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Carrette L, Santos A, Brennan M, Othman D, Collazo A, George O. Antagonists of the stress and opioid systems restore the functional connectivity of the prefrontal cortex during alcohol withdrawal through divergent mechanisms. bioRxiv 2024:2023.09.30.560339. [PMID: 37873478 PMCID: PMC10592857 DOI: 10.1101/2023.09.30.560339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Chronic alcohol consumption leads to dependence and withdrawal symptoms upon cessation, contributing to persistent use. However, the brain network mechanisms by which the brain orchestrates alcohol withdrawal and how these networks are affected by pharmacological treatments remain elusive. Recent work revealed that alcohol withdrawal produces a widespread increase in coordinated brain activity and a decrease in modularity of the whole-brain functional network using single-cell whole-brain imaging of immediate early genes. This decreased modularity and functional hyperconnectivity are hypothesized to be novel biomarkers of alcohol withdrawal in alcohol dependence, which could potentially be used to evaluate the efficacy of new medications for alcohol use disorder. However, there is no evidence that current FDA-approved medications or experimental treatments known to reduce alcohol drinking in animal models can normalize the changes in whole-brain functional connectivity. In this report, we tested the effect of R121919, a CRF1 antagonist, and naltrexone, an FDA-approved treatment for alcohol use disorder, on whole-brain functional connectivity using the cellular marker FOS combined with graph theory and advanced network analyses. Results show that both R121919 and naltrexone restored the functional connectivity of the prefrontal cortex during alcohol withdrawal, but through divergent mechanisms. Specifically, R121919 increased FOS activation in the prefrontal cortex, partially restored modularity, and normalized connectivity, particularly in CRF1-rich regions, including the prefrontal, pallidum, and extended amygdala circuits. On the other hand, naltrexone decreased FOS activation throughout the brain, decreased modularity, and increased connectivity overall except for the Mu opioid receptor-rich regions, including the thalamus. These results identify the brain networks underlying the pharmacological effects of R121919 and naltrexone and demonstrate that these drugs restored different aspects of functional connectivity of the prefrontal cortex, pallidum, amygdala, and thalamus during alcohol withdrawal. Notably, these effects were particularly prominent in CRF1- and Mu opioid receptors-rich regions highlighting the potential of whole-brain functional connectivity using FOS as a tool for identifying neuronal network mechanisms underlying the pharmacological effects of existing and new medications for alcohol use disorder.
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Affiliation(s)
- L.L.G. Carrette
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - A. Santos
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - M. Brennan
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - D. Othman
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
| | - A. Collazo
- Beckman Institute, CalTech, Passadena, CA, United States
| | - O. George
- Department of Psychiatry, UC San Diego, La Jolla, CA, United States
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Donoghue K, Boniface S, Brobbin E, Byford S, Coleman R, Coulton S, Day E, Dhital R, Farid A, Hermann L, Jordan A, Kimergård A, Koutsou ML, Lingford-Hughes A, Marsden J, Neale J, O'Neill A, Phillips T, Shearer J, Sinclair J, Smith J, Strang J, Weinman J, Whittlesea C, Widyaratna K, Drummond C. Adjunctive Medication Management and Contingency Management to enhance adherence to acamprosate for alcohol dependence: the ADAM trial RCT. Health Technol Assess 2023; 27:1-88. [PMID: 37924307 PMCID: PMC10641712 DOI: 10.3310/dqkl6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
Background Acamprosate is an effective and cost-effective medication for alcohol relapse prevention but poor adherence can limit its full benefit. Effective interventions to support adherence to acamprosate are therefore needed. Objectives To determine the effectiveness of Medication Management, with and without Contingency Management, compared to Standard Support alone in enhancing adherence to acamprosate and the impact of adherence to acamprosate on abstinence and reduced alcohol consumption. Design Multicentre, three-arm, parallel-group, randomised controlled clinical trial. Setting Specialist alcohol treatment services in five regions of England (South East London, Central and North West London, Wessex, Yorkshire and Humber and West Midlands). Participants Adults (aged 18 years or more), an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of alcohol dependence, abstinent from alcohol at baseline assessment, in receipt of a prescription for acamprosate. Interventions (1) Standard Support, (2) Standard Support with adjunctive Medication Management provided by pharmacists via a clinical contact centre (12 sessions over 6 months), (3) Standard Support with adjunctive Medication Management plus Contingency Management that consisted of vouchers (up to £120) to reinforce participation in Medication Management. Consenting participants were randomised in a 2 : 1 : 1 ratio to one of the three groups using a stratified random permuted block method using a remote system. Participants and researchers were not blind to treatment allocation. Main outcome measures Primary outcome: self-reported percentage of medication taken in the previous 28 days at 6 months post randomisation. Economic outcome: EuroQol-5 Dimensions, a five-level version, used to calculate quality-adjusted life-years, with costs estimated using the Adult Service Use Schedule. Results Of the 1459 potential participants approached, 1019 (70%) were assessed and 739 (73 consented to participate in the study, 372 (50%) were allocated to Standard Support, 182 (25%) to Standard Support with Medication Management and 185 (25%) to Standard Support and Medication Management with Contingency Management. Data were available for 518 (70%) of participants at 6-month follow-up, 255 (68.5%) allocated to Standard Support, 122 (67.0%) to Standard Support and Medication Management and 141 (76.2%) to Standard Support and Medication Management with Contingency Management. The mean difference of per cent adherence to acamprosate was higher for those who received Standard Support and Medication Management with Contingency Management (10.6%, 95% confidence interval 19.6% to 1.6%) compared to Standard Support alone, at the primary end point (6-month follow-up). There was no significant difference in per cent days adherent when comparing Standard Support and Medication Management with Standard Support alone 3.1% (95% confidence interval 12.8% to -6.5%) or comparing Standard Support and Medication Management with Standard Support and Medication Management with Contingency Management 7.9% (95% confidence interval 18.7% to -2.8%). The primary economic analysis at 6 months found that Standard Support and Medication Management with Contingency Management was cost-effective compared to Standard Support alone, achieving small gains in quality-adjusted life-years at a lower cost per participant. Cost-effectiveness was not observed for adjunctive Medication Management compared to Standard Support alone. There were no serious adverse events related to the trial interventions reported. Limitations The trial's primary outcome measure changed substantially due to data collection difficulties and therefore relied on a measure of self-reported adherence. A lower than anticipated follow-up rate at 12 months may have lowered the statistical power to detect differences in the secondary analyses, although the primary analysis was not impacted. Conclusions Medication Management enhanced with Contingency Management is beneficial to patients for supporting them to take acamprosate. Future work Given our findings in relation to Contingency Management enhancing Medication Management adherence, future trials should be developed to explore its effectiveness and cost-effectiveness with other alcohol interventions where there is evidence of poor adherence. Trial registration This trial is registered as ISRCTN17083622 https://doi.org/10.1186/ISRCTN17083622. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim Donoghue
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Sadie Boniface
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Institute of Alcohol Studies, London, UK
| | - Eileen Brobbin
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology and Neuroscience, King's Health Economics, King's College London, London UK
| | - Rachel Coleman
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Edward Day
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Ranjita Dhital
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Arts and Sciences Department, University College London, London, UK
| | - Anum Farid
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- What Works for Children's Social Care, London, UK
| | - Laura Hermann
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - Amy Jordan
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- Black Country Healthcare NHS Foundation Trust, West Bromwich, UK
| | - Andreas Kimergård
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | | | - Anne Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - John Marsden
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Joanne Neale
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
| | - Aimee O'Neill
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Thomas Phillips
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
| | - James Shearer
- Institute of Psychiatry, Psychology and Neuroscience, King's Health Economics, King's College London, London UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joanna Smith
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - John Strang
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Cate Whittlesea
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Kideshini Widyaratna
- Institute of Psychiatry Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
| | - Colin Drummond
- National Addictions Centre, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Metz VE, Leibowitz A, Satre DD, Parthasarathy S, Jackson-Morris M, Cocohoba J, Sterling SA. Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial. Contemp Clin Trials 2022; 123:107004. [PMID: 36379437 PMCID: PMC9729439 DOI: 10.1016/j.cct.2022.107004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Alcohol use problems are associated with serious medical, mental health and socio-economic consequences. Yet even when patients are identified in healthcare settings, most do not receive treatment, and use of pharmacotherapy is rare. This study will test the effectiveness of the Alcohol Telemedicine Consult (ATC) Service, a novel, personalized telehealth intervention approach for primary care patients with alcohol use problems. METHODS This cluster-randomized pragmatic trial, supplemented by qualitative interviews, will include adults with a primary care visit between 9/10/21-3/10/23 from 16 primary care clinics at two large urban medical centers within Kaiser Permanente Northern California, a large, integrated healthcare system. Clinics are randomized to the ATC Service (intervention), including alcohol pharmacotherapy and SBIRT (screening, MI (Motivational Interviewing)-based brief intervention and referral to addiction treatment) delivered by clinical pharmacists, or the Usual Care (UC) arm that provides systematic alcohol SBIRT. Primary outcomes include a comparison of the ATC and UC arms on 1) implementation outcomes (alcohol pharmacotherapy prescription rates, specialty addiction treatment referrals); and 2) patient outcomes (medication fills, addiction treatment initiation, alcohol use, healthcare services utilization) over 1.5 years. A general modeling approach will consider clustering of patients/providers, and a random effects model will account for intra-class correlations across patients within providers and across clinics. Qualitative interviews with providers will examine barriers and facilitators to implementation. DISCUSSION The ATC study examines the effectiveness of a pharmacist-provided telehealth intervention that combines pharmacotherapy and MI-based consultation. If effective, the ATC study could affect treatment models across the spectrum of alcohol use problems. CLINICAL TRIALS REGISTRATION This study has been registered on ClinicalTrials.gov (NCT05252221).
