Naltrexone's Effect on Cue‐Elicited Craving Among Alcoholics in Treatment

Monti, Peter M.; Rohsenow, Damaris J.; Hutchison, Kent E.; Swift, Robert M.; Mueller, Timothy I.; Colby, Suzanne M.; Brown, Richard A.; Gulliver, Suzy B.; Gordon, Alan; Abrams, David B.

doi:10.1111/j.1530-0277.1999.tb04361.x

Cited by 136 publications

(116 citation statements)

References 53 publications

Supporting

Mentioning

106

Contrasting

Order By: Relevance

“…For example, NTX selectively reduces consumption of preferred foods (Apfelbaum and Mandenoff, 1981). Moreover, decreased attentional bias toward attractive stimuli by NTX is consistent with data showing that NTX reduces cue-elicited alcohol craving in alcoholics (Monti et al, 1999;Rohsenow et al, 2000;O'Malley et al, 2002). Thus, effects on attentional bias could be one means by which NTX exerts its therapeutic effects in alcoholics.…”

Section: Ntx Effects On MMsupporting

confidence: 81%

“…Another possibility is that NTX reduces drinking by generating aversive side effects, such as nausea, when ethanol is consumed (Davidson et al, 1999;de Wit et al, 1999;McCaul et al, 2000;Mitchell et al, 2005a). However, there is also evidence that NTX significantly reduces alcohol craving in alcoholics during abstinence (Monti et al, 1999;Rohsenow et al, 2000;O'Malley et al, 2002), and improves resistance to thoughts, urges, and behaviors associated with drinking (Anton et al, 1999). Thus, it is plausible that NTX acts, in part, via alteration of certain cognitive processes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Mitchell

Fields

et al. 2006

Neuropsychopharmacol

View full text Add to dashboard Cite

The opioid receptor antagonist naltrexone (NTX) is one of few approved treatments for alcoholism, yet the mechanism by which it reduces drinking remains unclear. In rats, NTX reduces morphine-induced impulsive choice bias; however, nothing is known about the drug's effect on discrete aspects of impulsive behavior in humans, such as decision-making and inhibitory control. Here, we used a modified delay discounting procedure to investigate whether NTX improves decision-making or inhibitory control in humans. We measured the effect of acute NTX (50 mg) on choice between smaller sooner (SS) and larger later monetary rewards and on response errors (motor mismatch) in a high conflict condition in a group of abstinent alcoholics (AA) and healthy control subjects (CS). We previously reported that AA selected the SS option significantly more often than did CS in this paradigm. If the choice bias of AA is due to enhanced endogenous opioid signaling in response to potential reward, NTX should reduce such bias in the AA group. We found that NTX did not reliably reduce impulsive choice in the AA group; however, NTX's effect on choice bias across individuals was robustly predictable. NTX's effect on choice bias was significantly correlated with scores on Rotter's Locus of Control (LOC) scale; increasingly internal LOC scores predicted increasing likelihood of impulsive choices on NTX. In addition, we found that NTX significantly enhanced control of motor responses, particularly within the CS group. These results suggest that endogenous opioids may impair response selection during decision-making under conflict, and that NTX's effects on explicit decision-making are personality-dependent. Determining the biological basis of this dependence could have important implications for effective alcoholism treatment.

show abstract

Section: Ntx Effects On MMsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Mitchell

Fields

et al. 2006

Neuropsychopharmacol

View full text Add to dashboard Cite

show abstract

“…However, craving was the most commonly used subjective response outcome, and most studies reporting subjective response measures included craving. Given this issue, and that craving is considered a proximal determinant of consumption (Monti et al , 1999), we elected to restrict the analysis to craving as the sole self‐report outcome. Although a small number of otherwise eligible studies reporting other subjective effects were excluded as a result, focusing on craving allowed us to report on arguably the most clinically relevant outcome, while avoiding the potential problem of combining different subjective response domains in the analysis (King et al , 2011).…”

