Six-Month Follow-up of Naltrexone and Psychotherapy for Alcohol Dependence

O’Malley, Stephanie S.; Jaffe, Adam B.; Chang, Grace; Rode, Sarah A.; Schottenfeld, Richard S.; Meyer, Roger E.; Rounsaville, Bruce J.

doi:10.1001/archpsyc.1996.01830030039007

Cited by 259 publications

(122 citation statements)

References 12 publications

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“…therapeutic efficacy of NTX in treating alcoholism (O'Malley et al, 1992(O'Malley et al, , 1996Volpicelli et al, 1992Volpicelli et al, , 1997Anton et al, 1999;Chick et al, 2000;Johnson and Ait-Daoud, 2000;Heinala et al, 2001;Krystal et al, 2001;Morris et al, 2001;Guardia et al, 2002), identifying factors that predict therapeutic response to NTX is a critical goal of alcoholism research. Although the cognitive effects of acute and chronic NTX may differ, recent data supports equivalent or greater efficacy of acute NTX dosing, relative to daily maintenance, in reducing excessive alcohol intake (Hernandez-Avila et al, 2006).…”

Section: Discussion Ntx Effects On Impulsive Choicementioning

confidence: 99%

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Mitchell

Fields

et al. 2006

Neuropsychopharmacol

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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.

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Section: Discussion Ntx Effects On Impulsive Choicementioning

confidence: 99%

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Mitchell

Fields

et al. 2006

Neuropsychopharmacol

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“…Clinical studies also demonstrate that treatment of detoxified alcoholics with naltrexone reduces both the frequency of drinking and the relapse to heavy drinking (Volpicelli et al, 1992;O'Malley et al, 1992O'Malley et al, , 1996O'Malley et al, , 2002. Also, in a clinical laboratory setting, it was shown that non-treatmentseeking alcoholics treated with naltrexone consume less alcohol when presented in a laboratory setting than do placebo treatment subjects.…”

Section: Introductionmentioning

confidence: 97%

The Nociceptin/Orphanin FQ Receptor Agonist Ro 64-6198 Reduces Alcohol Self-Administration and Prevents Relapse-Like Alcohol Drinking

Kuzmin

Kreek

Bakalkin

et al. 2006

Neuropsychopharmacol

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Effects of the opioid receptor like-1 (ORL-1) receptor agonist Ro 64-6198 (0.1, 0.3, and 1.0 mg/kg intraperitoneally (i.p.)) on operant ethanol self-administration and activation of self-administration by ethanol deprivation were studied in male Wistar rats. Acute administration of Ro 64-6198 caused a dose-dependent reduction of ethanol self-administration. In comparison, the opioid antagonist naltrexone (0.1, 0.3, and 1.0 mg/kg i.p.) inhibited ethanol self-administration at all doses tested. Ethanol deprivation for 10 days significantly increased ethanol self-administration during the first 2 days after deprivation. Daily pretreatment with Ro 64-6198 (0.3 mg/kg) or naltrexone (0.3 mg/kg) during the last 3 days of ethanol deprivation abolished the deprivation-induced increase in ethanol intake. Thus, stimulation of the ORL-1 receptors by Ro 64-6198 reduced the acute reinforcing effects of ethanol and prevented relapse-like behavior in the ethanol-deprivation model in a similar manner as a blockade of opioid receptors by naltrexone. Ro 64-6198 at 0.1 and 0.3 mg/kg doses did not alter self-administration of 0.2% saccharin solution, indicating an apparent selectivity of this compound in modification of ethanol reward. These findings add further support to the idea that Ro 64-6198 and potentially other synthetic ORL-1 receptor agonists are as effective as naltrexone in blocking the actions of ethanol important for its addictive potential in animal experiments, and therefore may have therapeutic value in the treatment of alcoholism. Neuropsychopharmacology (2007) 32, 902-910.

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“…71 Other studies have also shown naltrexone to reduce the reinforcing effects and to increase the unpleasant (i.e., sedative) properties of initial alcohol consumption. 72,73 O'Malley et al 74 found that the beneficial effects of naltrexone diminished gradually during a posttreatment follow-up period. Further, abstinence during treatment strongly predicted whether subjects met criteria for alcohol abuse or dependence at a 6-month posttreatment follow-up.…”

Section: Treatment Of Alcohol Dependencementioning

confidence: 98%

Treatment of alcohol dependence

Kranzler¹

1997

Liver Transpl

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Six-Month Follow-up of Naltrexone and Psychotherapy for Alcohol Dependence

Abstract: Some but not all of the benefits resulting from short-term naltrexone treatment persist after discontinuation of treatment. The findings suggest that continued treatment with naltrexone may be beneficial for some patients.

Cited by 259 publications

References 12 publications

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

Endogenous Opioid Blockade and Impulsive Responding in Alcoholics and Healthy Controls

The Nociceptin/Orphanin FQ Receptor Agonist Ro 64-6198 Reduces Alcohol Self-Administration and Prevents Relapse-Like Alcohol Drinking

Treatment of alcohol dependence

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