I had to laugh when Miriam (not her real name) told me the best thing about sobriety is that her husband is not so annoying to be around. The hardest thing: dealing with cravings.

Miriam is in her late 50’s and completed an Alcohol Detox at the Coleman Institute for Addiction Medicine four months earlier. She was at the office to receive her 3rd naltrexone implant.

“Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and the craving for alcohol. It has been shown to reduce relapse to problem drinking in some patients.”

Naltrexone is the medication that the Coleman Institute has specialized in for over twenty years. It is, in the collective experience of all our providers, hands down, the best medication for helping people diminish cravings for alcohol.


In his introduction to Dr. Judson Brewer’s book The Craving Mind, Jon Kabat-Zinn says, “Our habits of craving seem to be the root cause of so much of our suffering, both large and small.”

And Dr. Kevin McCauleysays this about cravings: "Craving for the addict is being up in the middle of the night, craving just one more hit, one more drink and the sound of ice tumbling in a glass, one more pull on a syringe," he said. "Make no mistake — that is genuine, profound suffering ... Even if addicts aren't using, they are craving, and within that craving, there is intense suffering."


Miriam had been drinking almost daily for close to 30 years. Like many women, she was able to stop drinking easily both times she was pregnant. Her glass of wine after work while preparing dinner became two, then a half bottle. She did everything she could to not focus on the steady increase in her drinking, and always found ways to normalize it.

She put the (now daily) bottle immediately into the outdoor recycling bin so neither she nor her husband would see the bottles pile up inside over the two week pick-up period. She began to order more wine from a place that did home delivery so when she went to the ABC store or the grocery store it didn’t look like she was buying too much.

She doesn’t really remember when one bottle became two, but she clearly recalls that it took more and more for her to even catch a buzz. Her cravings were increasing, but the pleasure was diminishing.

Addictive drugs keep spiking dopamine in the brain, so there is never true satiety, but rather the continuation of needing more and more and more to scratch an itch that the drug is perpetuating.

Everyone who stops using addictive drugs deals with cravings. This is one reason a person in recovery may choose to have naltrexone be a component in their toolbox. My patients tell me they no longer feel the strong tug of needing a drink with the help of this medication.

Addiction therapists and recovery meetings are also integral resources for helping with cravings, especially in early sobriety. In fact, "Coping with Urges and Cravings" is Point 2 of the SMART Recovery 4-Point Program, and we often recommend these meetings to our patients. Their website has many free tools available to people who are on the behavioral change continuum.

While I can’t guarantee that Miriam will continue to find her husband less annoying, I know for a fact that over time as she learns ways to deal with her cravings, they will definitely subside over time.

If you want to discuss your drinking or have questions about the safe way to stop, please give us a call.

Joan R. Shepherd, FNP