same medicine and start working within hours: the pill peaks in about an hour, and Vivitrol about 2 hours after the shot. The difference is how often you take it, once a day or once a month, and how steady the level stays.
| Naltrexone pill | Vivitrol shot | |
|---|---|---|
| How often | Once a day (50 mg for most people) | Once every 4 weeks |
| Peak level | Within about 1 hour | About 2 hours, then again at 2 to 3 days |
| How long one dose lasts | Up to 24 hours of opioid blocking at 50 mg | More than a month |
| Given by | You, at home | A healthcare provider |
Sources: naltrexone tablet prescribing information; Vivitrol prescribing information. For people who forget a daily pill, the monthly shot removes that step. Both require being opioid-free for at least 7 to 10 days before starting. See how they compare to another option in Vivitrol vs Antabuse.
Wondering whether naltrexone could quiet your cravings? Ask us on your first call. See how getting started at CMAR works.
Naltrexone works best with therapy, consistent dosing and a provider who adjusts the plan with you. The medication does its part. The rest comes from what surrounds it, and James puts willingness first:
If cravings keep pulling you back, naltrexone can take some of that pull away while you do the rest of the work. CMAR offers both the daily pill and the monthly Vivitrol shot through MAT for alcohol in Denver, as part of our medication-assisted treatment with therapy and groups.
Same-day starts are often possible, and we verify your insurance benefits before you come in.
Have more questions first? Our medication-assisted treatment questions post answers the ones we hear most, and our look at how effective medication-assisted treatment is covers the evidence. Call CMAR in Denver at (833) 448-0127.
A single 50 mg naltrexone pill blocks opioids for up to 24 hours, which is why it is taken once a day. Vivitrol, the monthly shot, keeps measurable levels in the body for more than a month. Ask your provider how long to wait before any planned surgery or pain medication.
No. Naltrexone does not produce a high, and its label states it does not lead to physical or psychological dependence. Most people notice quieter cravings rather than a change in mood. Some feel mild nausea, headache or tiredness in the first days.
Not while opioids are still in your body. Naltrexone blocks them, which can set off sudden withdrawal. Per the label, plan on 7 to 10 days opioid-free first, and up to 2 weeks after buprenorphine or methadone. Your provider will work out the timing with you before the first dose.
With the daily pill, the opioid block and craving support fade as the dose wears off, so ask your provider ahead of time what to do if you miss one. Using opioids during that gap can lead to a fatal overdose. If daily pills are hard to keep up with, ask about Vivitrol, given once every 4 weeks.
No. Vivitrol is not a deterrent like Antabuse, so drinking on it will not make you sick. It blocks the opioid receptors tied to the reward of drinking, so alcohol feels less rewarding and cravings get quieter. That still does not make drinking on it a good idea, so talk it through with your provider.
For most people who want to stop drinking, naltrexone or Vivitrol is the first medication to try. James calls it the first line “for the overwhelming majority of patients” because side effects are few, and the most common ones with Vivitrol come from the injection and ease over time.
For many people it does, and you can find out without committing for life. James tells patients they “have nothing to lose by giving it a shot.” If you see a benefit, you keep going. If not, you can stop and try a different approach with your care team.
Programs
Our Center
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Cortland Mathers-Suter
MSSA
Managing Partner
Cortland Mathers-Suter entered the treatment space after his own battle with addiction. He first worked as a peer mentor, before starting clinical work while completing his Masters of Science in social administration from Case Western Reserve University where he focused on policy and direct practice. Cortland moved to Colorado in 2015 to start his first addiction treatment program, AspenRidge Recovery. Under his tenure, AspenRidge Recovery became a two-location, nationally accredited organization. He has since spent the last two years researching and developing what is now Colorado Medication Assisted Recovery (CMAR).
According to Cortland, “Colorado Medication Assisted Recovery is the most important organization I have had the honor to help build. We’re offering a service that seeks to not only improve the lives of our patients but also evolve how we look at medication-assisted treatment in Colorado entirely. Most individuals receiving medication-assisted care only receive medication and urinalysis. Sure you can call that ‘treatment,’ but you can’t call that ‘recovery.’ Our model is about adding the missing recovery component, and thus affords an opportunity to achieve lasting change for each patient and the industry.”
Cortland and his treatment programs have received numerous honors. These include Colorado Business Magazine’s “GenXYZ” award, the 2020 “Titan 100” award, and his program AspenRidge Recovery was both a finalist for “Best Healthcare Company” and named in the “Company’s to Watch” by Colorado Business Magazine as well. He has been interviewed and quoted by numerous publications for his “addiction expertise”, including News Week, 5280 Magazine, the Denver Post, Elephant Journal, Colorado Biz Mag, and TheRecoverySource.org.
