Drinking on naltrexone

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Drinking on Naltrexone: Effects and Efficacy

Introduction to Naltrexone and Alcohol Use Disorder

Naltrexone is an opioid receptor antagonist commonly used to treat alcohol use disorder (AUD). It works by blocking the activation of the endogenous opioid system, which plays a significant role in the reinforcing properties of alcohol consumption. This article synthesizes findings from multiple studies to understand how naltrexone affects drinking behavior, craving, and subjective responses to alcohol.

Naltrexone's Impact on Drinking Behavior

Reduction in Drinking Intensity

Several studies have shown that naltrexone can reduce the intensity of drinking episodes. For instance, a study on young adults found that while naltrexone did not significantly reduce the frequency of heavy drinking days, it did reduce the number of drinks per drinking day and the percentage of days with a blood alcohol concentration (BAC) of 0.08 g/dL or higher. Similarly, another study demonstrated that naltrexone decreased the amount of beer consumed and increased the time taken to finish each glass, indicating a reduction in drinking speed and volume.

Effects on Binge Drinking

Targeted naltrexone has been particularly effective in reducing binge drinking among specific populations. A study focusing on sexual and gender minority men with mild to moderate AUD found that naltrexone significantly reduced the number of binge-drinking days and the overall number of drinks consumed per month. These findings suggest that naltrexone can be a valuable tool in managing binge drinking behaviors.

Naltrexone and Alcohol Craving

Craving Reduction

Naltrexone has been shown to reduce alcohol craving, which is a critical factor in preventing relapse. In a laboratory study, naltrexone-treated subjects reported lower levels of craving and consumed fewer drinks during a self-administration experiment. Another study found that naltrexone reduced the urge to drink alcohol in social drinkers, which was reflected in increased latency to take the first sip of an alcoholic beverage.

Subjective Response to Alcohol

Naltrexone also affects the subjective experience of drinking. It has been found to blunt the intense subjective effects of alcohol, such as feeling "drunk" or "impaired". In a clinical trial, a larger proportion of naltrexone-treated subjects reported that the "high" produced by alcohol was significantly less than usual, which likely contributed to their reduced alcohol consumption.

Naltrexone's Mechanisms of Action

Affect and Reinforcement

Naltrexone's ability to disrupt the association between affect and alcohol use is noteworthy. A study on adolescents found that naltrexone moderated the relationship between estimated BAC levels and negative affect (NA) during drinking episodes. Higher NA was associated with reduced subsequent BAC levels, suggesting that naltrexone may help in managing the emotional triggers of drinking.

Endocrine Effects

Naltrexone's impact on the hypothalamo-pituitary-adrenocortical (HPA) axis has also been explored. Increased levels of cortisol and adrenocorticotropic hormone (ACTH) were observed in naltrexone-treated subjects, which were negatively correlated with alcohol craving. This suggests that naltrexone's efficacy may be partly due to its activation of the HPA axis.

Safety and Tolerability

Naltrexone is generally well-tolerated, with common side effects including sleepiness, nausea, and headache. Serious adverse events are rare, making it a safe option for many individuals with AUD . Long-term studies have shown that naltrexone does not interfere with the normalization of biochemical markers of heavy drinking or liver function markers, further supporting its safety profile.

Conclusion

Naltrexone is an effective medication for reducing the intensity of drinking, managing cravings, and altering the subjective experience of alcohol consumption. Its ability to disrupt the affective reinforcement of drinking and activate the HPA axis contributes to its efficacy. While it may not significantly reduce the frequency of drinking days, its impact on drinking intensity and craving makes it a valuable tool in the treatment of alcohol use disorder.