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Affiliation(s)
- Verena E Metz
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA.
| | - Amy Leibowitz
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Derek D Satre
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco 94107, CA, USA
| | - Sujaya Parthasarathy
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Melanie Jackson-Morris
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA
| | - Jennifer Cocohoba
- School of Pharmacy, University of California, San Francisco, 521 Parnassus Avenue, San Francisco 94117, CA, USA
| | - Stacy A Sterling
- Kaiser Permanente Northern California Division of Research, Center for Addiction and Mental Health Research, 2000 Broadway, Oakland 94612, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco 94107, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Avenue, Pasadena 91101, CA, USA.
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4
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Leung JG, Narayanan PP, Markota M, Miller NE, Philbrick KL, Burton MC, Kirchoff RW. Assessing Naltrexone Prescribing and Barriers to Initiation for Alcohol Use Disorder: A Multidisciplinary, Multisite Survey. Front Psychiatry 2022; 13:856938. [PMID: 35619618 PMCID: PMC9127043 DOI: 10.3389/fpsyt.2022.856938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To survey barriers in prescribing naltrexone for alcohol use disorder. METHODS A 12-question survey related to naltrexone prescribing patterns, perceptions, and knowledge was sent to 770 prescribers in the departments of internal medicine, family medicine, and psychiatry across a health system with sites in Arizona, Florida, and Minnesota. RESULTS Responses were obtained and included for 146/770 prescribers (19.0% response rate). Most respondents were in the department of internal medicine (n = 94, 64.4%), but the departments of psychiatry (n = 22, 15.1%) and family medicine (n = 30, 20.5%) were also represented. Only 34 (23.3%) respondents indicated they had prescribed naltrexone in the previous 3 months. The most common reasons for not prescribing naltrexone were "unfamiliarity with naltrexone for treatment of alcohol use disorder" and "patients do not have appropriate follow-up or are not in a formal treatment program." Compared with those representing internal/family medicine, psychiatry respondents were more likely to prescribe naltrexone and answer knowledge questions correctly. CONCLUSION In this survey among primarily non-addiction-trained prescribers, a disparity was shown for prescribing naltrexone and in knowledge barriers between staff in internal/family medicine and psychiatry. There exist opportunities for education and quality improvement that promote the prescribing of naltrexone for alcohol use disorder by non-addiction specialists.
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Affiliation(s)
| | | | - Matej Markota
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | | | - Kemuel L Philbrick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Robert W Kirchoff
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, United States
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5
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Costa ACDM, Freitas LMD, Tranin GCG, Sales TLS, Pestana ACNR, Alpoim PN, Sanches C, Chequer FMD. Pharmacotherapy used for alcohol and cocaine use disorders in a CAPS-AD of Minas Gerais. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Slavin-Stewart C, Minhas M, Turna J, Brasch J, Olagunju AT, Chaimowitz G, MacKillop J. Pharmacological interventions for alcohol misuse in correctional settings: A systematic review. Alcohol Clin Exp Res 2021; 46:13-24. [PMID: 34825363 DOI: 10.1111/acer.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The prevalence of alcohol use disorder (AUD) is estimated to be 10 times higher amongst individuals in the criminal justice system than the general population. Alcohol use is also one of the strongest modifiable risk factors for recidivism. One intervention that has been shown to be effective in reducing alcohol consumption in the general population is medication-assisted treatment (MAT), and this systematic review synthesized the existing evidence on MAT for AUD in correctional settings. METHODS Empirical, peer-reviewed studies on approved medications for AUD in correctional populations were searched in major databases. One hundred sixty-two articles were initially screened and 14 eligible articles were included in the final review. Four articles examined disulfiram, and 10 articles examined naltrexone. RESULTS The studies on disulfiram were considerably older than those on naltrexone, predating contemporary scientific standards. Disulfiram in combination with substantial contingencies in a supervised setting significantly reduced alcohol-related measures of consumption and recidivism and had acceptable safety and tolerability. All naltrexone studies showed significant reductions in alcohol-related measures, but effects on recidivism were mixed. The naltrexone studies indicated that it was highly acceptable and well tolerated. In addition, offenders receiving naltrexone had significantly greater medication adherence, treatment attendance, and treatment duration than with placebo. CONCLUSIONS A small number of studies on pharmacological interventions for AUD in the correctional population suggest that MAT is effective in reducing alcohol consumption, although results on recidivism are mixed. On balance, the evidence was more supportive of naltrexone in reducing alcohol-related outcomes than disulfiram and it may also be a more feasible intervention in correctional settings. Further research on MAT to address AUD in correctional populations with larger sample sizes, longer duration, and in combination with behavioral interventions is warranted.
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Affiliation(s)
- Claire Slavin-Stewart
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Meenu Minhas
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jasmine Turna
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jennifer Brasch
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Andrew Toyin Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Gary Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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7
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Hartwell EE, Feinn R, Morris PE, Gelernter J, Krystal J, Arias AJ, Hoffman M, Petrakis I, Gueorguieva R, Schacht JP, Oslin D, Anton RF, Kranzler HR. Systematic review and meta-analysis of the moderating effect of rs1799971 in OPRM1, the mu-opioid receptor gene, on response to naltrexone treatment of alcohol use disorder. Addiction 2020; 115:1426-1437. [PMID: 31961981 PMCID: PMC7340566 DOI: 10.1111/add.14975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS There is wide inter-individual variability in response to the treatment of alcohol use disorder (AUD) with the opioid receptor antagonist naltrexone. To identify patients who may be most responsive to naltrexone treatment, studies have examined the moderating effect of rs1799971, a single nucleotide polymorphism (SNP) that encodes a non-synonymous substitution (Asn40Asp) in the mu-opioid receptor gene, OPRM1. The aims of this study were to: (1) conduct a systematic review of randomized clinical trials (RCTs); (2) assess the bias of the available studies and gauge publication bias; and (3) meta-analyze the interaction effect of the Asn40Asp SNP on the response to naltrexone treatment. METHODS We searched for placebo-controlled RCTs that examined the effect of Asn40Asp on the response to naltrexone treatment of heavy drinking or AUD. We tested the hypothesis that the minor (Asp40) allele was associated with a greater reduction in five alcohol consumption measures (relapse to heavy drinking, abstinence, percentage of heavy drinking days, percentage of days abstinent and drinks per day) in naltrexone-treated participants by meta-analyzing the interaction effects using a random effects model. RESULTS Seven RCTs met the study criteria. Overall, risk of bias was low and we observed no evidence of publication bias. Of the five alcohol consumption outcomes considered, there was a nominally significant moderating effect of the Asn40Asp SNP only on drinks per day (d = -0.18, P = 0.02). However, the effect was not significant when multiple comparisons were taken into account. CONCLUSIONS From the evidence to date, it remains unclear whether rs1799971, the OPRM1 Asn40Asp single nucleotide polymorphism, predicts naltrexone treatment response in individuals with alcohol use disorder or heavy drinking.
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Affiliation(s)
- Emily E. Hartwell
- Mental Illness Research, Education and Clinical Center, Cpl. Michael J. Crescenz VAMC, Philadelphia, PA 19104,Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT 06473
| | - Paige E. Morris
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Joel Gelernter
- Departments of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, and VA Connecticut Healthcare, West Haven, CT 06516
| | - John Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
| | - Albert J. Arias
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23298
| | - Michaela Hoffman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Ismene Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
| | - Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - David Oslin
- Mental Illness Research, Education and Clinical Center, Cpl. Michael J. Crescenz VAMC, Philadelphia, PA 19104,Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Henry R. Kranzler
- Mental Illness Research, Education and Clinical Center, Cpl. Michael J. Crescenz VAMC, Philadelphia, PA 19104,Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104,To whom correspondence should be addressed at: Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 500, Philadelphia, PA 19104; Telephone: 215-746-1943;
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Abstract
PURPOSE OF REVIEW We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction. RECENT FINDINGS Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.
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Affiliation(s)
- Leo Malandain
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France.
| | - Jean-Victor Blanc
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florian Ferreri
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), Paris University, AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
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9
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Kelty E, Hulse G, Joyce D. A comparison of blood toxicology in fatalities involving alcohol and other drugs in patients with an opioid use disorder treated with methadone, buprenorphine, and implant naltrexone. The American Journal of Drug and Alcohol Abuse 2019; 46:241-250. [DOI: 10.1080/00952990.2019.1698587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Erin Kelty
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia
| | - Gary Hulse
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - David Joyce
- School of Medicine, University of Western Australia, Crawley, Western Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia
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Stewart SH, Walitzer KS, Blanco J, Swiatek D, Paine Hughes L, Quiñones-Lombraña A, Shyhalla K. Medication-enhanced behavior therapy for alcohol use disorder: Naltrexone, Alcoholics Anonymous Facilitation, and OPRM1 genetic variation. J Subst Abuse Treat 2019; 104:7-14. [PMID: 31370987 DOI: 10.1016/j.jsat.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 01/24/2023]
Abstract
Medication-assisted behavior treatment for alcohol use disorder (AUD) holds promise to enhance the efficacy of medication and of behavior therapy when administered individually. The present study examines the treatment benefit of combined outpatient naltrexone (NTX) treatment with Alcoholics Anonymous Facilitation (AAF) behavior therapy, in the context of OPRM1 genotype. The minor OPRM1 Asp40 G-allele has been associated with greater positive reinforcing effects of alcohol consumption and greater alcohol craving, suggesting that individuals carrying the OPRM1 G allele may have an improved naltrexone response. Twenty patients, including 7 G-allele carriers, received 90 days of naltrexone with medication support and dispensing sessions, and ten AAF behavior therapy sessions. During treatment and the eight-week posttreatment follow-up, an overall increase in percent days abstinent was observed for the sample as a whole, but G-allele carriers reported relatively heavier drinking relative to other subjects. These findings suggest that this enhanced medication-assisted behavior treatment is a promising therapeutic combination, and mirror other recent findings that G-allele carriers may require more intensive treatment.
