Within‐ and between‐person effects of naltrexone on the subjective response to alcohol and craving: A daily diary investigation

Abstract

Objective: Naltrexone is an effective treatment for heavy drinking among young adults. Laboratory-based studies have shown that naltrexone dampens the subjective response to alcohol and craving. However, few studies have tested naltrexone's dynamic, within-person effects on subjective response and craving among young adults in natural drinking environments.Methods: Using daily diary data from a randomized, placebo-controlled study of naltrexone's efficacy in young adults, we examined the between-person effects of treatment condition (i.e., naltrexone vs. placebo) and medication dosage (i.e., daily, targeted, and daily + targeted) on the subjective response to alcohol and craving on drinking days. Multilevel mediation models predicted subjective response and craving from treatment condition (between-person) and medication dosage (within-person), accounting for drinking levels. All effects were disaggregated within and between persons. Results:At the between-person level, naltrexone directly blunted intense subjective effects (i.e., "impaired", "drunk") and indirectly blunted subjective effects through reduced drinking. Naltrexone was not associated with craving. Between-person effects were not significant after alpha correction, but their effect sizes (bs = 0.14 to 0.17) exceeded the smallest effect size of interest. At the within-person level, taking two (vs. 1) pills was associated with heavier drinking, and taking one (vs. 0) pill was associated with lighter drinking, and lighter drinking was associated with a lower subjective response and craving. Treatment condition did not moderate the within-person effects of dosing on outcomes. Conclusions:Our findings suggest that the direct between-person effect of naltrexone was largest on intense subjective responses, blunting feelings of being "drunk" and "impaired". Future research using momentary (rather than daily) assessments could confirm and extend these findings.

Subjective effects of simultaneous alcohol and cannabis versus alcohol-only use: A qualitative analysis.

“…First, since increased cognitive/behavioral impairment was the most often reported subjective effect concept, and impairment is often viewed as aversive/negative (i.e., Fromme et al, 1993; Morean et al, 2012), it is possible that individuals expect positive effects from simultaneous use but may not necessarily experience these effects. In support of this possibility, positive simultaneous use expectancies are reported much more frequently than expectancies of cognitive/behavioral impairment (Waddell, Corbin, et al, 2022). Thus, it is possible that aligning one’s expectancies with such impairment via an expectancy challenge intervention (e.g., Darkes & Goldman, 1998) could decrease engagement in simultaneous use, leading to potentiated risk for negative outcomes.…”

“…Thus, outside of validated single-substance measures and researcher-selected items (e.g., “drunk,” “intoxicated,” “euphoria”), little is known about how participants describe the subjective experience of simultaneous use. Further explicating these effects is important for theoretical models of simultaneous use (e.g., Risso et al, 2020; Subbaraman, 2016), as well as interventions that target an individual’s subjective experiences when using (e.g., Darkes & Goldman, 1998; Waddell, Corbin, et al, 2022). Therefore, the present study sought to better understand patterns and language related to subjective effects of simultaneous alcohol and cannabis use compared to using alcohol-alone, particularly in college students.…”

Event-level risk for negative alcohol consequences in emerging adults: The role of affect, motivation, and context.

“…First, the data were collected during the COVID-19 pandemic and in the midst of cannabis legalization in Arizona; thus, we accounted for day of study to detrend the data based upon early versus late study days. Similar approaches have been used in other EMA studies (e.g., Waddell et al, 2022). Event-level and percent of days coused were covaried, as research suggests that each is associated with heavier drinking and negative consequences at the within-and betweenperson levels (e.g., Gunn et al, 2019;Waddell, Blake, & Chassin, 2021;Waddell, Gunn, et al, 2021).…”

Event-level risk for negative alcohol consequences in emerging adults: The role of affect, motivation, and context.

“…First, the data were collected during the COVID-19 pandemic and in the midst of cannabis legalization in Arizona; thus, we accounted for day of study to detrend the data based on early versus late study days. Similar approaches have been used in other EMA studies (e.g., Waddell, Corbin, et al, 2022). Event-and person-level alcohol and cannabis couse was covaried, as research suggests that each is associated with heavier drinking and negative consequences at the within-and between-person levels (e.g., Gunn et al, 2019;Waddell, Blake, & Chassin, 2021;Waddell, Gunn, et al, 2021;Waddell, Jager, & Chassin, 2022).…”