A 6‐Month Controlled Naltrexone Study: Combined Effect With Cognitive Behavioral Therapy in Outpatient Treatment of Alcohol Dependence

Balldin, Jan; Berglund, Mats; Borg, S; Månsson, Marianne; Bendtsen, Preben; Franck, Johan; Gustafsson, Lisa; Halldin, Jan; Nilsson, LH; Stolt, Göran; Willander, Anders

doi:10.1097/01.alc.0000075548.83053.a9

Cited by 155 publications

(96 citation statements)

References 34 publications

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“…Studies have found that naltrexone reduces the occurrence of heavy drinking days (Balldin et al, 2003;Monti et al, 2001;Rubio et al, 2002), increases time to first relapse (Anton et al, 1999;Guardia et al, 2002;Kiefer et al, 2003), yields lower relapse rates (Heinala et al, 2001;Latt et al, 2002;Volpicelli et al, 1992), reduces the number of drinking days (O'Malley et al, 1992;Volpicelli et al, 1992), the number of drinks per drinking episode (Chick et al, 2000;Guardia et al, 2002;Morris et al, 2001;O'Malley et al, 1992), and the latency between first and second drink among social drinkers (Davidson et al, 1996). More recently, a large multisite controlled trial has found that naltrexone was an effective treatment for alcohol dependence when delivered in combination with a medically oriented behavioral intervention (Anton et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetics of Naltrexone in Asian Americans: A Randomized Placebo-Controlled Laboratory Study

Ray

Bujarski

Chin

et al. 2011

Neuropsychopharmacol

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Recent clinical and laboratory studies have shown that the effects of naltrexone for alcoholism may be moderated by the Asn40Asp single-nucleotide polymorphism (SNP) of the m-opioid receptor gene (OPRM1). Allele frequencies for this polymorphism, however, have been shown to vary substantially as a function of ethnic background, such that individuals of Asian descent are more likely to carry the minor (Asp40) allele. The objective of this study is to test the naltrexone pharmacogenetic effects of the Asn40Asp SNP in a sample of Asian Americans. This study consists of a double-blinded, randomized, placebo-controlled laboratory trial of naltrexone. Participants (n ¼ 35, 10 females; 13 Asn40Asn and 22 Asp40 carriers) were non-treatment-seeking heavy drinkers recruited from the community. After taking naltrexone or placebo, participants completed an intravenous alcohol administration session. The primary outcome measures were subjective intoxication and alcohol craving. Results suggested that Asp40 carriers experienced greater alcohol-induced sedation, subjective intoxication, and lower alcohol craving on naltrexone, as compared to placebo, and to Asn40 homozygotes. There results were maintained when controlling for ALDH2 (rs671) and ADH1B (rs1229984) markers and when examining the three levels of OPRM1 genotype, thereby supporting an OPRM1 gene dose response. These findings provide a much-needed extension of previous studies of naltrexone pharmacogenetics to individuals of Asian descent, an ethnic group more likely to express the minor allele putatively associated with improved biobehavioral and clinical response to this medication. These findings help further delineate the biobehavioral mechanisms of naltrexone and its pharmacogenetics.

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Section: Introductionmentioning

confidence: 99%

Pharmacogenetics of Naltrexone in Asian Americans: A Randomized Placebo-Controlled Laboratory Study

Ray

Bujarski

Chin

et al. 2011

Neuropsychopharmacol

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“…The current guidelines for the pharmacotherapy of alcohol dependence with opioid antagonist recommends daily use of naltrexone alongside nonpharmacological interventions (Balldin et al, 2003;O'Malley et al, 2003;O'Malley, 1995;Srisurapanont and Jarusuraisin, 2002). However, the treatment regimen has failed to reduce alcohol drinking in several studies (Gastpar et al, 2002;Krystal et al, 2001) and patients treated with naltrexone have experienced adverse effects that have led to poor medication compliance and impaired treatment outcome (Kranzler et al, 2000;Oncken et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Prolonged Central μ-Opioid Receptor Occupancy after Single and Repeated Nalmefene Dosing

Ingman

Hagelberg

Aalto

et al. 2005

Neuropsychopharmacol

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The opioid antagonist nalmefene offers an alternative to traditional pharmacological treatments for alcoholism. The present study was designed to investigate the relationship between nalmefene plasma concentration and central m-opioid receptor occupancy after a clinically effective dose (20 mg, orally). Pharmacokinetics and m-opioid receptor occupancy of nalmefene after single and repeated dosing over 7 days was studied in 12 healthy subjects. Serial blood samples were obtained after both dosings, and pharmacokinetic parameters for nalmefene and main metabolites were determined. Central m-opioid receptor occupancy of nalmefene was measured with positron emission tomography (PET) and [ 11 C]carfentanil at four time points (3, 26, 50, 74 h) after both dosings. Nalmefene was rapidly absorbed in all subjects. The mean t 1/2 of nalmefene was 13.4 h after single and repeated dosing. The accumulation of nalmefene and its main metabolites in plasma during the repeated dosing period was as expected for a drug with linear pharmacokinetics, and steady-state was reached for all analytes. Both nalmefene dosings resulted in a very high occupancy at m-opioid receptors (87-100%), and the decline in the occupancy was similar after both dosings but clearly slower than the decline in the plasma concentration of nalmefene or metabolites. High nalmefene occupancy (83-100%) persisted at 26 h after the dosings. The prolonged m-opioid receptor occupancy by nalmefene indicates slow dissociation of the drug from m-opioid receptors. These results support the rational of administering nalmefene when needed before alcohol drinking, and they additionally suggest that a high m-opioid receptor occupancy can be maintained when nalmefene is taken once daily.

