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01-10-2013 | Leading Article

Targeted Opioid Receptor Antagonists in the Treatment of Alcohol Use Disorders

Authors: Mark J. Niciu, Albert J. Arias

Published in: CNS Drugs | Issue 10/2013

Abstract

In 1994, the US Food and Drug Administration approved the μ-opioid receptor antagonist naltrexone to treat alcohol dependence. However, treatments requiring daily administration, such as naltrexone, are inconsistently adhered to in substance abusing populations, and constant medication exposure can increase risk of adverse outcomes, e.g., hepatotoxicity. This has fostered a ‘targeted’ or ‘as needed’ approach to opioid receptor antagonist treatment, in which medications are used only in anticipation of or during high-risk situations, including times of intense cravings. Initial studies of the ability of targeted naltrexone to reduce drinking-related outcomes were conducted in problem drinkers and have been extended into larger, multi-site, placebo-controlled investigations with positive results. Another μ-opioid receptor antagonist, nalmefene, has been studied on an ‘as-needed’ basis to reduce heavy drinking in alcohol-dependent individuals. These studies include three large multi-site trials in Europe of up to 1 year in duration, and serve as the basis for the recent approval of nalmefene by the European Medicines Agency as an ‘as-needed’ adjunctive treatment for alcohol dependence. We review potential moderators of opioid receptor antagonist treatment response including subjective assessments, objective clinical measures and genetic variants. In sum, the targeted or ‘as-needed’ approach to treatment with opioid antagonists is an efficacious harm-reduction strategy for problem drinking and alcohol dependence.

We have primarily used the Diagnostic and Statistical Manual, fifth edition (DSM-V) revised diagnosis of ‘alcohol use disorder’, which encompasses both alcohol abuse and dependence in DSM-IV-TR. However, in studies where either alcohol abuse and/or dependence were diagnosed via older DSM criteria, this terminology has been retained.

BRENDA is a brief psychosocial treatment modality for alcoholism that includes several key components, and the acronym is formed from these components: Biopsychosocial evaluation, Report to the patient on assessment, Empathic understanding of the patient’s situation, Needs collaboratively identified by the patient and treatment provider, Direct advice to the patient on how to meet those needs, Assess reaction of the patient to advice and adjust as necessary for best care.

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Title: Targeted Opioid Receptor Antagonists in the Treatment of Alcohol Use Disorders
Authors: Mark J. Niciu
Albert J. Arias
Publication date: 01-10-2013
Publisher: Springer International Publishing
Published in: CNS Drugs / Issue 10/2013
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI: https://doi.org/10.1007/s40263-013-0096-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Targeted Opioid Receptor Antagonists in the Treatment of Alcohol Use Disorders

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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