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Affiliation(s)
- Scott H Stewart
- Section on Addiction Medicine, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Kimberly S Walitzer
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
| | - Javier Blanco
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Denise Swiatek
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Adolfo Quiñones-Lombraña
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Kathleen Shyhalla
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
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11
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Elton A, Dove S, Spencer CN, Robinson DL, Boettiger CA. Naltrexone Acutely Enhances Connectivity Between the Ventromedial Prefrontal Cortex and a Left Frontoparietal Network. Alcohol Clin Exp Res 2019; 43:965-978. [PMID: 30848494 DOI: 10.1111/acer.13999] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Naltrexone, an opioid receptor antagonist that is Food and Drug Administration approved for treating alcohol use disorder (AUD), reduces alcohol craving and intake. Despite known pharmacological properties, little is known regarding the effects of naltrexone on neural circuit function. Thus, a data-driven examination of the neural effects of naltrexone in human subjects may offer novel insight into its treatment mechanisms. METHODS Twenty-one alcohol using males (22 to 39) participated in a double-blind, placebo-controlled crossover study of the effects of naltrexone on brain voxel-wise functional connectivity (FC) using intersubject FC correlation mapping. We first cross-correlated the time series from each gray matter voxel to produce a 6,356 × 6,356 FC matrix for each subject and session. We then subtracted the placebo FC matrix from the naltrexone FC matrix. To identify brain regions demonstrating significant reconfiguration of whole-brain FC patterns following naltrexone treatment, we statistically quantified the consistency of patterns of voxel FC changes across subjects. Permutation testing identified significant clusters of voxels undergoing significant reconfiguration. Using the identified clusters in a seed-based FC analysis, we then compared the FC patterns of affected brain areas on placebo versus naltrexone in a paired t-test. Ridge regression analyses identified self-report measures, including substance use, that significantly predicted individual differences in FC among naltrexone-modulated regions. RESULTS Two clusters in the rostral anterior cingulate cortex (rACC)/ventromedial prefrontal cortex (vmPFC) demonstrated significant modulation of FC by naltrexone. Using these 2 proximal clusters as a single seed, specific FC changes were identified in regions associated with a left frontoparietal network (increasing), as well as visual and motor regions (decreasing). Stronger FC between the rACC/vmPFC and this set of regions on placebo was associated with more external locus of control, whereas weaker connectivity was associated with greater substance use problems. Naltrexone strengthened these connections most among individuals who reported greater drinking to cope. CONCLUSIONS Enhancing connectivity between the rACC/vmPFC, implicated in alcohol craving, and components of a left frontoparietal network involved in executive control may represent an effective strategy for the treatment of AUD.
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Affiliation(s)
- Amanda Elton
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina.,Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina
| | - Samantha Dove
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Cory N Spencer
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Donita L Robinson
- Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina.,Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Charlotte A Boettiger
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina.,Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina.,Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, North Carolina
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12
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Kelty E, Joyce D, Hulse G. A retrospective cohort study of mortality rates in patients with an opioid use disorder treated with implant naltrexone, oral methadone or sublingual buprenorphine. The American Journal of Drug and Alcohol Abuse 2019; 45:285-291. [DOI: 10.1080/00952990.2018.1545131] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Erin Kelty
- Discipline of Psychiatry, University of Western Australia, Nedlands, Western Australian, Australia
- School of Population and Global Health, University of Western Australia, Crawley, Western Australian, Australia
| | - David Joyce
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Gary Hulse
- Discipline of Psychiatry, University of Western Australia, Nedlands, Western Australian, Australia
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13
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Hamida SB, Boulos LJ, McNicholas M, Charbogne P, Kieffer BL. Mu opioid receptors in GABAergic neurons of the forebrain promote alcohol reward and drinking. Addict Biol 2019; 24:28-39. [PMID: 29094432 PMCID: PMC5932272 DOI: 10.1111/adb.12576] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/07/2017] [Accepted: 10/06/2017] [Indexed: 01/21/2023]
Abstract
Mu opioid receptors (MORs) are widely distributed throughout brain reward circuits and their role in drug and social reward is well established. Substantial evidence has implicated MOR and the endogenous opioid system in alcohol reward, but circuit mechanisms of MOR-mediated alcohol reward and intake behavior remain elusive, and have not been investigated by genetic approaches. We recently created conditional knockout (KO) mice targeting the Oprm1 gene in GABAergic forebrain neurons. These mice (Dlx-MOR KO) show a major MOR deletion in the striatum, whereas receptors in midbrain (including the Ventral Tegmental Area or VTA) and hindbrain are intact. Here, we compared alcohol-drinking behavior and rewarding effects in total (MOR KO) and conditional KO mice. Concordant with our previous work, MOR KO mice drank less alcohol in continuous and intermittent two-bottle choice protocols. Remarkably, Dlx-MOR KO mice showed reduced drinking similar to MOR KO mice, demonstrating that MOR in the forebrain is responsible for the observed phenotype. Further, alcohol-induced conditioned place preference was detected in control but not MOR KO mice, indicating that MOR is essential for alcohol reward and again, Dlx-MOR KO recapitulated the MOR KO phenotype. Taste preference and blood alcohol levels were otherwise unchanged in mutant lines. Together, our data demonstrate that MOR expressed in forebrain GABAergic neurons is essential for alcohol reward-driven behaviors, including drinking and place conditioning. Challenging the prevailing VTA-centric hypothesis, this study reveals another mechanism of MOR-mediated alcohol reward and consumption, which does not necessarily require local VTA MORs but rather engages striatal MOR-dependent mechanisms.
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Affiliation(s)
- Sami Ben Hamida
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM U-964, CNRS UMR-7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
- Douglas Research Center, Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, H4H 1R3, Canada
| | - Laura-Joy Boulos
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM U-964, CNRS UMR-7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
- Douglas Research Center, Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, H4H 1R3, Canada
| | - Michael McNicholas
- Douglas Research Center, Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, H4H 1R3, Canada
| | - Pauline Charbogne
- Douglas Research Center, Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, H4H 1R3, Canada
| | - Brigitte Lina Kieffer
- Département de Médecine Translationnelle et Neurogénétique, Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM U-964, CNRS UMR-7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
- Douglas Research Center, Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, H4H 1R3, Canada
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14
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Moskal D, Maisto SA, Possemato K, Lynch KG, Oslin DW. Testing Mediators of Reduced Drinking for Veterans in Alcohol Care Management. Mil Med 2018; 183:e594-e602. [PMID: 29590436 DOI: 10.1093/milmed/usy024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/05/2018] [Accepted: 02/11/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Alcohol Care Management (ACM) is a manualized treatment provided by behavioral health providers working in a primary care team aimed at increasing patients' treatment engagement and decreasing their alcohol use. Research has shown that ACM is effective in reducing alcohol consumption; however, the mechanisms of ACM are unknown. Therefore, the purpose of this study is to examine the mechanisms of change in ACM in the context of a randomized clinical trial evaluating the effectiveness of ACM. MATERIALS AND METHODS This study performed secondary data analysis of existing data from a larger study that involved a sample of U.S. veterans (N = 163) who met criteria for current alcohol dependence. Upon enrollment into the study, participants were randomized to receive either ACM or standard care. ACM was delivered in-person or by telephone within the primary care clinic and focused on the use of oral naltrexone and manualized psychosocial support. According to theory, we hypothesized several ACM treatment components that would mediate alcohol consumption outcomes: engagement in addiction treatment, reduced craving, and increased readiness to change. Parallel mediation models were performed by the PROCESS macro Model 4 in SPSS to test study hypotheses. The institutional review boards at each of the participating facilities approved all study procedures before data collection. RESULTS As hypothesized, results showed that treatment engagement mediated the relation between treatment and both measures of alcohol consumption outcomes, the percentage of alcohol abstinent days, and the percentage of heavy drinking days. Neither craving nor readiness to change mediated the treatment effect on either alcohol consumption outcome. CONCLUSIONS Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol use disorder interventions should aim to increase treatment engagement and reduce barriers to care.
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Affiliation(s)
- Dezarie Moskal
- Center for Integrated Healthcare, Syracuse Department of Veterans Affairs Medical Center, Syracuse, NY.,Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY
| | - Stephen A Maisto
- Center for Integrated Healthcare, Syracuse Department of Veterans Affairs Medical Center, Syracuse, NY.,Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY
| | - Kyle Possemato
- Center for Integrated Healthcare, Syracuse Department of Veterans Affairs Medical Center, Syracuse, NY
| | - Kevin G Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA
| | - David W Oslin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA.,Mental Illness Research, Education and Clinical Center at the Cpl. Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA
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15
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16
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Ahmed R, Kotapati VP, Khan AM, Hussain N, Hussain M, Dar S, Kumar J, Begum GA, Esang M, Brainch N, Ahmed S. Adding Psychotherapy to the Naltrexone Treatment of Alcohol Use Disorder: Meta-analytic Review. Cureus 2018; 10:e3107. [PMID: 30338182 PMCID: PMC6175267 DOI: 10.7759/cureus.3107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background It remains unclear if naltrexone combined with psychotherapy is superior to naltrexone alone in treating alcohol use disorders (AUD). The current meta-analysis examined the hypothesis that psychotherapy is a significant moderator that influences AUD-related outcomes and that naltrexone combined with psychotherapy is associated with significantly better AUD-related outcomes than naltrexone alone. Methods A total of 30 studies (Nnaltrexone = 2317; Nplacebo = 2056) were included. Random effects model meta-analyses were carried out for each of the studied outcomes. Subsequently, the random effects model pooled estimates from studies with and without psychotherapy were compared using a Wald test. A mixed-effect model, incorporating psychotherapy as a moderator, was used to examine the impact of psychotherapy on treatment outcomes. Results Naltrexone had a significant treatment effect on abstinence relapse and Gamma-Glutamyl Transferase levels, but not cravings. The pooled estimates for studies with and without psychotherapy were not significantly different for any of the studied outcomes. Psychotherapy was not a significant moderator in the mixed effects models for any of the studied outcomes. Conclusions Naltrexone treatment is efficacious in reducing alcohol consumption, but not reducing cravings. Adding psychotherapy on top naltrexone did not result in any significant additional benefit for AUD patients.
