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Opioid Antagonists and Alcoholism Treatment

Published online by Cambridge University Press:  07 November 2014

Robert M. Swift
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Abstract

The increasing evidence for a neurobiologic basis for alcoholism has spurred the search for pharmacologic agents to treat alcohol abuse. The complex set of symptoms and behaviors that characterizes alcoholism has been linked to dopaminergic and opioid neurotransmitter systems, suggesting that opioid antagonists, such as naltrexone, may alter the positive reinforcement effects and craving involved in alcoholism. Laboratory and clinical investigations of naltrexone have demonstrated the potential for this agent to reduce craving, increase the aversive effects of alcohol, decrease drinking days, and increase abstinence. While naltrexone and other opioid antagonists, such as nalmefene, may be effective components of an alcohol-treatment program, they should only be used in combination with psychosocial interventions, such as support groups and psychotherapy.

Type
Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 2: Novel Pharmacotherapies for Alcoholism , February 2000 , pp. 49 - 57
Copyright
Copyright © Cambridge University Press 2000

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References

REFERENCES

1.Gerstein, DR. Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment (CALDATA). Sacramento, Calif: California Department of Alcohol and Drug Programs; 1994.Google Scholar
2.Holder, HD, Blose, JO. The reduction of health care costs associated with alcoholism treatment: a 14 year longitudinal study. J Stud Alcohol. 1992;53:293–302.CrossRefGoogle ScholarPubMed
3.Hoffmann, NG, DeHart, SS, Fulkerson, JA. Medical care utilization as a function of recovery status following chemical addictions treatment. J Addict Dis. 1993;12:97–108.CrossRefGoogle ScholarPubMed
4.Finney, JW, Hahn, AC, Moos, RH. The effectiveness of inpatient and outpatient treatment for alcohol abuse. Addiction. 1996;91:1773–1796.CrossRefGoogle ScholarPubMed
5.Litten, RZ, Allen, JP. Pharmacotherapies for alcoholism: promising agents and clinical issues. Alcohol Clin Exp Res. 1991;15:620–633.CrossRefGoogle ScholarPubMed
6.Litten, RZ, Allen, J, Fertig, J. Pharmacotherapies for alcohol problems: a review of research with focus on developments since 1991. Alcohol Clin Exp Res. 1996;20:859–876.CrossRefGoogle ScholarPubMed
7.Chick, J, Erickson, CK. Conference summary: Consensus Conference on Alcohol Dependence and the Role of Pharmacotherapy in its Treatment. Alcohol Clin Exp Res. 1996;20:391–402.CrossRefGoogle ScholarPubMed
8.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.Google Scholar
9.Koob, GF, Weiss, F. Neuropharmacology of cocaine and ethanol dependence. Recent Dev Alcohol. 1992;10:201–233.CrossRefGoogle ScholarPubMed
10.Samson, HH, Hodge, CW. The role of the mesoaccumbens dopamine system in ethanol reinforcement: studies using the techniques of microinjection and voltammetry. Alcohol Alcohol Suppl. 1993;2:469–474.Google ScholarPubMed
11.Wise, RA, Bozarth, MA. A psychomotor stimulant theory of addiction. Psychiatry Rev. 1987;94:469–492.Google ScholarPubMed
12.Robinson, TE, Berridge, KC. The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Rev. 1993;18:247–291.CrossRefGoogle ScholarPubMed
13.Martin, CS, Earleywine, M, Musty, RE, Perrine, MW, Swift, RM. Development and validation of the Biphasic Alcohol Effects Scale. Alcohol Clin Exp Res. 1993;17:140–146.CrossRefGoogle ScholarPubMed
14.Littleton, J, Little, H. Current concepts of ethanol dependence. Addiction. 1994;89:1397–1412.CrossRefGoogle ScholarPubMed
15.Nestler, EJ, Alreja, M, Aghajanian, GK. Molecular and cellular mechanisms of opiate action: studies in the rat locus coeruleus. Brain Res Bull. 1994;35:521–528.CrossRefGoogle ScholarPubMed
16.Rohsenow, D, Monti, P, Abrams, DB, et al.Cue elicited urge to drink and salivation in alcoholics: relationship to individual differences and relapse. Adv Behav Res Ther. 1992;14:195–210.CrossRefGoogle Scholar
