In this episode, Dr. Joseph Vachelli, a leading expert on naltrexone (Nxone), discusses how patients can determine if they need a higher dose of the medication when treating alcohol use disorder. He explains that the standard dose of 50 mg may not be effective for everyone, especially those who continue to experience the pleasurable effects of alcohol despite taking the medication. Dr. Vachelli highlights that the effectiveness of naltrexone can be assessed by the change in how alcohol feels—specifically, a reduced “high” or euphoria and diminished cravings after a few drinks are signs that the dose is working. However, if someone still experiences a “buzz” or pleasurable effects from drinking, it may indicate that a higher dose is necessary or that the person metabolizes the drug quickly, reducing its efficacy.

He emphasizes that different drinking habits, such as rapidly consuming high-concentration alcohol like shots, may require a higher naltrexone dose compared to slower consumption of beer. Dr. Vachelli also clarifies that naltrexone does not block all effects of alcohol, particularly its sedative effects, so feeling tired after drinking is not an indication of insufficient medication.

Importantly, Dr. Vachelli warns against misusing naltrexone to “game” the system—to continue drinking and still achieve a buzz. He stresses the need for using naltrexone as part of a structured recovery plan that includes psychosocial and behavioral support. Drawing from his clinical experience, he shares that medication alone is insufficient if patients are not genuinely motivated to recover. He developed a psychosocial program to enhance treatment adherence and motivation, which dramatically improved outcomes.

Finally, he underscores the critical role of social support, such as peer groups or coaching, in sustaining recovery. Whether patients use the Sinclair Method, daily oral dosing, or extended-release injections, coupling medication with behavioral support is essential for long-term success in overcoming alcohol addiction.

About Katie Lain

Katie Lain struggled with alcohol use disorder for nearly ten years until she stumbled upon The Sinclair Method. She couldn’t believe how effective the treatment was as it truly allowed her to become a moderate “normal drinker” – yet somehow, most people hadn’t even heard about it before. Katie Lain’s personal success with The Sinclair Method has inspired her to be a lifelong advocate for this method. Today, Katie is "accidentally" alcohol-free as she unexpectedly lost interest in drinking, thanks to this treatment. Now she advocates for and supports others through this wildly effective (yet unknown) treatment for alcohol use disorder. 

*Links*

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