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Affiliation(s)
- Rizwan Ahmed
- Psychiatry, Liaquat College of Medicine & Dentistry, Karachi, PAK
| | | | - Ali M Khan
- Psychiatry Resident, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Nuzhat Hussain
- Psychiatry, Penn State University College of Medicine, Pennsylvania, USA
| | | | - Sara Dar
- Psychiatry, Brigham and Women's Hospital, Boston, USA
| | | | | | - Michael Esang
- Behavioral Health Sciences, Nassau University Medical Center, East Meadow, USA
| | | | - Saeed Ahmed
- Behavioral Health Sciences, Nassau University Medical Center, East Meadow, USA
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17
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Pikovsky M, Peacock A, Larney S, Larance B, Conroy E, Nelson E, Degenhardt L. Alcohol use disorder and associated physical health complications and treatment amongst individuals with and without opioid dependence: A case-control study. Drug Alcohol Depend 2018; 188:304-10. [PMID: 29807218 DOI: 10.1016/j.drugalcdep.2018.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Dependence upon one substance may increase vulnerability for dependence on other substances. This study aimed to i) examine the association between opioid dependence and alcohol use and dependence; and ii) identify demographic, mental health, substance use, and alcohol-related withdrawal, physical health complications, and treatment correlates of comorbid alcohol and opioid dependence versus the former only. METHODS In this case-control study, 1475 participants with opioid dependence recruited from opioid substitution therapy (OST) clinics and 516 non-opioid dependent matched participants completed a structured interview covering psychiatric history, substance dependence, child maltreatment, and history of alcohol use. Analyses were mainly concentrated on cases (n = 696) and controls (n = 194) reporting lifetime alcohol dependence. RESULTS Cases with opioid dependence had higher rates of lifetime alcohol dependence than controls. Binary logistic regression analyses showed comorbid cases reported greater socio-economic disadvantage, poorer psychiatric history, greater incidence of dependence on other substances, earlier onset of regular drinking and alcohol dependence, and greater severity of alcohol dependence (relative to controls with alcohol dependence only). Comorbid cases were also more likely to report endorsement of certain DSM-IV criteria (i.e., legal problems due to alcohol and desire/inability to cut down use), specific withdrawal symptoms (e.g., tachycardia, hallucinations), using other substances to relieve withdrawal symptoms, and experiencing liver disease/jaundice. Rates of lifetime treatment engagement were low overall. CONCLUSIONS Though strongly associated with alcohol dependence and alcohol-related harms, people with a history of opioid dependence have complex social and clinical backgrounds, which appear to be important factors associated with higher levels of alcohol dependence.
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18
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Henderson-Redmond AN, Lowe TE, Tian XB, Morgan DJ. Increased ethanol drinking in "humanized" mice expressing the mu opioid receptor A118G polymorphism are mediated through sex-specific mechanisms. Brain Res Bull 2018; 138:12-19. [PMID: 28780411 PMCID: PMC5796878 DOI: 10.1016/j.brainresbull.2017.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 11/22/2022]
Abstract
The A118G single nucleotide polymorphism (SNP) of the mu-opioid receptor gene (Oprm1) has been implicated in mediating the rewarding effects of alcohol. Clinical and preclinical studies suggest that the G allele may confer a genetic vulnerability to alcohol dependence, though it remains unknown whether these effects are sex-specific. We used male and female mice homozygous for the "humanized" 118AA or 118GG alleles to determine whether the A118G SNP potentiates ethanol consumption in a sex-specific manner in both the two-bottle choice and drinking-in-the-dark (DID) paradigms. Mice were also assessed for differences in naltrexone sensitivity, ethanol reward assessed via conditioned place preference (CPP), and sensitivity to the sedative/ataxic effects of ethanol using the rota-rod and loss of righting reflex (LORR) assays. We found that male and female 118GG mice drank significantly more ethanol than 118AA littermates using a continuous access, two-bottle choice paradigm. In the limited-access DID drinking model, (i) female (but not male) 118GG mice consumed more ethanol than 118AA mice and (ii) naltrexone pretreatment was equally efficacious at attenuating ethanol intake in both 118AA and 118GG female mice while having no effect in males. Male and female 118GG and female 118AA mice developed a robust conditioned place preference (CPP) for ethanol. Female 118GG mice displayed less sensitivity to the sedative/ataxic effects of ethanol compared to female 118AA mice on both the rota-rod and the LORR assays while male mice did not differ in their responses on either assay. Our findings suggest that increased ethanol consumption in male 118GG mice may be due to increased ethanol reward, while increased drinking in female 118GG mice might be due to decreased sensitivity to the sedative/ataxic effects of ethanol. Collectively, these data might be used to help identify sex-specific pharmacotherapies to combat alcohol use disorders.
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MESH Headings
- Alcohol Drinking/genetics
- Alcohol Drinking/physiopathology
- Alleles
- Analgesics, Non-Narcotic/pharmacology
- Analysis of Variance
- Animals
- Choice Behavior/drug effects
- Conditioning, Operant/drug effects
- Dose-Response Relationship, Drug
- Ethanol/administration & dosage
- Ethanol/blood
- Female
- Genotype
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Mutagenesis, Site-Directed
- Naltrexone/analogs & derivatives
- Naltrexone/pharmacology
- Narcotic Antagonists/pharmacology
- Polymorphism, Single Nucleotide/genetics
- Quinine/pharmacology
- Receptors, Opioid, mu/genetics
- Receptors, Opioid, mu/metabolism
- Reflex/drug effects
- Reflex/genetics
- Reward
- Self Administration
- Self Stimulation
- Sex Characteristics
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Affiliation(s)
- Angela N Henderson-Redmond
- Department of Anesthesiology & Perioperative Medicine, Penn State University College of Medicine, Hershey, PA 17033, United States.
| | - Tammy E Lowe
- Department of Anesthesiology & Perioperative Medicine, Penn State University College of Medicine, Hershey, PA 17033, United States; Benedict College, Columbia, SC 29204, United States
| | - Xi B Tian
- Department of Anesthesiology & Perioperative Medicine, Penn State University College of Medicine, Hershey, PA 17033, United States
| | - Daniel J Morgan
- Department of Anesthesiology & Perioperative Medicine, Penn State University College of Medicine, Hershey, PA 17033, United States; Department of Pharmacology, Penn State University College of Medicine, Hershey, PA 17033, United States; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey PA 17033, United States.
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19
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Baldo BA. Prefrontal Cortical Opioids and Dysregulated Motivation: A Network Hypothesis. Trends Neurosci 2017; 39:366-377. [PMID: 27233653 DOI: 10.1016/j.tins.2016.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 02/06/2023]
Abstract
Loss of inhibitory control over appetitively motivated behavior occurs in multiple psychiatric disorders, including drug abuse, behavioral addictions, and eating disorders with binge features. In this opinion article, novel actions of μ-opioid peptides in the prefrontal cortex (PFC) that could contribute to inhibitory control deficits will be discussed. Evidence has accrued to suggest that excessive intra-PFC μ-opioid receptor (μ-OR) signaling alters the PFC response to excitatory drive, resulting in supernormal and incoherent recruitment of multiple PFC output pathways. Affected pathways include functionally opposed PFC→hypothalamus 'appetitive driver' and PFC→striatum 'appetitive limiter' projections. This network perturbation engenders disorganized, impulsive appetitive responses. Evidence supporting this hypothesis from human imaging and animal studies will be discussed, and combinatorial drug treatments targeting μ-ORs and specific PFC subcortical targets will be explored.
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Affiliation(s)
- Brian A Baldo
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, 6001 Research Park Blvd, Madison, WI 53719, USA.
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20
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Hendershot CS, Wardell JD, Samokhvalov AV, Rehm J. Effects of naltrexone on alcohol self-administration and craving: meta-analysis of human laboratory studies. Addict Biol 2017; 22:1515-1527. [PMID: 27411969 PMCID: PMC6139429 DOI: 10.1111/adb.12425] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/19/2016] [Accepted: 06/21/2016] [Indexed: 12/21/2022]
Abstract
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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Affiliation(s)
- Christian S. Hendershot
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthCanada
- Department of Psychiatry, University of TorontoCanada
- Department of PsychologyUniversity of TorontoCanada
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthCanada
| | - Jeffrey D. Wardell
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthCanada
| | - Andriy V. Samokhvalov
- Department of Psychiatry, University of TorontoCanada
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthCanada
- Institute for Medical SciencesUniversity of TorontoCanada
| | - Jürgen Rehm
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthCanada
- Department of Psychiatry, University of TorontoCanada
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthCanada
- Dalla Lana School of Public HealthUniversity of TorontoCanada
- Technische UniversitätGermany
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Dwyer-Clonts M, Frates E, Suzuki J. Managing Problem Drinking: Screening Tools and Brief Interventions for Primary Care Physicians. Am J Lifestyle Med 2017; 11:424-429. [PMID: 30202365 PMCID: PMC6125007 DOI: 10.1177/1559827616629929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/11/2016] [Indexed: 11/16/2022] Open
Abstract
A high percentage of patients seen in primary care clinics partake in excessive alcohol consumption. It leads to numerous health problems and remains one of the leading risk factors for chronic disease. Despite the health concerns, screening for and intervening in patients' alcohol misuse has yet to become standard practice in many primary care settings. There is well-established empirical evidence that brief doctor-patient interactions reduce alcohol consumption among excessive drinkers in primary care settings. This article draws on randomized controlled trials and literature on screening techniques, motivational interviewing, the transtheoretical model of behavior change, and medication-assisted treatments to enhance brief intervention methodology. Through this review, evidence-based practical strategies are presented to primary care doctors that reduce alcohol consumption in patients screened as problem drinkers. Referral information for those individuals with severe drinking problems is included. We propose that short, multicomponent interventions are most effective when they include interventions that utilize the lifestyle medicine philosophy, a nonjudgmental therapeutic alliance, and account for patient concerns more directly.
