Targeted naltrexone for problem drinkers - PubMed (original) (raw)
Randomized Controlled Trial
Targeted naltrexone for problem drinkers
Henry R Kranzler et al. J Clin Psychopharmacol. 2009 Aug.
Abstract
This study aimed to replicate and extend prior research showing that the targeted use of naltrexone is a useful strategy to reduce heavy drinking. We compared the effects of naltrexone with those of placebo in a sample of 163 individuals (58.3% male) whose goal was to reduce their drinking to safe limits. Patients received study medication (ie, naltrexone 50 mg or placebo) and were instructed to use it daily or targeted to situations identified by them as being high risk for heavy drinking. An interactive voice response system was used to obtain daily reports of drinking and medication use during the 12-week trial. Analyses were conducted using hierarchical linear modeling, with sex as a potential moderator variable. On the primary outcome measure, mean drinks per day, at week 12, men in the targeted naltrexone group drank significantly less than patients in the other groups did. On a secondary outcome measure, drinks per drinking day, during week 12, the targeted naltrexone group drank significantly less than the other groups did, with no moderating effect of sex. These results support the use of a targeted approach to reduce drinking among heavy drinkers, particularly men, but argue for the use of additional strategies or more efficacious medications than naltrexone to increase the effects of such an intervention.
Trial registration: ClinicalTrials.gov NCT00369408.
Figures
Figure 1
Number of Standard Drinks Per Day by Study Group [Mean (SEM)], Separately by Sex. Data are presented as biweekly means (at the midpoint of 2-week period), derived from daily reports. There were no pretreatment group differences on this measure. Differences evident at period 1, i.e., during weeks 1–2, reflect differences that emerged during the first two weeks following the initiation of treatment. Significant treatment effects are described in the text.
Figure 2
Number of Standard Drinks Per Drinking Day by Study Group [Mean (SEM)]. Data are presented as biweekly means (at the midpoint of 2-week period), derived from daily reports. There were no pretreatment group differences on this measure. Differences evident at period 1, i.e., during weeks 1–2, reflect differences that emerged during the first two weeks following the initiation of treatment. Significant treatment effects are described in the text.
Similar articles
- Targeted versus daily naltrexone: secondary analysis of effects on average daily drinking.
Hernandez-Avila CA, Song C, Kuo L, Tennen H, Armeli S, Kranzler HR. Hernandez-Avila CA, et al. Alcohol Clin Exp Res. 2006 May;30(5):860-5. doi: 10.1111/j.1530-0277.2006.00101.x. Alcohol Clin Exp Res. 2006. PMID: 16634855 Clinical Trial. - Targeted nalmefene with simple medical management in the treatment of heavy drinkers: a randomized double-blind placebo-controlled multicenter study.
Karhuvaara S, Simojoki K, Virta A, Rosberg M, Löyttyniemi E, Nurminen T, Kallio A, Mäkelä R. Karhuvaara S, et al. Alcohol Clin Exp Res. 2007 Jul;31(7):1179-87. doi: 10.1111/j.1530-0277.2007.00401.x. Epub 2007 Apr 19. Alcohol Clin Exp Res. 2007. PMID: 17451401 Clinical Trial. - Advancing Precision Medicine for Alcohol Use Disorder: Replication and Extension of Reward Drinking as a Predictor of Naltrexone Response.
Witkiewitz K, Roos CR, Mann K, Kranzler HR. Witkiewitz K, et al. Alcohol Clin Exp Res. 2019 Nov;43(11):2395-2405. doi: 10.1111/acer.14183. Epub 2019 Sep 11. Alcohol Clin Exp Res. 2019. PMID: 31436886 Free PMC article. Clinical Trial. - The status of naltrexone in the treatment of alcohol dependence: specific effects on heavy drinking.
Pettinati HM, O'Brien CP, Rabinowitz AR, Wortman SP, Oslin DW, Kampman KM, Dackis CA. Pettinati HM, et al. J Clin Psychopharmacol. 2006 Dec;26(6):610-25. doi: 10.1097/01.jcp.0000245566.52401.20. J Clin Psychopharmacol. 2006. PMID: 17110818 Review. - What place does naltrexone have in the treatment of alcoholism?
Rohsenow DJ. Rohsenow DJ. CNS Drugs. 2004;18(9):547-60. doi: 10.2165/00023210-200418090-00001. CNS Drugs. 2004. PMID: 15222772 Review.
Cited by
- Targeted opioid receptor antagonists in the treatment of alcohol use disorders.
Niciu MJ, Arias AJ. Niciu MJ, et al. CNS Drugs. 2013 Oct;27(10):777-87. doi: 10.1007/s40263-013-0096-4. CNS Drugs. 2013. PMID: 23881605 Free PMC article. Review. - Effects of naltrexone on smoking cessation outcomes and weight gain in nicotine-dependent men and women.
King AC, Cao D, O'Malley SS, Kranzler HR, Cai X, deWit H, Matthews AK, Stachoviak RJ. King AC, et al. J Clin Psychopharmacol. 2012 Oct;32(5):630-6. doi: 10.1097/JCP.0b013e3182676956. J Clin Psychopharmacol. 2012. PMID: 22926596 Free PMC article. Clinical Trial. - Advances in the science and treatment of alcohol use disorder.
Witkiewitz K, Litten RZ, Leggio L. Witkiewitz K, et al. Sci Adv. 2019 Sep 25;5(9):eaax4043. doi: 10.1126/sciadv.aax4043. eCollection 2019 Sep. Sci Adv. 2019. PMID: 31579824 Free PMC article. Review. - Within- and between-person effects of naltrexone on the subjective response to alcohol and craving: A daily diary investigation.
Waddell JT, Corbin WR, MacKinnon DP, Leeman RF, DeMartini KS, Fucito LM, Kranzler HR, O'Malley SS. Waddell JT, et al. Alcohol Clin Exp Res. 2022 Mar;46(3):477-491. doi: 10.1111/acer.14780. Epub 2022 Feb 17. Alcohol Clin Exp Res. 2022. PMID: 35076087 Free PMC article. Clinical Trial. - Medications for unhealthy alcohol use: across the spectrum.
O'Malley SS, O'Connor PG. O'Malley SS, et al. Alcohol Res Health. 2011;33(4):300-12. Alcohol Res Health. 2011. PMID: 23580015 Free PMC article. Review.
References
- Volpicelli JR, Alterman AI, Hayashida M, et al. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. 1992;49:876–80. - PubMed
- O’Malley S, Jaffe AJ, Chang G, et al. Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch Gen Psychiatry. 1992;49:881–7. - PubMed
- Bouza C, Angeles M, Munoz A, et al. Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction. 2004;99:811–28. - PubMed
- Srisurapanont M, Jarusuraisin N. Naltrexone for the treatment of alcoholism: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol. 2005;8:267–80. - PubMed
- Heinala P, Alho H, Kiianmaa K, et al. Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. J Clin Psychopharmacol. 2001;21:287–92. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- P50 AA03510/AA/NIAAA NIH HHS/United States
- P50 AA003510/AA/NIAAA NIH HHS/United States
- K23 AA017689/AA/NIAAA NIH HHS/United States
- M01 RR06192/RR/NCRR NIH HHS/United States
- K24 AA13736/AA/NIAAA NIH HHS/United States
- K24 AA013736/AA/NIAAA NIH HHS/United States
- M01 RR006192/RR/NCRR NIH HHS/United States
LinkOut - more resources
Full Text Sources
Medical