Tyler Whitman
Compliance/HR Administrator
Tyler is originally from Omaha, Nebraska. He worked in manufacturing administration for 18 years until he chose to pursue recovery from alcohol addiction, which led him to Chicago, Illinois. Since then, Tyler gained experience in retail, retail pharmacy, and healthcare as a vaccine coordinator for a local Colorado clinic. At the clinic, Tyler discovered that healthcare was the career change he had been looking for. His newfound passion for healthcare, combined with his lived experience with addiction, brought him to Colorado Medication Assisted Recovery as an Office Administrator.
In his free time, Tyler enjoys cooking, hiking, and skiing. He is currently pursuing a master’s degree in Health Services Administration from Regis University.
Simmeren Boanvala
BA
Outreach and Admissions Representative
Simmeren comes to CMAR after several years working admissions in inpatient psychiatry and addiction. A first-generation Colorado Native, Simmeren attended CU Boulder, where she earned a BA in psychology. Simmeren is currently completing her CAC III while working toward her master’s degree in marriage and family therapy.
According to Simmeren, “I joined CMAR because I believe in the quality and importance of the program whole-heartedly. My goal at CMAR is to guide each prospect who calls CMAR to find the best possible pathway to their recovery”. Simmeren currently lives in her hometown with her dog and cat.
Tyler Hale
Community Partnership Lead
Tyler Hale began his career in addiction treatment following a decades-long fight with his own substance abuse issues. Since achieving long-term recovery, Tyler has held various positions in direct care, client services, admissions and outreach departments at various addiction treatment organizations. From sober living program director to outreach director to admissions director at a drug and alcohol treatment program, Tyler consistently finds himself in leadership roles within the addiction treatment space.
Tyler is originally from Chicago, IL, where he graduated from Loyola University Chicago with a Bachelor of Arts in Sociology and Bioethics. Thereafter, Tyler built a successful career in the tech industry, before finding sobriety and a subsequent calling to help others. Tyler joined the team at CMAR because he believes in the efficacy of comprehensive and patient-centered outpatient treatment. In his free time Tyler enjoys camping, hiking and spending time with his newborn son.
Kirstin O’Carroll
MSW
Engagement and Relations Director
Kirstin O’Carroll started her career in addiction and mental health services 23 years ago after graduating with an MSW from The Oho State University. Hired directly from an internship program, she served as a case manager and vocational specialist on a community treatment team in Columbus, OH, working to help severely mentally ill adults remain at home and in a community setting. Within the same organization, she later transitioned to clinical assessment and crisis intervention services with children, adolescents, and adults. Through these experiences, she learned the importance of providing empathetic, high-quality care and the need to “start wherever the patient is” with regard to finding the best treatment & solutions for her patients.
After seven years, Kirstin made a career change to diagnostic sales and worked for several Fortune 500 companies as an acute care sales specialist. She is delighted to return “home” to her passion for helping others and believes her new role as community engagement coordinator for CMAR is the perfect alignment of both her clinical and sales skills. When not promoting CMAR, she can be found reading, running, hiking, watching movies, and spending time with her husband Dennis and senior canine son Reggie.
Thomas Mazzarella
LAC
Primary Therapist
Thomas is a Licensed Addiction Counselor (LAC) in the State of Colorado and a Licensed Addictions Specialist (LCAS) in the State of North Carolina with particular expertise in the treatment of chronic Substance Abuse Addiction and Dependency.
Thomas is dedicated to Individual, Couples, Family, and Group Counseling and Therapy for individuals with Substance Use and Mental Health issues and concerns.
James Jackman
CAS
Primary Therapist
James Jackman is a Certified Addiction Specialist and has been practicing addiction treatment in Colorado since 2015. James is pursuing his bachelor’s degree in psychology from Metropolitan State University Denver. James is a traditional CBT therapist specializing in childhood events that lead to adult addictions.
James has received special training in Family Systems, Inner Child, Maladaptive Schemas, and Adverse Childhood Experiences. James has worked in many treatment settings throughout his career and uses a client-centered treatment approach to help one recover from destructive patterns that facilitate addiction. In addition, James enjoys working with rescue animals and advocates for several local rescue organizations outside of work.
Megan Hanekom
LPC, LAC, NCC
Therapist & Clinical Compliance Officer
Megan is a licensed counselor who has worked in various mental health and addiction treatment environments. She practices cognitive behavioral therapy and motivational interviewing and believes in pulling from various therapeutic approaches to best support each individual. Megan received her bachelor’s in psychology and Spanish from Concordia College. She relocated from North Dakota to Colorado where she earned a master’s in counseling psychology from the University of Denver.