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Affiliation(s)
- Michael Dwyer-Clonts
- Michael Dwyer-Clonts, AA, Harvard University, 28 Myrtle Street, Medford, MA 02155; e-mail:
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Busch AC, Denduluri M, Glass J, Hetzel S, Gugnani SP, Gassman M, Krahn D, Deyo B, Brown R. Predischarge Injectable Versus Oral Naltrexone to Improve Postdischarge Treatment Engagement Among Hospitalized Veterans with Alcohol Use Disorder: A Randomized Pilot Proof-of-Concept Study. Alcohol Clin Exp Res 2017; 41:1352-1360. [PMID: 28605827 DOI: 10.1111/acer.13410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 04/21/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injectable naltrexone for alcohol use disorders (AUDs) has been efficacious in several studies. It has not been (i) compared head-to-head with oral naltrexone or (ii) examined in the hospital setting as an intervention that might facilitate treatment attendance after hospital discharge. METHODS Fifty-four hospitalized veterans identified as having DSM-IV-TR alcohol dependence were randomized to receive (i) a 50 mg oral naltrexone plus a 30-day prescription or (ii) a 380 mg intramuscular naltrexone injection prior to discharge. Of 113 veteran inpatients deemed eligible based on screening criteria, 54 met final eligibility criteria and were enrolled and randomized. Baseline data included demographics, alcohol consumption, and comorbidity. Measures of treatment initiation and engagement and alcohol consumption were reassessed at 14- and 45-day follow-ups. RESULTS Thirty-five participants (64.8%) completed the entire study protocol (received a study medication and completed 14- and 45-day follow-ups). Among those who received a study medication (n = 45), 77.8% completed all follow-up interviews. This pilot study was not designed to have sufficient statistical power for hypothesis testing, and thus, as expected, there were no significant differences between groups in medication adherence (self-report of >80% of daily doses taken in oral group; receipt of second injection in the injection group), treatment engagement (at least treatment 3 visits in the 30 days postdischarge, and 2 or more visits per month in each of the 3 months following discharge) or alcohol consumption at 14 or at 45 days (p > 0.05). The median number of drinks among the entire cohort in the 2 weeks prior to hospitalization (128 drinks) was significantly higher than at day 14 (0 drinks, p < 0.001) or day 45 (0 drinks, p < 0.001). Rates of medication adherence were 62% in the oral group and 61% in the injection group. CONCLUSIONS Results indicate feasibility for larger, more definitive study. Both groups had significant reductions in alcohol consumption over time and high-treatment engagement rates. Both oral and injectable formulations are feasible to initiate prior to discharge for hospital inpatients identified as having an AUD.
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Affiliation(s)
- Angela Christina Busch
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | | | - Joseph Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, Seattle, Wisconsin
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Shalu P Gugnani
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | - Michele Gassman
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Dean Krahn
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Brienna Deyo
- Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Family Medicine & Community Health, University of Wisconsin, Madison, Wisconsin
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Kang SY, Kwon OS, Moon JY, Cho SJ, Choi KH, Kim J, Ahn SH, Ryu Y. Mechanical Stimulation of the HT7 Acupuncture Point to Reduce Ethanol Self-Administration in Rats. Evid Based Complement Alternat Med 2017; 2017:6578621. [PMID: 28638432 DOI: 10.1155/2017/6578621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Alcoholism, which is a disabling addiction disorder, is a major public health problem worldwide. The present study was designed to determine whether the application of acupuncture at the Shenmen (HT7) point suppresses voluntary alcohol consumption in addicted rats and whether this suppressive effect is potentiated by the administration of naltrexone. Methods Rats were initially trained to self-administer a sucrose solution by operating a lever. A mechanical acupuncture instrument (MAI) for objective mechanical stimulation was used on rats whose baseline response had been determined. In addition, the effect of HT7 acupuncture on beta-endorphin concentration and ethanol intake via naltrexone were investigated in different groups. Results We found that ethanol intake and beta-endorphin level in rats being treated with the MAI at the HT7 point reduced significantly. The treatment of naltrexone at high doses reduced the ethanol intake and low-dose injection of naltrexone in conjunction with the MAI also suppressed ethanol intake. Conclusions The results of the current study indicate that using the MAI at the HT7 point effectively reduces ethanol consumption in rats. Furthermore, the coadministration of the MAI and a low dose of naltrexone can produce some more potent reducing effect of ethanol intake than can acupuncture alone.
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25
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Selleck RA, Baldo BA. Feeding-modulatory effects of mu-opioids in the medial prefrontal cortex: a review of recent findings and comparison to opioid actions in the nucleus accumbens. Psychopharmacology (Berl) 2017; 234:1439-49. [PMID: 28054099 DOI: 10.1007/s00213-016-4522-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/20/2016] [Indexed: 12/20/2022]
Abstract
RATIONALE Whereas reward-modulatory opioid actions have been intensively studied in subcortical sites such as the nucleus accumbens (Acb), the role of cortical opioid transmission has received comparatively little attention. OBJECTIVES The objective of this study is to describe recent findings on the motivational actions of opioids in the prefrontal cortex (PFC), emphasizing studies of food motivation and ingestion. PFC-based opioid effects will be compared/contrasted to those elicited from the Acb, to glean possible common functional principles. Finally, the motivational effects of opioids will be placed within a network context involving the PFC, Acb, and hypothalamus. RESULTS Mu-opioid receptor (μ-OR) stimulation in both the Acb and PFC induces eating and enhances food-seeking instrumental behaviors; μ-OR signaling also enhances taste reactivity within a highly circumscribed zone of medial Acb shell. In both the Acb and PFC, opioid-sensitive zones are aligned topographically with the sectors that project to feeding-modulatory zones of the hypothalamus and intact glutamate transmission in the lateral/perifornical (LH-PeF) hypothalamic areas is required for both Acb- and PFC-driven feeding. Conversely, opioid-mediated feeding responses elicited from the PFC are negatively modulated by AMPA signaling in the Acb shell. CONCLUSIONS Opioid signaling in the PFC engages functionally opposed PFC➔hypothalamus and PFC➔Acb circuits, which, respectively, drive and limit non-homeostatic feeding, producing a disorganized and "fragmented" pattern of impulsive food-seeking behaviors and hyperactivity. In addition, opioids act directly in the Acb to facilitate food motivation and taste hedonics. Further study of this cortico-striato-hypothalamic circuit, and incorporation of additional opioid-responsive telencephalic structures, could yield insights with translational relevance for eating disorders and obesity.
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Abstract
BACKGROUND People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. OBJECTIVE To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. METHOD Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. RESULTS The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.
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Affiliation(s)
- Marc Galanter
- a Department of Psychiatry , NYU School of Medicine , New York , NY , USA
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27
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Cousins SJ, Crèvecoeur-MacPhail D, Kim T, Rawson RA. The Los Angeles County hub-and-provider network for promoting the sustained use of extended-release naltrexone (XR-NTX) in Los Angeles County (2010-2015). J Subst Abuse Treat 2017; 85:78-83. [PMID: 28291571 DOI: 10.1016/j.jsat.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
Extended-release naltrexone (XR-NTX) is a medication-assisted treatment (MAT) that is used in conjunction with psychosocial treatment for substance use disorder. It is associated with a reduction in the number of days that patients use alcohol or opioids, in cravings and drug-seeking behaviors, and in healthcare utilization costs, as well as improved medication adherence rates for patients in substance use disorder (SUD) treatment programs and improved quality of life. Despite the clinical effectiveness of XR-NTX, its clinical use has been slow to develop. There is little research describing the utilization of XR-NTX over time at the treatment-system level and few documented attempts to promote MAT by creating a system to explicitly promote and sustain MAT use. This study examines changes between April 1, 2010, and March 30, 2015, in the utilization patterns of XR-NTX for SUDs as promoted and delivered in a system of "medication hubs," comprised of community providers and a medication coordinating center, and training efforts. This system was implemented as part of a large demonstration project that was designed to provide access to XR-NTX in Los Angeles County. Our findings indicated an increase in the initiation of XR-NTX (59% increase) and subsequent doses (89% increase) from Year 1 to Year 5 of the project (p<0.001). These findings suggest that it is possible to improve MAT utilization (in this case XR-NTX) through the use of a system of care that minimizes MAT payment issues for providers and patients, provides an infrastructure (medication hubs and SUD treatment providers), promotes system coordination, and educates providers.
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Affiliation(s)
- Sarah J Cousins
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA.
| | - Desirée Crèvecoeur-MacPhail
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
| | - Tina Kim
- Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, 1000 S Fremont Avenue, A-9 East, 3rd Floor Alhambra, CA 91803, USA
| | - Richard A Rawson
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
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Abstract
Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept "intermediate harm reduction" (European Medicines Agency) or "low-risk drinking limits" (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.
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Affiliation(s)
- Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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29
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Abstract
The patient with a current or former history of substance use disorder can be challenging to adequately care for in the perioperative period. A thorough preoperative evaluation is essential. In addition to drug abuse screening, the evaluation should include an assessment of the effects of the substance abuse, associated diseases, end-organ damage, and an awareness of the potential perioperative risks so appropriate plans are developed to minimize the risks. Intraoperatively, anesthetic management needs to be appropriately modified. Signs and symptoms of withdrawal should be monitored for postoperatively. Pain management is particularly challenging. After discharge, this patient population is vulnerable and requires close follow-up and early referral to appropriate specialists when needed.
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Affiliation(s)
- Debra Domino Pulley
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus Box 8054, St Louis, MO 63110, USA.