17.Anton, RF, Moak, D, Latham, PK. The obsessive compulsive drinking scale: assessing outcome in alcoholism treatment studies. Arch Gen Psychiatry. 1996;53:225–231.CrossRefGoogle ScholarPubMed
18.Reid, LD, Hubbell, CL. Excess of drinking related to excess activity of opioid systems. Alcohol. 1987;4:149–168.Google Scholar
19.Wild, KD, Reid, LD. Modulation of ethanol intake by morphine: evidence for a central site of action. Life Sci. 1990;47:49–54.CrossRefGoogle ScholarPubMed
20.National Institute of Alcohol Abuse and Alcoholism. Methadone maintenance and patients in alcoholism treatment. Alcohol Alert. 1988;1:1–4.Google Scholar
21.Gianoulakis, C, Beliveau, D, Angelogianni, P. Different pituitary beta-endorphin and adrenal cortisol response to ethanol in individuals with high and low risk for future development of alcoholism. Life Sci. 1989;45:1097–1109.CrossRefGoogle ScholarPubMed
22.Volpicelli, J, Davis, M, Olgin, J. Naltrexone blocks the post-shock increase of alcohol consumption. Life Sci. 1986;38:841–847.CrossRefGoogle Scholar
23.George, SR, Roldan, L, Lui, A, Naranjo, CA. Endogenous opioids are involved in genetically determined high preference for alcohol consumption. Alcohol Clin Exp Res. 1991;15:668–672.CrossRefGoogle Scholar
24.Froelich, JC, Harts, J, Lumeng, L, Li, TK. Naloxone attenuates voluntary ethanol intake in rats selectively bred for high ethanol preference. Pharmacol Biochem Behav. 1990;35:385–390.CrossRefGoogle Scholar
25.Gessa, GL, Montoni, F, Collu, M, Vargiu, L, Mereu, G. Low doses of ethanol activate dopaminergic neurones in the ventral tegmental area. Brain Res. 1985;348:201–203.CrossRefGoogle ScholarPubMed
26.Benjamin, D, Grant, E, Pohorecky, LA. Naltrexone reverses ethanol-induced dopamine release in the nucleus accumbens in awake, freely moving rats. Brain Res. 1993;621:137–140.CrossRefGoogle ScholarPubMed
27.Volavka, J, Cho, D, Mallya, A, Bauman, J. Naloxone increases ACTH and cortisol levels in man. N Engl J Med. 1979;300:1056–1057.Google ScholarPubMed
28.Nabor, D, Pikar, D, Davis, GC. Naloxone effects on beta-endorphin, cortisol, growth hormone, HVA and MHPG in plasma of normal volunteers. Psychopharmacology. 1981;74:125–128.CrossRefGoogle Scholar
29.Schluger, JH, Ho, A, Borg, L, et al.Nalmefene causes greater hypothalamic-pituitary-adrenal axis activation than naloxone in normal volunteers: implications for the treatment of alcoholism. Alcohol Clin Exp Res. 1998;22:1430–1436.CrossRefGoogle ScholarPubMed
30.Lukas, SE, Mendelson, JH. Electroencephalographic activity and plasma ACTH during ethanol-induced euphoria. Biol Psychiatry. 1988;23:141–148.CrossRefGoogle ScholarPubMed
31.Kosten, TR, Kreek, MJ, Ragunath, J, Kleber, HD. Chronic naltrexone effect on serum cortisol. NIDA Res Monog. 1986;67:362–365.Google Scholar
32.Swift, RM, Whelihan, W, Kuznetsov, O, Buongiorno, G, Hsuing, H. Naltrexone-induced alterations in human ethanol intoxication. Am J Psychiatry. 1994;151:1463–1467.Google ScholarPubMed
33.King, AC, Volpicelli, JR, Frazer, A, O'Brien, CP. Effect of naltrexone on subjective alcohol response in subjects at high and low risk for future alcohol dependence. Psychopharmacology. 1997;129:15–22.CrossRefGoogle ScholarPubMed
34.Davidson, D, Palfai, T, Bird, C, Swift, R. Effects of naltrexone on alcohol self-administration in heavy drinkers. Alcohol Clin Exp Res. 1999;23:195–203.CrossRefGoogle ScholarPubMed
35.Volpicelli, JR, Alterman, AI, Hayashida, M, O'Brien, CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. 1992;49:876–880.CrossRefGoogle ScholarPubMed
36.Volpicelli, JR, Watson, NT, King, AC, Sherman, C, O'Brien, CP. Effect of naltrexone on alcohol “high” in alcoholics. Am J Psychiatry. 1995;152:613–615.Google Scholar
37.Monti, PM, Rohsenow, DJ, Swift, RM, Abrams, DB, Colby, SM, Mueller, TI. Effect of naltrexone on urge to drink during alcohol cue exposure: preliminary results. Alcohol Clin Exp Res. 1996;20:92A.Google Scholar
38.Davidson, D, Swift, RM, Fitz, E. Naltrexone increases the latency to drink alcohol in social drinkers. Alcohol Clin Exp Res. 1996;20:732–739.CrossRefGoogle ScholarPubMed