Section: Cravingmentioning

confidence: 99%

Effects of naltrexone on alcohol self‐administration and craving: meta‐analysis of human laboratory studies

et al. 2016

View full text Add to dashboard Cite

Randomized clinical trials have established the efficacy of naltrexone for reducing quantity of alcohol consumption and incidence of relapse to heavy drinking. To evaluate putative treatment mechanisms, human laboratory studies have examined naltrexone's effects on alcohol responses and self‐administration during short‐term medication protocols. Results from these studies are inconsistent and have yet to be examined in aggregate. This meta‐analysis aimed to quantify naltrexone's effects on alcohol self‐administration and craving in the context of placebo‐controlled human laboratory trials. Potential moderators of medication effects were also examined. Meta‐analyses of alcohol self‐administration (k = 9, N = 490) and craving (k = 16, N = 748) confirmed that, under controlled experimental conditions, naltrexone reduces the quantity of consumption (Hedges' g = −.277, SE = .074, 95 percent CI = −.421, −.133, p < .001) and magnitude of self‐reported craving (g = −.286, SE = .066, 95 percent CI = −.416, −.156, p < .001) relative to placebo. Subgroup and moderation analyses found no evidence that effect sizes differed by study population (dependent versus non‐dependent drinkers), laboratory paradigm or duration of medication exposure. These results substantiate prior evidence for reductions in event‐level craving and consumption as potential treatment mediators, also establishing effect sizes to inform future human laboratory trials. From a clinical perspective, these results may provide additional evidence regarding naltrexone's efficacy in the context of acute or subacute dosing regimens.

show abstract

“…In general, self-report measures are viewed as indicators of the phenotype of the disorder, whereas neurocognitive, and neurobiological dispositions, are viewed as endophenotypical indicators of the disorder. Other examples of endophenotypical indicators are electroencephalogram measures of attentional bias (Waters et al 2003), and the neuropharmacological effects on craving (Monti et al 1999). Reviews suggest that endophenotypes may have a stronger prognostic value for the course of addictions and other mental health problems than phenotypical indicators (Gottesman & Gould, 2003 ;Ooteman et al 2005).…”

Section: Introductionmentioning

confidence: 99%

The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers

et al. 2007

View full text Add to dashboard Cite

Background. Disinhibition and decision-making skills play an important role in theories on the cause and outcome of addictive behaviors such as substance use disorders and pathological gambling. In recent studies, both disinhibition and disadvantageous decision-making strategies, as measured by neurocognitive tests, have been found to influence the course of substance use disorders. Research on factors affecting relapse in pathological gambling is scarce.Method. This study investigated the effect of both self-reported impulsivity and reward sensitivity, and neurocognitively assessed disinhibition and decision-making under conflicting contingencies, on relapse in a group of 46 pathological gamblers.Results. Logistic regression analysis indicated that longer duration of the disorder and neurocognitive indicators of disinhibition (Stop Signal Reaction Time) and decision-making (Card Playing Task) were significant predictors of relapse (explaining 53 % of the variance in relapse), whereas self-reported impulsivity and reward sensitivity did not significantly predict relapse. Overall classification accuracy was 76 %, with a positive classification accuracy of 76 % and a negative classification accuracy of 75 %.Conclusions. Duration of the disorder and neurocognitive measures of disinhibition and decision-making are powerful predictors of relapse in pathological gambling. The results suggest that endophenotypical neurocognitive characteristics are more promising in the prediction of relapse in pathological gambling than phenotypical personality characteristics. Neurocognitive predictors may be useful to guide treatment planning of follow-up contacts and booster sessions.

show abstract

Naltrexone's Effect on Cue‐Elicited Craving Among Alcoholics in Treatment

Abstract: The results have implications for models of relapse and naltrexone's effects. Cue reactivity methodology has utility for investigating hypothesized mediators of therapeutic effects of pharmacotherapies as well as behavioral treatments.

Cited by 136 publications

References 53 publications

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Effects of naltrexone on alcohol self‐administration and craving: meta‐analysis of human laboratory studies

The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers

Contact Info

Product

Resources

About