For individuals committed to overcoming opioid or alcohol addiction, the risk of relapse is often the greatest hurdle in early recovery. While behavioral therapy is essential, the intense physical cravings and brain chemistry changes caused by addiction can make maintaining sobriety incredibly difficult. This is where the Vivitrol shot, a brand-name formulation of the medication naltrexone, has changed the landscape of addiction medicine.
Unlike other medications used in Medication-Assisted Treatment (MAT) that partially or fully activate opioid receptors, Vivitrol is a complete blocker. Administered as a once-monthly injection, it provides a powerful safety net that prevents patients from experiencing a high if they relapse, while simultaneously reducing the biological urge to drink or use drugs. This guide explains how the Vivitrol shot works, who it is best suited for, and what to expect during treatment.
What Is the Vivitrol Shot?
Vivitrol is the brand name for an extended-release, injectable form of naltrexone. Naltrexone is an FDA-approved medication used to treat both opioid use disorder and alcohol use disorder. While naltrexone is available in a daily pill form (Revia), the Vivitrol shot is administered intramuscularly by a healthcare professional once every 28 days.
The extended-release formulation is considered a major clinical breakthrough because it removes the burden of daily medication compliance. For someone in early recovery, remembering to take a pill every single day can be challenging. A single monthly injection ensures that the medication remains active in the patient’s system continuously, providing uninterrupted protection against relapse.
How Does Naltrexone Work in the Brain?
To understand how Vivitrol supports recovery, it is important to understand its mechanism of action as an opioid antagonist.
When a person consumes opioids (such as heroin, fentanyl, or prescription painkillers), the drugs bind to opioid receptors in the brain, triggering a massive release of dopamine that creates a euphoric high. Over time, the brain becomes dependent on this chemical surge.
Naltrexone works by binding to these exact same opioid receptors—but instead of activating them, it completely blocks them. If a patient receives a Vivitrol shot and subsequently attempts to use opioids, the drugs cannot attach to the receptors. As a result, the patient will not feel any high or euphoric effects. This blockade effectively breaks the psychological connection between drug use and reward.
For alcohol use disorder, the mechanism is slightly different but equally effective. While alcohol affects multiple neurotransmitter systems, the euphoria associated with drinking is partly mediated by the brain’s endogenous opioid system. By blocking these receptors, Vivitrol significantly reduces the pleasure and reward a person gets from drinking, which in turn reduces intense alcohol cravings over time.
The Critical Detox Requirement
The most important clinical requirement for starting Vivitrol is that the patient must be completely detoxed and free of all physical dependence before the first injection.
Because naltrexone is a powerful antagonist, if it is administered while opioids are still present in the patient’s system, it will immediately strip those opioids from the receptors. This triggers a sudden, severe, and potentially dangerous condition known as precipitated withdrawal.
To safely begin Vivitrol treatment, patients must abstain from all short-acting opioids (like heroin or oxycodone) for a minimum of 7 to 10 days, and from long-acting opioids (like methadone or buprenorphine) for up to 14 days. For this reason, starting Vivitrol is usually done following a supervised medical detox program or a residential treatment stay.
The Benefits of the Vivitrol Shot
For patients who successfully complete detox, the Vivitrol shot offers several unique advantages over other MAT medications like Suboxone or methadone:
- Because Vivitrol is an antagonist, it produces no high, has no street value, and is not addictive. Patients cannot develop a physical dependence on naltrexone.
- The once-a-month injection eliminates the need for daily clinic visits or the responsibility of managing daily prescription pills.
- Vivitrol is the only MAT medication FDA-approved to treat both opioid use disorder and alcohol use disorder, making it an excellent option for patients with co-occurring substance issues.
- Patients on Vivitrol report feeling completely clear-headed, with no sedation or cognitive impairment, allowing them to fully engage in work, family life, and behavioral therapy.
Effectiveness and Clinical Outcomes
Clinical data strongly supports the use of extended-release naltrexone in addiction treatment. In the landmark X:BOT trial, which compared Vivitrol directly to Suboxone (buprenorphine), researchers found that once a patient successfully initiated Vivitrol treatment, it was equally as effective as Suboxone at preventing opioid relapse over a 24-week period.
The primary clinical challenge with Vivitrol is the induction phase—the period where the patient must remain opioid-free for 7 to 14 days before receiving the shot. However, for patients who complete a residential rehab program where abstinence is monitored and supported, Vivitrol provides a highly effective transition strategy for returning to everyday life.
Potential Side Effects
Like all medications, the Vivitrol shot can cause side effects. The most common side effects are generally mild and include:
- Nausea or decreased appetite
- Headache or dizziness
- Fatigue or sleep disturbances
- Pain, swelling, or bruising at the injection site
In rare cases, naltrexone can cause liver damage, so physicians will typically perform a blood test to check liver function before starting treatment and periodically during the course of care.
Vivitrol as Part of a Comprehensive Program
It is critical to understand that the Vivitrol shot is not a cure for addiction. It is a powerful medical tool that provides a window of opportunity for the patient to engage in the real work of recovery: behavioral therapy.
Addiction is a complex disease rooted in trauma, environment, and behavioral patterns. While Vivitrol blocks the physical high and reduces cravings, it does not teach a patient how to cope with stress, rebuild relationships, or manage emotional triggers. For this reason, the FDA strictly mandates that Vivitrol be used in conjunction with a comprehensive counseling and behavioral therapy program.
Treatment at Discovery Point Retreat
At Discovery Point Retreat, we believe in utilizing every evidence-based tool available to help our clients achieve lasting sobriety. Our medical team provides comprehensive Medication-Assisted Treatment, including the Vivitrol shot, integrated seamlessly with our residential and outpatient therapy programs. We guide clients safely through the initial medical detox phase, ensuring they are physically prepared to begin naltrexone therapy without the risk of precipitated withdrawal.
If you or a loved one is ready to break the cycle of opioid or alcohol addiction, we are here to help. Our admissions team is available 24/7 to discuss your treatment options and verify your insurance benefits.
Frequently Asked Questions
Does the Vivitrol shot hurt?
The Vivitrol shot is administered intramuscularly, typically in the gluteal muscle (buttocks), using a specialized needle. Some patients experience mild to moderate pain, soreness, or swelling at the injection site for a few days following the shot. Your healthcare provider can recommend over-the-counter pain relievers or warm compresses to manage any discomfort.
What happens if I use opioids while on Vivitrol?
If you attempt to use opioids while the Vivitrol shot is active in your system, the naltrexone will block the opioid receptors, and you will not feel high. However, attempting to overcome this blockade by taking massive doses of opioids is extremely dangerous and can lead to a fatal overdose, as the opioids can still suppress your respiratory system even if you do not feel the euphoric effects.
How long should I stay on Vivitrol?
The duration of Vivitrol treatment varies for each individual. Many addiction specialists recommend staying on the medication for at least 6 to 12 months to allow the brain sufficient time to heal and to give the patient time to establish a strong foundation in behavioral therapy. Some patients choose to remain on it longer for continued peace of mind.
If you or a loved one is struggling with addiction, call Discovery Point Retreat today at 855-245-4127 or visit discoverypointretreat.com/contact-us/ to learn how our evidence-based treatment programs can help.
References
[1] SAMHSA. (2023). Naltrexone. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/naltrexone
[2] Lee JD, et al. (2018). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). Lancet. PMC5806119.