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Qin HL, Zheng Q, Bare GAL, Wu P, Sharpless KB. A Heck-Matsuda Process for the Synthesis of β-Arylethenesulfonyl Fluorides: Selectively Addressable Bis-electrophiles for SuFEx Click Chemistry. Angew Chem Int Ed Engl 2016. [DOI: 10.1002/ange.201608807] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Hua-Li Qin
- Department of Chemistry; The Scripps Research Institute; La Jolla CA 92037 USA
- School of Chemistry; Chemical Engineering and Life Science; Wuhan University of Technology; Wuhan Hubei Province 430070 China
| | - Qinheng Zheng
- Department of Chemistry; The Scripps Research Institute; La Jolla CA 92037 USA
| | - Grant A. L. Bare
- Department of Chemistry; The Scripps Research Institute; La Jolla CA 92037 USA
| | - Peng Wu
- Department of Chemical Physiology; The Scripps Research Institute; La Jolla CA 92037 USA
| | - K. Barry Sharpless
- Department of Chemistry; The Scripps Research Institute; La Jolla CA 92037 USA
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31
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Qin HL, Zheng Q, Bare GAL, Wu P, Sharpless KB. A Heck-Matsuda Process for the Synthesis of β-Arylethenesulfonyl Fluorides: Selectively Addressable Bis-electrophiles for SuFEx Click Chemistry. Angew Chem Int Ed Engl 2016; 55:14155-14158. [PMID: 27723200 DOI: 10.1002/anie.201608807] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 11/06/2022]
Abstract
A Heck-Matsuda process for the synthesis of the otherwise difficult to access compounds, β-arylethenesulfonyl fluorides, is described. Ethenesulfonyl fluoride (i.e., vinylsulfonyl fluoride, or ESF) undergoes β-arylation with stable and readily prepared arenediazonium tetrafluoroborates in the presence of the catalyst palladium(II) acetate to afford the E-isomer sulfonyl analogues of cinnamoyl fluoride in 43-97 % yield. The β-arylethenesulfonyl fluorides are found to be selectively addressable bis-electrophiles for sulfur(VI) fluoride exchange (SuFEx) click chemistry, in which either the alkenyl moiety or the sulfonyl fluoride group can be the exclusive site of nucleophilic attack under defined conditions, making these rather simple cores attractive for covalent drug discovery.
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Affiliation(s)
- Hua-Li Qin
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA, 92037, USA.,School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan, Hubei Province, 430070, China
| | - Qinheng Zheng
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Grant A L Bare
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Peng Wu
- Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA, 92037, USA.
| | - K Barry Sharpless
- Department of Chemistry, The Scripps Research Institute, La Jolla, CA, 92037, USA.
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Ray LA, Bujarski S, Roche DJO. Subjective Response to Alcohol as a Research Domain Criterion. Alcohol Clin Exp Res 2016; 40:6-17. [PMID: 26727518 DOI: 10.1111/acer.12927] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 10/12/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Individual differences in the subjective experience of the pharmacological effects of alcohol have long been implicated in the likelihood that one will drink heavily and develop alcoholism. The theme of this conceptual review and perspective article is to synthesize the literature on subjective responses to alcohol and to set an agenda for the next generation of research in the area. Specifically, we contend that in order for subjective response to alcohol to play a prominent role in alcoholism research, it is critical that it be studied as a multimodal phenotype. METHODS First, we review the human research on subjective response to alcohol measured under controlled laboratory conditions and draw recommendations for the application of these findings to understanding alcoholism neurobiology in humans. Second, we highlight multimodal approaches, including studies of the genetic and neural substrates of individual differences in subjective response to alcohol. Third, we review treatment implications with a focus on subjective response to alcohol as an intervention target. Upon review of the research on subjective response to alcohol across levels of analyses, we provide recommendations for leveraging these phenotypes in a systematic and methodologically rigorous fashion that can address central questions about alcoholism etiology, disease progression, and personalized treatment. DISCUSSION The approach recommended herein is largely consistent with the Research Domain Criteria (RDoC) initiative across the National Institute of Mental Health. The defining feature of such domains is that they inform behavior yet be amenable to examination through multiple units of analysis, such as molecular, genetic, circuit-level, and behavioral measurements. To that end, we contend that subjective response to alcohol represents a behaviorally and biologically plausible phenotype upon which to build using the RDoC framework for understanding alcohol use disorder.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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Gutmann B, Weigl U, Cox DP, Kappe CO. Batch- and Continuous-Flow Aerobic Oxidation of 14-Hydroxy Opioids to 1,3-Oxazolidines-A Concise Synthesis of Noroxymorphone. Chemistry 2016; 22:10393-8. [PMID: 27172347 DOI: 10.1002/chem.201601902] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Indexed: 01/15/2023]
Abstract
14-Hydroxymorphinone is converted to noroxymorphone, the immediate precursor of important opioid antagonists, such as naltrexone and naloxone, in a three-step reaction sequence. The initial oxidation of the N-methyl group in 14-hydroxymorphinone with in situ generated colloidal palladium(0) as the catalyst and molecular oxygen as the terminal oxidant constitutes the key transformation in this new route. This oxidation results in the formation of an unexpected oxazolidine ring structure. Subsequent hydrolysis of the oxazolidine under reduced pressure followed by hydrogenation in a packed-bed flow reactor using palladium(0) as the catalyst provides noroxymorphone in high purity and good overall yield. To overcome challenges associated with gas-liquid reactions with molecular oxygen, the key oxidation reaction was translated to a continuous-flow process.
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Affiliation(s)
- Bernhard Gutmann
- Institute of Chemistry, University of Graz, NAWI Graz, Heinrichstrasse 28, 8010, Graz, Austria.,Research Center Pharmaceutical Engineering (RCPE), Inffeldgasse 13, 8010, Graz, Austria
| | - Ulrich Weigl
- Cilag AG, Hochstrasse 201, 8200, Schaffhausen, Switzerland
| | - D Phillip Cox
- Noramco Inc., 503 Carr Rd, Suite 200, Wilmington, DE, 19809, USA
| | - C Oliver Kappe
- Institute of Chemistry, University of Graz, NAWI Graz, Heinrichstrasse 28, 8010, Graz, Austria. .,Research Center Pharmaceutical Engineering (RCPE), Inffeldgasse 13, 8010, Graz, Austria.
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Oberdick J, Ling Y, Phelps MA, Yudovich MS, Schilling K, Sadee W. Preferential Delivery of an Opioid Antagonist to the Fetal Brain in Pregnant Mice. J Pharmacol Exp Ther 2016; 358:22-30. [PMID: 27189967 DOI: 10.1124/jpet.115.231902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/27/2016] [Indexed: 02/01/2023] Open
Abstract
Prolonged fetal exposure to opioids results in neonatal abstinence syndrome (NAS), a major medical problem requiring intensive care and increased hospitalization times for newborns with NAS. Multiple strategies are currently available to alleviate withdrawal in infants with NAS. To prevent NAS caused by opioid maintenance programs in pregnant women, blocking fetal dependence without compromising the mother's opiate therapy is desirable. Here we tested in pregnant mice whether a peripherally selective opioid antagonist can preferentially enter the fetal brain and, thereby, in principle, selectively protect the fetus. We show using mass spectrometry that 6β-naltrexol, a neutral opioid antagonist with very limited ability to cross the blood-brain barrier (BBB), readily crosses the placental barrier and enters the fetal brain at high levels, although it is relatively excluded from the maternal brain. Furthermore, owing to the late development of the BBB in postnatal mice, we show that 6β-naltrexol can readily enter the juvenile mouse brain until at least postnatal day 14. Taking advantage of this observation, we show that long-term exposure to morphine starting in the second postnatal week causes robust and quantifiable dependence behaviors that are suppressed by concomitant administration of 6β-naltrexol with much greater potency (ID50 0.022-0.044 mg/kg, or 1/500 the applied dose of morphine) than previously demonstrated for either the suppression of central nervous system opioid effects or the induction of withdrawal in adults. These results indicate that peripherally selective opioid antagonists capable of penetrating the placenta may be beneficial for preventing or reducing neonatal dependence and NAS in a dose range that should not interfere with maternal opioid maintenance.
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Affiliation(s)
- John Oberdick
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Yonghua Ling
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Mitch A Phelps
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Max S Yudovich
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Karl Schilling
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
| | - Wolfgang Sadee
- Department of Neuroscience (J.O., M.S.Y.), and College of Medicine Center for Pharmacogenomics (W.S.), Wexner Medical Center, and College of Pharmacy, Division of Pharmaceutics and Pharmaceutical Chemistry (Y.L., M.A.P.), The Ohio State University, Columbus, Ohio; and Anatomisches Institut, Anatomie und Zellbiologie (K.S.), Universität Bonn, Bonn, Germany
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Zorlu N, Kurtgoz Zorlu P, Tok T, Erol A, Mete L. One Week of Naltrexone Treatment Does Not Reduce Impulsivity During Inpatient Treatment of Alcohol-dependent Patients. Addictive Disorders & Their Treatment 2016; 15:25-33. [DOI: 10.1097/adt.0000000000000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Alcohol addiction is one of the most common and devastating diseases in the world. Given the tremendous heterogeneity of alcohol addicted individuals, it is unlikely that one medication will help nearly all patients. Thus, there is a clear need to develop predictors of response to existing medications. Naltrexone is a mu-opioid receptor antagonist which has been approved in the United States for treatment of alcohol addiction since 1994. It has limited efficacy, in part due to noncompliance, but many patients do not respond despite high levels of compliance. There are reports that a mis-sense single nucleotide polymorphism (rs179919 or A118G) in the mu-opioid receptor gene predicts a favorable response to naltrexone if an individual carries a 'G' allele. This chapter will review the evidence for this hypothesis. The data are promising that the 'G' allele predisposes to a beneficial naltrexone response among alcohol addicted persons, but additional research is needed to prove this hypothesis in prospective clinical trials.
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Affiliation(s)
- Wade Berrettini
- Center for Neurobiology and Behavior, Perelman School of Medicine, University of Pennsylvania, 125 S. 31st St., Philadelphia, PA 19104, USA.
