Opioid antagonist for alcohol dependence
Department of Psychiatry, Chiang Mai University, Amphoe Muang Chiang Mai, Chiang Mai, ThailandCochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2005; 1(1):CD001867. DOI: 10.1002/14651858.CD1867.pub2
Opioid antagonists can decrease alcohol consumption in animals. The review findings support that short-term treatment of naltrexone (NTX) decreases the chance of alcohol relapses for 36% and likely to reduce the chance of returning to drinking for 13%. NTX treatment can lower the risk of treatment withdrawal in alcohol-dependent patients for 28% (NNT = 13). The evidence so far have supported that NTX should be accepted as a short-term treatment for alcoholism. Strategies to improve adherence to NTX treatment, e.g., psychosocial interventions and management of adverse effects, should be concomitantly given. We have not yet known so far how long alcohol-dependent patients who respond to NTX treatment should continue their treatment. Nalmefene has too little evidence to support its clinical use.
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- "With the exception of topiramate (Blodgett et al., 2014), none of these medications systematically exhibit superior treatment response compared to placebo (Anton et al., 2014;Muller et al., 2014). In fact, reviews of placebo-control trials of naltrexone and acamprosate, arguably two of the most efficacious pharmacotherapies, show that roughly 40–70% of individuals taking either of these medications fail to respond positively (Rosner et al., 2010aRosner et al., , 2010bSrisurapanont and Jarusuraisin, 2005). Furthermore, response is heterogeneous; individual patients can exhibit divergent treatment responses and side effects for the same drug, and even at the same dose, with some patients responding favorably to one treatment but not another. "
ABSTRACT: Alcohol use disorders (AUDs) represent a significant health burden worldwide. Currently, there are three medications approved by the U.S. Food and Drug Administration for the treatment of AUDs, and other drugs are being prescribed off-label for this purpose. However, response rates for pharmacologic treatment are low, and extant research suggests that treatment effects may partially depend on genetic factors. Personalized medicine, or using a patient's genetics and/or personal history to determine efficacy of treatment prior to prescription, is an emerging tool that will help clinicians treat their patients more effectively and safely. This review systematically discusses current findings from AUD pharmacotherapy trials examining disulfiram, acamprosate, naltrexone, the injectable naltrexone, and topiramate. Furthermore, it presents pharmacogenetics findings associated with these medications in an attempt to further the field of personalized medicine. Research from trials examining AUDs and comorbid major depressive disorder and anxiety disorders is also presented, and pharmacogenetic findings for these treatments are discussed. Lastly, the authors comment on the present and future states of the field of personalized medicine for AUD.
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- "Naltrexone is not as widely used in the treatment of opiate dependence as methadone and buprenorphine, although it has a more favorable safety profile, no addictive liability, and diminished stigma since it is not a replacement therapy (Mason, 2003; Ross & Peselow, 2009). Although results have been mixed in regard to the effectiveness of naltrexone in the treatment of opiate dependence, it has been shown to reduce alcohol consumption, the rewarding effects of alcohol, craving for alcohol, and rates of relapse (Kranzler & Van Kirk, 2001; Rosner et al., 2010b; Srisurapanont, & Jarusuraisin, 2005). However, poor adherence is common and is associated with higher relapse rates (Pettinati, Volpicelli, Pierce, & O'Brien, 2000; Ross & Peselow, 2009). "
ABSTRACT: Data from a national study of 345 privately funded, community-based substance use disorder (SUD) treatment centers were used to investigate social workers' knowledge, perceptions of effectiveness, and perceptions of the acceptability of medication assisted treatments (MATs) for SUDs. Results reveal the importance of exposure to MATs for social workers to develop a knowledge base regarding the effectiveness of various pharmacological agents. Results also underline the importance of social workers' perceptions of effectiveness in forming opinions regarding the acceptability of the use of MATs in SUD treatment. Lastly, a 12-Step orientation toward treatment has a negative influence on social workers' opinions regarding the acceptability of MATs.
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- "Cocaine immunotherapy (popularly called a cocaine “vaccine”) to prevent cocaine molecules from entering the brain is now in development, but previews do not look promising for wide-scale use (96). Other types of medications include blocking agents, such as naltrexone for opiate addiction, which occupy neuronal receptors and blunt a drug’s effect (97). Aversive agents, such as Antabuse (disulfiram), cause people to feel nauseated and vomit when they ingest alcohol (98). "
ABSTRACT: From Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott Lilienfeld, copyright © 2013. Reprinted by permission of Basic Books, a member of The Perseus Books Group. The notion that addiction is a “brain disease” has become widespread and rarely challenged. The brain-disease model implies erroneously that the brain is necessarily the most important and useful level of analysis for understanding and treating addiction. This paper will explain the limits of over-medicalizing – while acknowledging a legitimate place for medication in the therapeutic repertoire – and why a broader perspective on the problems of the addicted person is essential to understanding addiction and to providing optimal care. In short, the brain-disease model obscures the dimension of choice in addiction, the capacity to respond to incentives, and also the essential fact people use drugs for reasons (as consistent with a self-medication hypothesis). The latter becomes obvious when patients become abstinent yet still struggle to assume rewarding lives in the realm of work and relationships. Thankfully, addicts can choose to recover and are not helpless victims of their own “hijacked brains.”
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