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Alcohol Addiction Treatment · Updated April 2026

Vivitrol for Alcohol Addiction

Once-monthly naltrexone injection to reduce alcohol cravings — prescribed and administered at our four CARF-accredited outpatient clinics across Tennessee and Georgia.

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Same-day appointments available in most cases · TennCare, BlueCare, BCBS, UHC, and most commercial insurance accepted.

At a glance

Who Vivitrol is best for

Vivitrol (extended-release naltrexone) is for patients with alcohol use disorder who want a monthly injection alternative to daily oral medications. A single intramuscular injection blocks alcohol’s rewarding effects for approximately 28 days. Garbutt 2005 JAMA documented reduced heavy-drinking days in patients on Vivitrol. Patients must be opioid-free for 7-14 days before initiation to avoid precipitated withdrawal; liver-function testing is recommended at baseline given hepatotoxicity considerations.

At Restoration Recovery, Vivitrol is offered specifically for alcohol use disorder — not for opioid use disorder, where buprenorphine-based MAT (Suboxone, Sublocade, Brixadi) is our primary OUD pathway. Vivitrol injections are administered in clinic at our Chattanooga and Cleveland clinics; Soddy-Daisy does not offer injection services and our Ringgold clinic is preparing to begin scheduling. Same-week first appointments; TennCare, BlueCare, BCBS, UHC, and most commercial insurance accepted.

What Is Vivitrol?

Vivitrol is the brand name for extended-release naltrexone, an FDA-approved injectable medication used to treat alcohol use disorder. Unlike daily oral medications, Vivitrol is administered as a single intramuscular injection once per month at your provider's office. This eliminates the need for daily pill compliance and provides a steady, consistent level of medication throughout the treatment period.

At Restoration Recovery, Vivitrol is prescribed specifically for patients with alcohol use disorder as part of a comprehensive outpatient treatment plan. The injection is given by a licensed provider during a brief clinic visit, and each dose provides approximately four weeks of continuous medication coverage.

Safety considerations before starting Vivitrol

Vivitrol is well-tolerated for most patients with alcohol use disorder, but two clinical checks happen before your first injection:

  • Liver function testing. Naltrexone is hepatically cleared, and the FDA label includes a boxed warning regarding hepatotoxicity at high doses. Your provider will review your liver-enzyme labs (AST, ALT, bilirubin) at intake. Patients with active hepatitis or significant hepatic impairment may be better candidates for Acamprosate, which is renally cleared and safer in liver disease.
  • Opioid-free interval. Naltrexone is an opioid antagonist, so injecting it while opioids are present in the body precipitates immediate, severe withdrawal. Patients who have been using opioids must be opioid-free for 7 to 14 days before the first Vivitrol injection. We screen carefully for this, and patients with co-occurring opioid use disorder are typically referred to Suboxone, Sublocade, or Brixadi instead.

Common side effects include injection-site reactions, nausea, headache, and fatigue, particularly in the first few days after a dose. Your provider will review the full safety profile and your individual medical history before your first injection.

How Vivitrol Works for Alcohol Use Disorder

Naltrexone, the active ingredient in Vivitrol, is an opioid receptor antagonist. While this may sound counterintuitive for alcohol treatment, the science behind it is well established. When a person drinks alcohol, the brain releases endorphins that bind to opioid receptors, producing feelings of pleasure and reward. Over time, this reinforcement cycle drives compulsive drinking behavior.

Vivitrol works by blocking the opioid receptors involved in this alcohol reward pathway. With these receptors blocked, drinking no longer produces the same pleasurable reinforcement. Patients on Vivitrol frequently report that their cravings diminish significantly and that alcohol simply becomes less appealing. This pharmacological support creates a window of clarity that allows patients to focus on the behavioral and emotional work of recovery.

Who Is a Candidate for Vivitrol?

Vivitrol may be appropriate for patients who meet one or more of the following criteria:

  • Adults diagnosed with alcohol use disorder who are seeking medication support for their recovery
  • Patients who are ready to pause drinking around the start of treatment and continue with counseling support
  • Individuals who prefer a once-monthly injection over daily oral medication
  • Patients who have difficulty with daily medication adherence
  • People looking for a non-addictive medication with no abuse potential

Your provider at Restoration Recovery will conduct a thorough evaluation to determine whether Vivitrol is the right fit for your situation. Not every patient with alcohol use disorder requires medication, and not every patient who does will be best served by Vivitrol. The goal is always an individualized treatment plan that reflects your clinical needs and personal goals.