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“…Cabe destacar lo anterior, en especial por lo que concierne al acuciante problema de las recaídas, puesto que la superioridad de la combinación terapéutica (esto es, Terapia Cognitivo-Conductual o la Terapia de Exposición a Señales de Droga/Entrenamiento en Habilidades de Afrontamiento más tratamiento farmacológico) se observó en diferentes estudios, con seguimientos de 3 meses (Feeney, Connor, Young, Tucker y McPherson, 2004), de 12 meses (Monti et al, 2001; y en un ensayo en doble ciego con seguimiento de 6 meses (Balldin et al, 2003). Por otra parte, la administración únicamente de la terapia basada en el "seguimiento/soporte prácticamente diario" por una enfermera especializada (NF en Tabla 3) durante varias semanas, ha demostrado mejorar la efectividad del acamprosato en la deshabituación alcohólica y prevención de recaídas durante 6 meses de seguimiento.…”

Section: Discussionunclassified

Integración e interacciones entre los tratamientos farmacológicos y psicológicos de las adicciones: una revisión.

Díaz-Morán

Fernández-Teruel

2013

analesps

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Resumen: Los tratamientos principales aplicados en el ámbito de las adicciones son la farmacoterapia y las terapias psicológicas, siendo escasas las intervenciones en las que se combinan estos dos tipos de terapias. El objetivo de este estudio es revisar y mostrar un resumen de los resultados de las principales investigaciones, que han evaluado la efectividad de la intervención combinada de estas terapias en comparación con la aplicación de los tratamientos administrados de forma aislada. Los resultados muestran que la aplicación combinada de tratamientos farmacológicos y psicológicos, presenta mayor efecto terapéutico y de prevención de recaídas, superando en parte las limitaciones que presentan estos dos tipos de tratamientos en su aplicación aislada. Palabras clave: Drogodependencias; farmacoterapia; terapias psicológicas; tratamientos combinados; eficacia terapéutica; prevención de recaídas.Title: Integration and interaction between pharmacological and psychological treatments of addiction: a review Abstract: The main therapies applied to treat substance abuse or addictions are pharmacotherapy and psychological therapies, with few interventions that combine these two types of therapies. The aim of the present study is to review and to summarize the main results of research devoted to evaluate the effectiveness of the combined action of these therapies, as compared to the effectiveness of each type of treatment administered alone. The results show that the combined application of pharmacological and psychological treatments has a greater therapeutic effect and relapse prevention, thus overcoming some of the limitations of these two types of treatments when administrated alone. Key words: Drug addiction; pharmacotherapy; psychological therapies; combination treatments; therapeutic efficacy; relapse prevention. IntroducciónEn el ámbito de las adicciones, los dos tipos principales de tratamientos, la farmacoterapia y las terapias psicológicas, se han desarrollado de forma paralela pero con trayectorias independientes. De forma consecuente, a pesar del desarrollo de farmacoterapias de potencia considerable, como la introducción de la buprenorfina y la naltrexona para la adicción a opiáceos (Fernández y Pereiro, 2007; Gowin, Ali y White, 2008) y al alcohol (Rösner et al., 2010b), los estudios sobre su uso y eficacia no han contemplado, en general, el papel que el contexto del tratamiento (factores psicológicos como el condicionamiento clásico a contextos o situaciones) tiene en los resultados terapéuticos. Así mismo, se ha demostrado la efectividad de varias terapias psicológicas en las adicciones, pero frecuentemente han sido evaluadas sin incluir el factor farmacológico en los respectivos estudios, incluso en casos en los que existirían farmacoterapias de comprobada eficacia (p. ej., Carroll, 1997).Según Secades-Villa y Fernández-Hermida (2001), existen actualmente suficientes investigaciones que avalan la eficacia de las intervenciones psicológicas en el tratamiento de las drogodependencias, aunque muestran mej...

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A 6‐Month Controlled Naltrexone Study: Combined Effect With Cognitive Behavioral Therapy in Outpatient Treatment of Alcohol Dependence

Abstract: This study supports the effect of naltrexone in outpatient treatment of alcohol dependence and suggests that a beneficial interaction effect with CBT can be expected.

Cited by 155 publications

References 34 publications

Pharmacogenetics of Naltrexone in Asian Americans: A Randomized Placebo-Controlled Laboratory Study

Pharmacogenetics of Naltrexone in Asian Americans: A Randomized Placebo-Controlled Laboratory Study

Prolonged Central μ-Opioid Receptor Occupancy after Single and Repeated Nalmefene Dosing

Integración e interacciones entre los tratamientos farmacológicos y psicológicos de las adicciones: una revisión.

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