Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings

Jonas, Daniel E; Amick, Halle R; Feltner, Cynthia; Bobashev, Georgiy; Thomas, Kelsey R.; Wines, Roberta; Kim, Mimi M.; Shanahan, Ellen; Gass, Clare; Rowe, Cassandra; Garbutt, James C.

doi:10.1001/jama.2014.3628

Cited by 754 publications

(827 citation statements)

References 89 publications

(40 reference statements)

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“…This effect was modest ( g = −.277) but reliable, with minimal heterogeneity observed across studies. By comparison, effect sizes for heavy drinking or drinking quantity outcomes across randomized clinical trials generally range between g = .10 and .20 (Jonas et al , 2014; Maisel et al , 2013; Rösner et al , 2010). Thus, a modest effect on laboratory SA is consistent with what is known about naltrexone's effects on self‐reported drinking quantity during longer periods of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Meta‐analyses support that, as an adjunct to psychosocial therapy, daily naltrexone reduces the number of drinking days, quantity of alcohol consumed and incidence of relapse to heavy drinking relative to placebo—albeit with modest effect sizes (Jonas et al , 2014; Maisel et al , 2013; Rösner et al , 2010). Meta‐analyses further indicate relatively greater efficacy of naltrexone versus acamprosate for reducing heavy drinking and craving (Maisel et al , 2013).…”

Section: Introductionmentioning

confidence: 99%

“…several days) medication schedules has, among other reasons, rendered them ineligible for prior meta‐analyses, which have required a minimum treatment duration of 4–12 weeks (e.g. Jonas et al , 2014; Rösner et al , 2010). Meta‐analysis permits aggregation of results across studies, improving power and precision in effect size estimates.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…3,4 These neuronal alterations form the targets of our current pharmaceutical therapies for addiction. Unfortunately however, these interventions demonstrate extremely limited efficacy 5 , leading to high relapse rates. This highlights a need to better understand the complex mechanisms behind drug addiction and then identify novel targets that may provide a more promising therapeutic intervention.…”

Section: Introductionmentioning

confidence: 99%

Drug addiction: targeting dynamic neuroimmune receptor interactions as a potential therapeutic strategy

Jacobsen

Hutchinson

Mustafa

2016

Current Opinion in Pharmacology

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After the embargo period via non-commercial hosting platforms such as their institutional repository  via commercial sites with which Elsevier has an agreement In all cases accepted manuscripts should: link to the formal publication via its DOI  bear a CC-BY-NC-ND license -this is easy to do, click here to find out how  if aggregated with other manuscripts, for example in a repository or other site, be shared in alignment with our hosting policy  not be added to or enhanced in any way to appear more like, or to substitute for, the published journal article Embargo 1471-4892 Current Opinion in Pharmacology 12months6 March 2017 Highlights• Drugs of abuse activate the neuroimmune system• The neuroimmune system is pivotal to the progression of addiction• Multiple independent parallel systems are not sufficient to explain complex states• Integrated signalling networks are crucial for addictive behaviours• Targeting receptor interactions may offer a novel therapeutic intervention AbstractDrug addiction and dependence have proven to be difficult psychiatric disorders to treat. The limited efficacy of neuronally-acting medication such as, acamprosate and naltrexone, highlights the need to identify novel targets. Recent research has underscored the importance of the neuroimmune system in many behavioural manifestations of drug addiction. In this review, we propose that our appreciation for complex phenotypes such as drug addiction and dependence will come with a greater understanding that these disorders are the result of intricate, interconnected signalling pathways that are, if only partially, determined at the receptor level. The idea of receptor heteromerisation and receptor mosaics will be introduced to explain cross talk between the receptors and signalling molecules implicated in neuroimmune signalling pathways.

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“…Recent meta-analyses of studies assessing injectable naltrexone's effectiveness indicate that its use in AUD patients is linked to a reduction in heavy drinking days (Jonas et al, 2014), longer refi ll persistence, and longer medication persistence compared with acamprosate (Campral) and tablet naltrexone (Hartung et al, 2014). Similarly, the use of injectable naltrexone for opioid use disorder has been linked to abstinence rates, longer duration of opioid-free days, improved treatment retention, less craving, and lower relapse (Gastfriend, 2011;Syed & Keating, 2013).…”

mentioning

confidence: 99%

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

Aletraris¹,

Edmond²,

Roman³

2015

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Medication-assisted treatment for substance use disorders (SUDs) is not widely used in treatment programs. The aims of the current study were to document the prevalence of adoption and implementation of extended-release injectable naltrexone, the newest U.S. Food and Drug Administration-approved medication for alcohol use disorder (AUD), in U.S. treatment programs and to examine associations between organizational and patient characteristics and adoption. Method: The study used interview data from a nationally representative sample of 307 U.S. SUD treatment programs to examine adoption and implementation of injectable naltrexone. Results: Thirteen percent of programs used injectable naltrexone for AUD, and 3% of programs used it for opioid use disorder. Every treatment program that offered injectable naltrexone to its patients used it in conjunction with psychosocial treatment, particularly cognitive behavioral therapy. Multivariate logistic regression results indicated that adoption was positively associated with the provision of wraparound services, the percentage of privately insured patients, and the presence of inpatient detoxifi cation services. For-profi t status and offering inpatient services were negatively associated with adoption. Within adopting programs, an average of 4.1% of AUD patients and 7.1% of patients with opioid use disorder were currently receiving the medication, despite clinical directors' reports of positive patient outcomes, particularly for relapsers and for those who had been noncompliant with other medications. Cost was a signifi cant issue for the majority of adopting organizations. Conclusions: The rate of adoption of injectable naltrexone in U.S. treatment programs remains limited. Researchers should continue to examine patient, organizational, and external characteristics associated with the adoption and implementation of injectable naltrexone over time. (J. Stud. Alcohol Drugs, 76, 143-151, 2015)

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Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings

Cited by 754 publications

References 89 publications

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

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

Drug addiction: targeting dynamic neuroimmune receptor interactions as a potential therapeutic strategy

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

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