How Treatment Works at Restoration Recovery

Vivitrol treatment at Restoration Recovery follows the same four-step first-visit flow used for all of our patients, typically lasting 60 to 120 minutes:

  1. Intake. You’ll complete paperwork and a clinical intake. For alcohol use disorder, this includes a DSM-5 assessment covering AUD criteria and severity, plus a review of your drinking history, current health, and any relevant lab work.
  2. Counseling. You’ll meet with a counselor to discuss your drinking history, prior treatment, and personal recovery goals.
  3. Doctor evaluation. A medical provider reviews your intake and counselor notes, determines whether Vivitrol is clinically appropriate for your situation, and explains what to expect before, during, and after the injection.
  4. Injection. If clinically appropriate and you’re ready to pause drinking around the start of treatment, your Vivitrol injection can be administered the same day — it takes only a few minutes during a standard office visit. Your care team will work with you on timing that fits your situation.

After your first visit, ongoing Vivitrol care at Restoration Recovery includes:

  • Monthly injection. Vivitrol is administered once a month in the clinic by a licensed provider.
  • Ongoing counseling. Medication alone is not a complete treatment plan. Vivitrol is paired with individual counseling, peer support, and structured follow-up to address the behavioral, emotional, and situational factors that contribute to alcohol use disorder.
  • Regular monitoring. Your provider will check in with you at each monthly visit to assess progress, manage any side effects, and adjust your treatment plan as needed.

Benefits of Vivitrol for Alcohol Addiction

Vivitrol offers several distinct advantages for patients managing alcohol use disorder:

  • Reduces alcohol cravings. By blocking the reward signals associated with drinking, Vivitrol helps patients experience fewer and less intense cravings over time.
  • Non-addictive. Vivitrol has no abuse potential and does not produce dependence. It can be discontinued at any time without withdrawal effects.
  • Once-monthly convenience. A single injection each month replaces the need for daily medication, which improves adherence and reduces the daily mental burden of treatment.
  • Clinically administered. Because the injection is given in the office, there are no pills to manage, misplace, or forget at home.
  • Supports long-term recovery. When combined with counseling and structured support, Vivitrol helps patients sustain the behavioral changes that lead to lasting sobriety.
The Evidence

What the Research Shows on Vivitrol

Vivitrol is one of the most rigorously studied medications for alcohol use disorder. The pivotal Garbutt trial earned it FDA approval for alcohol dependence in 2006, the larger COMBINE study confirmed the mechanism across 1,383 patients, and more recent real-world data from the Department of Veterans Affairs tracked how patients actually do once they start treatment. The story the research tells is consistent: Vivitrol reduces heavy drinking, keeps patients out of the hospital, and works as a platform for longer-term recovery.

Vivitrol reduces heavy drinking days

Pivotal 6-month randomized trial, 624 patients

25% Fewer heavy drinking days vs placebo Pivotal efficacy outcome

Source: Garbutt JC et al. JAMA. 2005;293(13):1617–1625. 380 mg monthly injection vs. placebo, 24 U.S. sites.

Patients on naltrexone were abstinent more days

Percent of days abstinent during treatment

75% Placebo + medical management
81% Naltrexone + medical management Statistically significant

Source: Anton RF et al. COMBINE study. JAMA. 2006;295(17):2003–2017. 1,383 patients, 11 U.S. academic sites. (Oral naltrexone; Vivitrol is the extended-release injection form of the same molecule.)

Fewer alcohol-related hospitalizations on Vivitrol

Year before vs. year on Vivitrol

58% Admitted in year before
35% Admitted in year on ~40% fewer admissions

Source: Grebla R et al. Subst Use Addctn J. 2024;18:29768357241280713. VA cohort, 3,665 patients initiating Vivitrol for alcohol use disorder.

What these numbers actually mean

The Garbutt trial was the study that earned Vivitrol its FDA approval for alcohol use disorder. Patients receiving the 380 mg monthly injection experienced a 25% reduction in the rate of heavy drinking days compared to those on a placebo injection, across a six-month treatment window.

The larger COMBINE trial, published the following year in JAMA, tested naltrexone at scale. Over 1,383 patients, those on naltrexone plus medical management were abstinent on 81% of days during treatment, compared to 75% on placebo plus medical management. COMBINE used oral naltrexone; Vivitrol is the extended-release monthly injection form of the same molecule, designed to eliminate the daily-pill adherence gap.

Real-world data have since validated the trial results at scale. A 2024 Department of Veterans Affairs cohort study tracked 3,665 patients initiating Vivitrol for alcohol use disorder. Alcohol-related hospital admissions dropped from 58% the year before treatment to 35% the year on treatment — nearly a 40% relative reduction in inpatient care.

The American Psychiatric Association’s 2018 practice guideline recommends naltrexone (including its extended-release injectable form) for moderate-to-severe alcohol use disorder at its highest evidence grade. For patients who want medication support, whose symptoms haven’t responded to behavioral treatment alone, or who are ready to reduce drinking in a structured way, Vivitrol is one of the most evidence-backed options available. (Full citations in References.)