39.O'Malley, SS, Jaffe, AJ, Chang, G, Schottenfeld, RS, Meyer, RE, Rounsaville, B. Naltrexone and coping skills therapy for alcohol dependence. Arch Gen Psychiatry. 1992;49:881–887.CrossRefGoogle ScholarPubMed
40.Jaffe, AJ, Rounsaville, B, Chang, G, Schottenfeld, RS, Meyer, RE, O'Malley, SS. Naltrexone, relapse prevention and supportive therapy with alcoholics: an analysis of patient-treatment matching. J Consult Clin Psychol. 1996;64:1044–1053.CrossRefGoogle ScholarPubMed
41.Monti, P, Rohsenow, D, Hutchison, K, et al.Naltrexone's effect on cue-elicited craving among alcoholics in treatment. Alcohol Clin Exp Res. 1999;23:1386–1394.Google ScholarPubMed
42.Farren, CK, O'Malley, S, Grebski, G, Maniar, S, Porter, M, Kreek, MJ. Variable dose naltrexone-induced hypothalamic-pituitary-adrenal stimulation in abstinent alcoholics: a preliminary study. Alcohol Clin Exp Res. 1999;23:502–508.Google ScholarPubMed
43.Garbutt, JC, West, SL, Carey, TS, Lohr, KN, Crews, FT. Pharmacological treatment of alcohol dependence: a review of the evidence. JAMA. 1999;281:1318–1325.CrossRefGoogle ScholarPubMed
44.Swift, RM. Drug treatment of alcohol dependence. N Engl J Med. 1999;340:1482–1490.CrossRefGoogle ScholarPubMed
45.Bohn, MJ, Kranzler, HR, Beazoglou, D, Stachler, BA. Naltrexone and brief counseling to reduce heavy drinking. Am J Addict. 1994;3:91–99.Google Scholar
46.Anton, R. Naltrexone and cognitive behavioral treatment of alcohol dependence. Paper presented at: Annual Meeting of the Research Society on Alcoholism; June 24, 1998; Hilton Head, SC.Google Scholar
47.Rohsenow, D. Naltrexone and coping skills training with cue exposure: preliminary treatment effects. Paper presented at: Annual Meeting of the Research Society on Alcoholism; June 24, 1998; Hilton Head, SC.Google Scholar
48.McCaul, B, Wand, GS, Sullivan, J, Mumford, G, Quigley, J. Beta-Naltrexol level predicts alcohol relapse. Alcohol Clin Exp Res. 1997;21(3 suppl):32A.Google Scholar
49.Hersh, D, Van Kirk, JR, Kranzler, HR. Naltrexone treatment of comorbid alcohol and cocaine use disorders. Psychopharmacology (Berl). 1998;139:44–52.CrossRefGoogle ScholarPubMed
50.Chick, J. UK multicentre study of naltrexone as adjunctive therapy in the treatment of alcoholism: efficacy results. Paper presented at: Tenth World Psychiatry Conference; August 24, 1996; Madrid, Spain.Google Scholar
51.Volpicelli, JR, Rhines, KC, Rhines, JS, Volpicelli, LA, Alterman, AI, O'Brien, CP. Naltrexone and alcohol dependence: role of subject compliance. Arch Gen Psychiatry. 1997;54:737–742.CrossRefGoogle ScholarPubMed
52.Salvato, FR, Mason, BJ. Changes in transaminases over the course of a 12-week, double-blind nalmefene trial in a 38-year-old female subject. Alcohol Clin Exp Res. 1994;18:1187–1189.CrossRefGoogle Scholar
53.Mason, BJ, Ritvo, EC, Morgan, RO. A double-blind, placebo-controlled trial of nalmefene in the treatment of alcoholism. Alcohol Clin Exp Res. 1994;18:1157–1167.Google Scholar
54.Croop, R. An open label usage study of naltrexone as adjunctive pharmacotherapy for individuals with alcoholism. Alcohol Clin Exp Res. 1995;19:77A.Google Scholar
55.Berg, BJ, Pettinati, HM, Volpicelli, JR. Risk-benefit assessment of naltrexone in the treatment of alcohol dependence. Drug Saf. 1997;15:274–282.CrossRefGoogle Scholar
56.Bertolotti, M, Ferrari, BM, Vitale, G, et al.Effect of liver cirrhosis on the systemic availability of naltrexone in humans. J Hepatol. 1997;27:505–511.CrossRefGoogle ScholarPubMed
57.King, AC, Volpicelli, JR, Gunduz, M, O'Brien, CP, Kreek, MJ. Naltrexone biotransformation and incidence of subjective side effects: a preliminary study. Alcohol Clin Exp Res. 1997;21:906–909.Google ScholarPubMed
58.Substance Abuse Mental Health Services Administration (SAMSHA). Treatment Improvement Protocol: Naltrexone in the Treatment of Alcohol Dependence. Washington, DC: US Department of Health and Human Services Substance Abuse Mental Health Services Administration; DHHS publication number SMA 98-3206; 1997.Google Scholar
59.Kranzler, HR, Modesto-Lowe, V, Nuwayser, ES. Sustained-release naltrexone for alcoholism treatment: a preliminary study. Alcohol Clin Exp Res. 1998;22:1074–1079.Google ScholarPubMed