Cole Nicholson, now 38, has spoken out about his journey to overcome alcohol dependence, crediting a medication called naltrexone with significantly reducing his cravings. Like nearly one in ten Americans, Nicholson found himself battling addiction, a struggle that spanned over two decades and deeply impacted his life.
Nicholson began experimenting with alcohol at age 14, initially viewing it as a harmless teenage activity. However, as he entered college at the University of Mississippi, drinking became deeply ingrained in the campus culture, progressing from occasional experimentation to daily dependence. Despite maintaining academic success and leadership roles, alcohol was a constant presence. "There were no consequences," he recalled, "So I didn't think I had a problem."
The first significant consequence arrived at age 25 when he was arrested for driving under the influence. He received a year of probation, a fine, and mandatory testing. However, Nicholson admitted he found ways to circumvent the system, passing screenings by abstaining from alcohol only 24 hours prior.
A year later, following a physical assault that left him shaken, Nicholson's drinking escalated into near-constant consumption. This led him to seek help, enrolling in an inpatient recovery program. He spent a year in Alcoholics Anonymous meetings and cognitive behavioral therapy, achieving eight months of sobriety.
His sobriety was interrupted by a relationship with a sommelier, which led him back to drinking, initially in moderation, but soon escalating to hard liquor. The return of withdrawal symptoms like shakes and night sweats marked a significant relapse. His personal relationships and professional life began to suffer, with employers noticing the lingering scent of alcohol.
At 27, Nicholson entered a 30-day rehabilitation program, followed by intensive outpatient treatment in Los Angeles. It was there that doctors recommended naltrexone. Approved in the U.S. for opioid dependence in 1984 and later for alcohol use disorder, naltrexone works by targeting the brain's opioid receptors, which are involved in pleasure and learning. The medication dampens the pleasurable effects of alcohol, reducing the reward response and weakening the brain's association between drinking and euphoria. "It's essentially taking the reward out of drinking," said Jessica Steinman, an addiction specialist. "It removes the sense of euphoria, escape or numbing that many people are seeking."
Nicholson, who later switched to a monthly injection form of the medication, Vivitrol, described the effect as a "switch flipped." He found his cravings vanished, even while living in West Hollywood, a vibrant party scene, and working in the catering industry, where alcohol is omnipresent. "The alcohol was there, but I didn't feel like I had to partake in it," he said.
A 30-day supply of generic naltrexone tablets typically costs between $25 and $100 without insurance, making each pill cost $3 or less. Discounts can further reduce the price. The long-acting monthly injection, Vivitrol, is significantly more expensive, usually ranging from $1,000 to $2,000 per dose without insurance. However, with insurance coverage, many patients pay much less.
Nicholson experienced a brief relapse at age 30 when he stopped Vivitrol and attempted moderate drinking, admitting he missed the effects and taste of alcohol. This led to another downward spiral, particularly during the COVID-19 pandemic.
In the fall of 2025, at age 38, Nicholson recommitted to recovery and began taking Vivitrol again. He reported that his cravings have once again disappeared, and he feels healthier. "I make sure that I get at least seven to eight hours of sleep at night. I get a little bit of exercise. I just take it day by day," he stated. He also continues to attend support group meetings.
Steinman emphasized that medication like naltrexone should ideally be used in conjunction with therapy or support networks, as individuals often turn to substances to cope with deeper underlying issues. While long-term use of naltrexone is considered safe, it is generally viewed as a tool to stabilize patients and reduce cravings as they develop more sustainable coping mechanisms. Nicholson views naltrexone and Vivitrol as an "insurance policy," a safeguard that helps him maintain his recovery.