Outside of the office, Megan enjoys spending time with her two German Shepherds and her cat. She is passionate about fostering animals through various local rescues to find adoptive homes for dogs and cats in need.
Maggie Coyle
MA, LPC
Primary Therapist
Maggie Coyle, MS, MA, LPP, LPCC has worked in the mental health and addictions counseling field for the past six years. She has extensive experience in working in the varying levels of mental health and addictions treatment as well as with diverse populations.
She practices cognitive-behavioral therapy and dialectical behavior therapy as primary intervention methods. She has earned a bachelor’s degree in sociology as well as a master’s degree in clinical mental health counseling both from Northern State University in Aberdeen, SD. She has also earned a master’s degree in addictions counseling from the University of South Dakota in Vermillion, SD. Maggie moved from South Dakota to Colorado in June 2020 and is excited to be a part of the CMAR team.
Michael Damioli
LCSW, CSAT
Clinical Director
Michael Damioli has been passionately working in the fields of addiction treatment and mental health since 2012. He has held a variety of different roles within the addiction recovery space, ranging from peer support to direct clinical practice. Notably, Michael was part of a leadership group that developed a small therapy practice into a nationally branded addiction treatment program, which offers multiple levels of care to recovering professionals. Michael is a strong believer in the family disease model of addiction and has focused much of his clinical work and training on supporting families impacted by addiction. He also specializes in treating individuals suffering from co-occurring chemical and process addictions.
Michael is honored to be leading the clinical care team at CMAR and believes that excellent clinical care begins by simply treating a patient with dignity and respect. Michael is a strong advocate for ethical reform within the addiction treatment field and is excited to promote CMAR as an ethical and thought leader throughout the treatment & recovery industry. Michael earned his master’s degree in social work from the University of Denver and is independently licensed as a clinical social worker with the state of Colorado. He holds an advanced post-graduate certificate in marriage and family therapy from the Denver Family Institute as well as an advanced certificate in sexual addiction counseling from the International Institute of Trauma and Addiction Professionals.
Dwight Duncan
Psy.D
Psychologist
Dr. Duncan was born and spent most of his early life in California. He received his doctorate in clinical psychology from the University of Denver in 1987. He is a licensed psychologist as well as a licensed addiction counselor. He has had extensive training and experience throughout his professional career in medical psychology, mindfulness, integrated behavioral healthcare, and substance abuse.
Dr. Duncan is married and has one daughter, a neurologic physical therapist in Los Angeles.
Susan Miget
NP
Medical Provider
Susan has been in healthcare for more than 20 years. She was an ICU nurse for nine years, then returned to school and completed her master of nursing and family nurse practitioner degree at the University of Missouri-St. Louis in 2007. She practiced pain management for many years before developing her current passion for addiction treatment.
Susan has transitioned her practice to focus entirely on addiction treatment. She has worked in residential treatment, partial hospitalization (PHP), and intensive outpatient (IOP) programs. Susan most enjoys working with patients one-on-one in a private office to protect their confidentiality and ensure top-rate care. Knowing that addiction can affect anyone, anywhere, and at any time, Susan continues to strive to make treatment more accessible and confidential.
Whitney Grant
MSN, FNP-BC, ARNP, RN, CPN
Medical Provider
Whitney Grant is an experienced family nurse practitioner with experience and expertise in medication-assisted treatment. Whitney earned her BSN at the University of Miami before moving on to achieve a master of science in nursing degree there as well, becoming a nurse practitioner immediately thereafter.
Whitney has since achieved board certification from the ANCC as a family nurse practitioner. After spending her entire formative and educational years in South Florida, Whitney moved to Denver in 2018 to pursue a career as a provider in family practice, sub-specializing in addictions medicine. Whitney has worked under the guidance of Dr. Nathaniel Moore, CMAR’s medical director, since moving to Denver.
Nathaniel Moore
MD
Medical Director
Dr. Nathan Moore is board-certified by the American Board of Family Medicine. Dr. Moore attended Stanford University in Palo Alto, CA for his undergraduate work and then attended Duke University School of Medicine and obtained his M.D. in 1995. Dr. Moore then came to Colorado and completed his residency in family medicine at the University of Colorado’s Family Medicine Program at Rose Medical Center.
Dr. Moore practices primarily at our Aurora location. He provides comprehensive family medicine services and has a special interest in addiction medicine, treating patients with opioid use disorder as well as alcohol addiction.
Dr. Moore is married with three children. He enjoys mountain biking, running, and golf.