At Restoration Recovery, Vivitrol is prescribed for alcohol use disorder alongside counseling, peer support, and ongoing medical check-ins. The medication reduces the physical pull of alcohol. The surrounding care makes recovery durable.

What to Expect Before Starting

Before your first Vivitrol injection, your provider will ask you to pause drinking so the medication can be started safely. Your care team will work with you on a plan that fits your situation and will discuss what to expect at each step.

Common side effects of Vivitrol may include nausea, headache, fatigue, or soreness at the injection site. Most side effects are mild and temporary. Your provider will review the full safety profile with you during your evaluation and will monitor for any concerns at each follow-up visit.

It is important to understand that Vivitrol is one component of a broader treatment approach. The medication is most effective when combined with regular counseling, peer support, and a commitment to recovery-oriented lifestyle changes. Your treatment team at Restoration Recovery will help you build a plan that addresses all of these elements together.

Why Patients Choose Restoration Recovery for Vivitrol

The research is clear that Vivitrol works — but the clinic you choose to receive it at shapes whether it actually sticks. Here is what patients find at Restoration Recovery:

  • Two injection-capable clinics today, with Ringgold preparing to begin scheduling. Vivitrol is administered in-clinic at our Chattanooga and Cleveland locations — so your monthly injection is also a built-in check-in with a provider who knows you. (Our Soddy-Daisy clinic does not offer injection services; Soddy-Daisy patients route to Chattanooga 25 minutes south for their Vivitrol injection on the same medical record. Once Ringgold opens, in-state Georgia patients can transition over.)
  • Licensed providers and a CARF-accredited program. CARF (Commission on Accreditation of Rehabilitation Facilities) is the gold standard in addiction-treatment accreditation — a level of clinical scrutiny most outpatient clinics do not pursue.
  • One of Chattanooga’s longest-running outpatient clinics. Some of our patients have been with us for more than five years. Continuity matters in recovery.
  • 4.5 stars across more than 40 verified Google reviews. Real patients, real experiences.
  • Integrated counseling and behavioral health in-house. Medication without counseling is only part of a treatment plan. We provide both under one roof so nothing falls between the cracks.
  • A second alcohol-medication option when you need it. Alongside Vivitrol, we also prescribe Acamprosate for patients who are already abstinent, who prefer a daily oral medication to a monthly injection, or who have liver-health considerations that make naltrexone a poor fit.
  • Most major insurance plans accepted. TennCare, Medicaid, Medicare, and commercial carriers.
  • Confidential by federal law. Your treatment is protected under HIPAA and 42 CFR Part 2.

Insurance and Payment

Restoration Recovery accepts most major insurance plans for Vivitrol treatment, including TennCare, Medicaid, and a wide range of commercial insurance plans. Our patient services team can verify your coverage before your first visit and explain any out-of-pocket costs so there are no surprises. If you have questions about insurance or payment options, visit our insurance page or call us directly.

Three Injection-Capable Locations

Vivitrol injections are administered at two of our four outpatient clinic locations today:

  • Chattanooga, Tennessee
  • Cleveland, Tennessee

Our Ringgold, GA clinic is preparing to begin scheduling and will offer Vivitrol injections once it opens. Soddy-Daisy does not offer injection services — Soddy-Daisy patients are routed to Chattanooga or Cleveland for their Vivitrol injection on the same medical record. Each injection-capable location is staffed by licensed providers experienced in alcohol use disorder treatment and medication-assisted care. Same-week appointments are frequently available.

Vivitrol vs. Other Medications

Vivitrol is one of two FDA-approved medications we prescribe for alcohol use disorder at Restoration Recovery. The other is Acamprosate, a daily oral medication that supports maintenance of abstinence. For the full MAT picture across both opioid and alcohol use disorder, see our MAT Medications Compared tracker (5 medications side by side). The two AUD medications work through different mechanisms and fit different patients:

  • Vivitrol (extended-release naltrexone) — a monthly injection that blocks the reward signaling associated with drinking. Strongest evidence for reducing heavy drinking days. Hepatically cleared, so liver health is a consideration. Not for patients currently using opioids.
  • Acamprosate (Campral) — a daily oral tablet (two 333 mg tablets, three times daily) that supports continuous abstinence by normalizing glutamate/GABA balance after alcohol cessation. Renally cleared, which makes it safer in liver disease. Requires the patient to already be abstinent at treatment initiation.

For opioid use disorder, we prescribe different medications — Suboxone (buprenorphine/naloxone), Sublocade, and Brixadi — all designed for that condition. Your provider will recommend the medication that best fits your diagnosis, medical history, and recovery goals.