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37
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Van Skike CE, Maggio SE, Reynolds AR, Casey EM, Bardo MT, Dwoskin LP, Prendergast MA, Nixon K. Critical needs in drug discovery for cessation of alcohol and nicotine polysubstance abuse. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:269-87. [PMID: 26582145 PMCID: PMC4679525 DOI: 10.1016/j.pnpbp.2015.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/29/2023]
Abstract
Polysubstance abuse of alcohol and nicotine has been overlooked in our understanding of the neurobiology of addiction and especially in the development of novel therapeutics for its treatment. Estimates show that as many as 92% of people with alcohol use disorders also smoke tobacco. The health risks associated with both excessive alcohol consumption and tobacco smoking create an urgent biomedical need for the discovery of effective cessation treatments, as opposed to current approaches that attempt to independently treat each abused agent. The lack of treatment approaches for alcohol and nicotine abuse/dependence mirrors a similar lack of research in the neurobiology of polysubstance abuse. This review discusses three critical needs in medications development for alcohol and nicotine co-abuse: (1) the need for a better understanding of the clinical condition (i.e. alcohol and nicotine polysubstance abuse), (2) the need to better understand how these drugs interact in order to identify new targets for therapeutic development and (3) the need for animal models that better mimic this human condition. Current and emerging treatments available for the cessation of each drug and their mechanisms of action are discussed within this context followed by what is known about the pharmacological interactions of alcohol and nicotine. Much has been and will continue to be gained from studying comorbid alcohol and nicotine exposure.
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Affiliation(s)
- C E Van Skike
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States
| | - S E Maggio
- Department of Psychology, University of Kentucky, Lexington, KY 40536, United States
| | - A R Reynolds
- Department of Psychology, University of Kentucky, Lexington, KY 40536, United States
| | - E M Casey
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States
| | - M T Bardo
- Department of Psychology, University of Kentucky, Lexington, KY 40536, United States; Center for Drug Abuse and Research Translation, University of Kentucky, Lexington, KY 40536, United States; Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, United States
| | - L P Dwoskin
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States; Center for Drug Abuse and Research Translation, University of Kentucky, Lexington, KY 40536, United States
| | - M A Prendergast
- Department of Psychology, University of Kentucky, Lexington, KY 40536, United States; Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, United States
| | - K Nixon
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States; Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, United States.
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Anker J, Kushner M, Thuras P, Menk J, Unruh A. Drinking to cope with negative emotions moderates alcohol use disorder treatment response in patients with co-occurring anxiety disorder. Drug Alcohol Depend 2016; 159:93-100. [PMID: 26718394 PMCID: PMC4782758 DOI: 10.1016/j.drugalcdep.2015.11.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/16/2015] [Accepted: 11/26/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidemiological studies and theory implicate drinking to cope (DTC) with anxiety as a potent moderator of the association between anxiety disorder (AnxD) and problematic alcohol use. However, the relevance of DTC to the treatment of alcohol use disorder (AUD) in those with a co-occurring AnxD has not been well studied. To address this, we examined whether DTC moderates the impact of two therapies: (1) a cognitive behavioral therapy (CBT) designed to reduce DTC and anxiety symptoms; (2) a progressive muscle relaxation training (PMRT) program designed to reduce anxiety symptoms only. METHODS Patients undergoing a standard AUD residential treatment with a co-occurring AnxD (N=218) were randomly assigned to also receive either the CBT or PMRT. DTC in the 30 days prior to treatment was measured using the Unpleasant Emotions subscale of the Inventory of Drinking Situations. RESULTS Confirming the predicted moderator model, the results indicated a significant interaction between treatment group and level of pre-treatment DTC behavior. Probing this interaction revealed that for those reporting more pre-treatment DTC behavior, 4-month alcohol outcomes were superior in the CBT group relative to the PMRT group. For those reporting less pre-treatment DTC behavior, however, 4-month alcohol outcomes were similar and relatively good in both treatment groups. CONCLUSIONS These findings establish a meaningful clinical distinction among those with co-occurring AUD-AnxD based on the degree to which the symptoms of the two disorders are functionally linked through DTC. Those whose co-occurring AUD-AnxD is more versus less strongly linked via DTC are especially likely to benefit from standard AUD treatment that is augmented by a brief CBT designed to disrupt this functional link.
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Affiliation(s)
| | - M.G. Kushner
- Corresponding author at: University of Minnesota, Department of Psychiatry, 282-2A West, 2450 Riverside Ave., Minneapolis, MN 55454, United States. (M.G. Kushner)
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DeMartini KS, Gueorguieva R, Leeman RF, Corbin WR, Fucito LM, Kranzler HR, O'Malley SS. Longitudinal findings from a randomized clinical trial of naltrexone for young adult heavy drinkers. J Consult Clin Psychol 2015; 84:185-90. [PMID: 26654213 DOI: 10.1037/ccp0000053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Behavioral interventions for young adults show limited effects 1-year posttreatment. Few studies have examined the longitudinal outcomes of pharmacotherapy trials to reduce heavy drinking. This study examined the posttreatment, longitudinal effects of the first placebo-controlled trial of naltrexone in young adult heavy drinkers. METHOD Randomized, double-blind, placebo-controlled, 8-week trial. Follow-up assessments at posttreatment (8 weeks [8W]), 3 months [3M], 6 months [6M], and 12 months [12M]). Participants were young adults ages 18-25 (N = 118) who reported ≥4 heavy drinking days in the prior 4 weeks. Outcomes were percent days heavy drinking (PHDD), percent days abstinent (PDA), and drinks per drinking day (DPDD). RESULTS There were no time effects on PHDD. Treatment improvements were maintained posttreatment. A main effect of time was found for PDA. Both conditions continued to increase PDA posttreatment. For DPDD, a Treatment ×Time interaction emerged. In the naltrexone condition, DPDD increased from 8W to 6M and decreased from 6M to 12M, resulting in no net change posttreatment. The placebo group had a nonsignificant decrease in DPDD. The result was a significant benefit of naltrexone at 8W but not 12M. CONCLUSIONS Participants showed improvements or no change on most outcomes over 1 year posttreatment. Naltrexone had significant benefits over placebo at 8W. Although differences among groups diminished during follow-up, overall effects were maintained. Behavioral monitoring during treatment may impact long-term outcomes more than a single intervention following discontinuation of active medication. (PsycINFO Database Record
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Affiliation(s)
| | - Ralitza Gueorguieva
- Department of Biostatistics, Schools of Public Health and Medicine, Yale University
| | | | | | | | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Abstract
Alcohol addiction is one of the most common and devastating diseases in the world. Given the tremendous heterogeneity of alcohol-addicted individuals, it is unlikely that one medication will help nearly all patients. Thus, there is a clear need to develop predictors of response to existing medications. Naltrexone is a mu opioid receptor antagonist which has been approved in the United States for treatment of alcohol addiction since 1994. It has limited efficacy, in part due to noncompliance, but many patients do not respond despite high levels of compliance. There are reports that a mis-sense single-nucleotide polymorphism (rs179919 or A118G) in the mu opioid receptor gene predicts a favorable response to naltrexone if an individual carries a "G" allele. This chapter will review the evidence for this hypothesis. The data suggest that the "G" allele has a complex role in alcohol addiction, increasing the rewarding valence of alcohol. Whether the G allele increases risk for alcoholism and whether it predisposes to a beneficial naltrexone response among alcohol-addicted persons must await additional research with large sample sizes of multiple ethnicities in prospective clinical trials.
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Affiliation(s)
- Wade Berrettini
- Karl E Rickles Professor of Psychiatry, Center for Neurobiology and Behavior, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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McLaughlin PJ, Zagon IS. Duration of opioid receptor blockade determines biotherapeutic response. Biochem Pharmacol 2015; 97:236-46. [DOI: 10.1016/j.bcp.2015.06.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/17/2015] [Indexed: 12/20/2022]
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Rasmussen DD, Kincaid CL, Froehlich JC. Prazosin + Naltrexone Decreases Alcohol Drinking More Effectively Than Does Either Drug Alone in P Rats with a Protracted History of Extensive Voluntary Alcohol Drinking, Dependence, and Multiple Withdrawals. Alcohol Clin Exp Res 2015; 39:1832-41. [PMID: 26260061 PMCID: PMC4558320 DOI: 10.1111/acer.12828] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prazosin (PRZ; an α1 -adrenergic receptor antagonist) and naltrexone (NTX; a nonspecific opioid receptor antagonist) each decrease alcohol drinking when administered to rats selectively bred for high voluntary alcohol drinking (alcohol-preferring or "P"), and the combination of PRZ + NTX decreases alcohol drinking more effectively than does either drug alone. As drug responsiveness can depend on history of alcohol drinking and dependence, we investigated whether various schedules of PRZ and NTX administration, alone or in combination, are effective in decreasing alcohol drinking in male P rats with a history of protracted voluntary alcohol drinking, dependence, and repeated withdrawals closely resembling human alcoholism. METHODS Male P rats became alcohol-dependent during 1 year of ad libitum 24 h/d access to food, water, and 20% alcohol with repetitive temporary alcohol withdrawals. Four sequential studies then addressed effects of oral PRZ (2 mg/kg) and NTX (10 mg/kg), alone or together, on alcohol drinking during: (i) daily alcohol access with daily drug treatment, (ii) intermittent alcohol access with daily drug treatment, (iii) intermittent alcohol access with occasional drug treatment, and (iv) postdeprivation reinstatement of alcohol access. RESULTS The combination of PRZ + NTX consistently suppressed alcohol drinking during daily or intermittent alcohol access conditions and when drug treatment was either daily or occasional. PRZ + NTX was consistently more effective than either drug alone. The reduction in alcohol drinking was not due to sedation, motor effects, or malaise. CONCLUSIONS Both daily and "as-needed" treatment with PRZ + NTX are highly effective in suppressing daily, intermittent, and postdeprivation alcohol drinking in male P rats with a protracted history of alcohol dependence and repeated withdrawals. This drug combination may be especially effective for treating individuals with long histories of heavy alcohol abuse, dependence, and repeated relapse, as commonly encountered in clinical practice.
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Affiliation(s)
- Dennis D Rasmussen
- VISN 20 Mental Illness Research, Education and Clinical Center, Seattle, WA 98108
- VA Puget Sound Health Care System, Seattle, WA 98108
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195
| | - Carrie L Kincaid
- VA Puget Sound Health Care System, Seattle, WA 98108
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195
| | - Janice C Froehlich
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-5124
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Banerjee TS, Hazra A, Mondal NB, Das S. The quinoline compound, S4 effectively antagonizes alcohol intake in mice: Possible association with the histone H3 modifications. Neurochem Int 2015; 87:117-27. [DOI: 10.1016/j.neuint.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 06/07/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
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Stoner SA, Arenella PB, Hendershot CS. Randomized controlled trial of a mobile phone intervention for improving adherence to naltrexone for alcohol use disorders. PLoS One 2015; 10:e0124613. [PMID: 25909320 PMCID: PMC4409303 DOI: 10.1371/journal.pone.0124613] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/28/2015] [Indexed: 11/18/2022] Open
Abstract
Background Naltrexone is a front-line treatment for alcohol use disorders, but its efficacy is limited by poor medication adherence. This randomized controlled trial evaluated whether a mobile health intervention could improve naltrexone adherence. Methods Treatment-seeking participants with an alcohol use disorder (N = 76) were randomized to intervention and control conditions. All participants received naltrexone (50 mg/day) with a medication event monitoring system (MEMS) and a prepaid smartphone, and received a daily text message querying medication side effects, alcohol use, and craving. Those in the intervention arm received additional medication reminders and adherence assessment via text message. Results The primary outcome, proportion of participants with adequate adherence (defined as ≥80% of prescribed doses taken through Week 8), did not differ between groups in intent-to-treat analyses (p = .34). Mean adherence at study midpoint (Week 4) was 83% in the intervention condition and 77% in the control condition (p = .35). Survival analysis found that the intervention group sustained adequate adherence significantly longer (M = 19 days [95% CI = 0.0–44.0]) than those in the control group (M = 3 days [95% CI = 0.0–8.1]) during the first month of treatment (p = .04). Medication adherence did not predict drinking outcomes. Conclusions These results suggest that in the context of daily monitoring and assessment via cell phone, additional text message reminders do not further improve medication adherence. Although this initial trial does not provide support for the efficacy of text messaging to improve adherence to pharmacotherapy for alcohol use disorders, additional trials with larger samples and alternate designs are warranted. Trial Registration ClinicalTrials.gov: NCT01349985
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Affiliation(s)
- Susan A. Stoner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Pamela B. Arenella
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Christian S. Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, United States of America
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Abstract
Drug therapy for alcohol dependence should only be used in conjunction with a comprehensive treatment plan. Naltrexone and acamprosate have well established efficacy and are first-line treatments. Naltrexone is recommended for patients aiming to cut down their alcohol intake who do not have severe liver disease or an ongoing need for opioids. Acamprosate is recommended for those who have achieved and wish to maintain abstinence. Disulfiram is no longer considered first-line treatment due to difficulties with compliance and toxicity. Although baclofen and topiramate have evidence of benefit, they are not registered for alcohol dependence and should only be considered in specialist practice.
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Wei J, Defries T, Lozada M, Young N, Huen W, Tulsky J. An inpatient treatment and discharge planning protocol for alcohol dependence: efficacy in reducing 30-day readmissions and emergency department visits. J Gen Intern Med 2015; 30:365-70. [PMID: 25092008 PMCID: PMC4351284 DOI: 10.1007/s11606-014-2968-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 06/16/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol dependence results in multiple hospital readmissions, but no discharge planning protocol has been studied to improve outcomes. The inpatient setting is a frequently missed opportunity to discuss treatment of alcohol dependence and initiate medication-assisted treatment, which is effective yet rarely utilized. AIM Our aim was to implement and evaluate a discharge planning protocol for patients admitted with alcohol dependence. SETTING The study took place at the San Francisco General Hospital (SFGH), a university-affiliated, large urban county hospital. PARTICIPANTS Learner participants included Internal Medicine residents at the University of California, San Francisco (UCSF) who staff the teaching service at SFGH. Patient participants included inpatients with alcohol dependence admitted to the Internal Medicine teaching service. PROGRAM DESCRIPTION We developed and implemented a discharge planning protocol for patients admitted with alcohol dependence that included eligibility assessment and initiation of medication-assisted treatment. PROGRAM EVALUATION Rates of medication-assisted treatment increased from 0% to 64% (p value < 0.001). All-cause 30-day readmission rates to SFGH decreased from 23.4% to 8.2% (p value = 0.042). All-cause emergency department visits to SFGH within 30 days of discharge decreased from 18.8% to 6.1% (p value = 0.056). DISCUSSION Through implementation of a discharge planning protocol by Internal Medicine residents for patients admitted with alcohol dependence, there was a statistically significant increase in medication-assisted treatment and a statistically significant decrease in both 30-day readmission rates and emergency department visits.
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Affiliation(s)
- Jennie Wei
- University of California, San Francisco, San Francisco, CA, USA,
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O’Malley SS, Corbin WR, Leeman RF, DeMartini KS, Fucito LM, Ikomi J, Romano DM, Wu R, Toll BA, Sher KJ, Gueorguieva R, Kranzler HR. Reduction of alcohol drinking in young adults by naltrexone: a double-blind, placebo-controlled, randomized clinical trial of efficacy and safety. J Clin Psychiatry 2015; 76:e207-13. [PMID: 25742208 PMCID: PMC4442987 DOI: 10.4088/jcp.13m08934] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 06/16/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Naltrexone, an opioid antagonist, may facilitate reduction in drinking among young adults. We compared the efficacy and safety of naltrexone administered daily plus targeted dosing with placebo to reduce drinking in young adults who engage in heavy drinking. METHOD A randomized, double-blind, placebo-controlled study was conducted in an outpatient research center in March 2008-January 2012. Participants were aged 18-25 years and reported ≥ 4 heavy drinking days in the prior 4 weeks. Interventions included naltrexone 25 mg daily plus 25 mg targeted (at most daily) in anticipation of drinking (n = 61) or daily/targeted placebo (n = 67). All participants received a personalized feedback session and brief counseling every other week. Primary outcomes were percent heavy drinking days and percent days abstinent over the 8-week treatment period. Secondary outcomes included number of drinks per drinking day and percentage of days with estimated blood alcohol concentration (BAC) levels ≥ 0.08 g/dL. RESULTS Of 140 randomized patients, 128 began treatment, comprising the evaluable sample. During treatment, percent heavy drinking days (naltrexone: mean = 21.60, SD = 16.05; placebo: mean = 22.90, SD = 13.20) (P = .58) and percent days abstinent (naltrexone: mean = 56.60, SD = 22.52; placebo: mean = 62.50, SD = 15.75) (P = .39) did not differ by group. Naltrexone significantly reduced the number of drinks per drinking day (naltrexone: mean = 4.90, SD = 2.28; placebo: mean = 5.90, SD = 2.51) (P = .009) and percentage of drinking days with estimated BAC ≥ 0.08 g/dL (naltrexone: mean = 35.4, SD = 28.40; placebo: mean = 45.7, SD = 26.80) (P = .042). There were no serious adverse events. Sleepiness was more common with naltrexone. CONCLUSIONS Naltrexone did not reduce frequency of drinking or heavy drinking days, but reduced secondary measures of drinking intensity. While effects were modest, the risk-benefit ratio favors offering naltrexone to help young adult heavy drinkers reduce the amount of alcohol they drink. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00568958.
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Affiliation(s)
- Stephanie S. O’Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT,Yale Cancer Center
| | | | - Robert F. Leeman
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | | | - Lisa M. Fucito
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Jolomi Ikomi
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Denise M. Romano
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Ran Wu
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | - Benjamin A. Toll
- Yale School of Medicine, Department of Psychiatry, New Haven, CT,Yale Cancer Center
| | - Kenneth J. Sher
- University of Missouri – Columbia, Department of Psychology, Columbia, MO
| | | | - Henry R. Kranzler
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry and Philadelphia VAMC, Philadelphia, PA
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Collins SE, Duncan MH, Smart BF, Saxon AJ, Malone DK, Jackson TR, Ries RK. Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence. Subst Abus 2015; 36:21-33. [DOI: 10.1080/08897077.2014.904838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Murphy NP. Dynamic measurement of extracellular opioid activity: status quo, challenges, and significance in rewarded behaviors. ACS Chem Neurosci 2015; 6:94-107. [PMID: 25585132 DOI: 10.1021/cn500295q] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Opioid peptides are the endogenous ligands of opioid receptors, which are also the molecular target of naturally occurring and synthetic opiates, such as morphine and heroin. Since their discovery in the 1970s, opioid peptides, which are found widely throughout the central nervous system and the periphery, have been intensely studied because of their involvement in pain and pleasure. Over the years, our understanding of opioid peptides has widened to cover a multitude of functions, including learning and memory, affective state, gastrointestinal transit, feeding, immune function, and metabolism. Unsurprisingly, aberrant opioid activity is implicated in numerous pathologies, including drug addiction, overeating, pain, depression, and obesity. To date, virtually all preclinical and clinical studies aimed at understanding the function of endogenous opioids have relied upon manipulating endogenous opioid fluxes using opioid receptor ligands or genetic manipulations of opioid receptors and endogenous opioids. Difficulties in directly monitoring endogenous opioid fluxes, particularly in the central nervous system, have presented a major obstacle to fully understanding endogenous opioid function. This review summarizes these challenges and offers suggestions for future goals while focusing on the neurobiology of reward, specifically drawing attention to studies that have succeeded in dynamically measuring opioid peptides.
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Affiliation(s)
- Niall P. Murphy
- Department of Psychiatry
and Biobehavioral Sciences, Univesity of California, Los Angeles, 2579 MacDonald
Research Laboratories, 675 Charles E. Young Drive
South Los Angeles, California 90095, United States
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