If you or someone you care about is struggling with alcohol use disorder, we encourage you to reach out. Recovery is possible, and the right combination of medical support and clinical care can make a meaningful difference. Contact Restoration Recovery today to schedule an evaluation or to learn more about how Vivitrol can support your path to sobriety.

For a full list of conditions we treat and treatment approaches we offer, visit our services page.

Frequently Asked Questions

How does Vivitrol work for alcohol use disorder?

Vivitrol is an extended-release naltrexone injection given once monthly. Naltrexone is an opioid antagonist — it blocks the reward pathway that alcohol activates, reducing the urge to keep drinking and blunting the pleasurable effects of alcohol if relapse occurs. It does NOT produce an alcohol-aversion reaction like disulfiram (Antabuse); it simply reduces craving and the “reward” feedback loop. Evidence from the Garbutt 2005 JAMA pivotal trial showed 25% fewer heavy drinking days over 6 months compared to placebo.

Do I need to be completely abstinent before starting Vivitrol?

You should not be actively drinking when you receive your first Vivitrol injection. Your provider will ask you to pause drinking so the medication can be started safely — typically at least a few days, though the exact duration depends on your individual history. This isn’t an absolute abstinence requirement like disulfiram; it’s a safety buffer. Many patients start Vivitrol after a brief period of reduced or stopped drinking and find the injection helps maintain abstinence from there.

Is Vivitrol used for opioid use disorder at Restoration Recovery?

At Restoration Recovery, we use Vivitrol only for alcohol use disorder. Naltrexone is FDA-approved for both opioid and alcohol use disorder, and some clinics use it for opioid. We’ve chosen to keep Vivitrol alcohol-only for reasons of clinical focus and patient safety — our opioid patients are best served by Suboxone, Sublocade, or Brixadi (all buprenorphine-based), which have a different safety profile and don’t require a prolonged opioid-free period before initiation.

What are the common side effects of Vivitrol?

Common side effects include injection-site reactions (soreness, redness, bruising), mild nausea (especially in the first month), fatigue, and occasional headache. Most side effects resolve within a few days of the injection. Serious but uncommon issues include liver enzyme changes — your provider may order baseline liver function tests before starting. Vivitrol can precipitate severe opioid withdrawal if you’re currently using opioids (even illicit or prescription), which is why we use it only for alcohol use disorder at this clinic.

Does my insurance cover Vivitrol?

Most insurance plans cover Vivitrol for alcohol use disorder, including TennCare (BlueCare, Wellpoint, UHC Community Plan), traditional Medicare, Medicare Advantage, and most commercial plans. Prior authorization is usually required. TennCare members typically have $0 out-of-pocket. Commercial copays vary — Vivitrol is often billed under the medical benefit since it’s office-administered. Our intake team verifies your specific coverage before your first injection. We don’t stock Vivitrol on-site; the injection is scheduled as a follow-up once the medication is ordered and approved. See our insurance page for carrier details.

What’s the difference between Vivitrol and Acamprosate for alcohol use disorder?

Both are evidence-based treatments for alcohol use disorder, but they work through different mechanisms. Vivitrol (naltrexone) blocks the reward pathway — you feel less desire to drink and less reward if you do. Acamprosate (Campral) works on the brain’s glutamate/GABA balance — it supports maintaining abstinence after you’ve already stopped drinking by reducing post-acute withdrawal symptoms (anxiety, insomnia, mood lability). Many patients use them together; others do well with one. Vivitrol is a monthly injection; Acamprosate is a daily oral tablet taken three times a day. Your provider will help you choose or combine.

References

The statistics and clinical findings on this page come from peer-reviewed medical research and authoritative public-health sources. Patients, family members, and providers are welcome to verify any claim against the original source.

  1. Garbutt JC, Kranzler HR, O’Malley SS, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005;293(13):1617–1625. [PubMed]
  2. Anton RF, O’Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–2017. [PubMed]
  3. Grebla R, Liu J, O’Sullivan AK, et al. Treatment Journey and Healthcare Resource Use Among Patients With Alcohol Use Disorder Who Initiated Extended-Release Naltrexone: An Analysis of Veterans Affairs Data. Substance Use. 2024;18:29768357241280713. [PubMed]
  4. Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. Am J Psychiatry. 2018;175(1):86–90. [PubMed]
  5. Leighty AE, Ansara ED. Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans. Mental Health Clinician. 2019;9(6):392–396.
  6. American Society of Addiction Medicine (ASAM) and U.S. Department of Veterans Affairs / Department of Defense (VA/DoD). Clinical Practice Guidelines for Substance Use Disorders. [VA/DoD]
  7. VIVITROL (naltrexone for extended-release injectable suspension). Prescribing Information. Alkermes, Inc. Accessed via DailyMed, U.S. National Library of Medicine. [DailyMed]
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