Naltrexone May Curb Binge-Drinking

New use of an addiction medication for episodic drinking

Naltrexone, marketed under the brand names Revia, Vivitrol, and Depade, prevents the activation of opioid receptors and reduces the euphoria of intoxication. That means it "undermines the purpose of drinking, making it easier for someone either not to drink or if they have a drink, to stop at that, rather than wanting to get a second one,” Dr. Elie G. Aoun, an addiction and forensic psychiatrist at Columbia University who wasn’t involved in the study, told Fox News Digital.^[1]

Naltrexone was approved by the Food and Drug Administration (FDA) for the treatment of opioid dependence in 1984 and extended to the treatment of alcoholism in 1995. But researchers wondered if it could curb the frequency of heavy episodic drinking among people with less severe problems.

A new study, published in the December issue of the American Journal of Psychiatry, recruited 120 gay and transgender men who wanted to cut back on their binge drinking and could be diagnosed with mild to moderate alcohol use disorder.^[2]

For men, binge drinking is defined as consuming five or more drinks on a single occasion. 2018 research found that 17% of US adults had engaged in binge drinking in the previous month.^[3] While most substance abuse treatment and research are refocused on those with severe alcohol dependency, binge drinking accounts for more than half of the 80,000 deaths attributed annually to excessive alcohol use in the United States.^[4]

Studies have found a higher frequency of binge drinking among sexual and gender minority men, who account for half of new HIV infections in the US. Doctors have therefore suggested that preventing heavy episodic drinking in these populations could be an important HIV prevention strategy.^[5]

Participants took naltrexone when they felt cravings or anticipated drinking

In the new randomized controlled trial, half of the 120 participants were given naltrexone to take when they felt cravings for alcohol or anticipated a heavy drinking session. The other half were given a placebo. As the study was double-blinded, neither the participants nor the researchers knew which they had received.

Naltrexone has typically been administered to those with severe drinking problems as a daily pill or a long-lasting subcutaneous implant. However, patients may struggle with the side effects, including gastrointestinal complaints, and fail to comply with dosing regimes. Allowing patients to take naltrexone as needed—an approach that has been used widely in Europe—may allow patients to feel more in control of the treatment and increase compliance.

Over the 12 weeks of the study, participants reported taking the medication or placebo 74% of the days that they craved alcohol or anticipated heavy drinking. The main side effect the naltrexone group reported was nausea, which was mild and subsided as they adjusted to the drug.

All participants also received counseling about reducing their alcohol intake.

Participants given naltrexone reduced their alcohol use

Over the course of the study, those given naltrexone reported bingeing less frequently and consuming less alcohol than those given the placebo.

“Specifically, when naltrexone was taken during periods of alcohol craving or in anticipation of heavy drinking, it reduced the number of binge-drinking days, number of weeks with any binge-drinking, number of drinks consumed, and intensity of alcohol cravings,” the study’s lead author Glenn-Milo Santos, professor at the University of California San Francisco, told Fox News.^[1]

At the outset of the study, participants in the naltrexone group reported a mean of 104.5 drinks in the previous month, while those in the placebo group reported a mean of 72.9 drinks. By month three, the mean number of drinks had fallen to 64 drinks among the naltrexone group but had risen to 80.9 in the placebo group.

"Therefore, the mean drinks in that past month decreased by 38.8% for those in the naltrexone group, but it increased by 10.9% for the placebo group," Santos said.

He added that the differences between the number of drinks reported by the groups at enrolment weren’t statistically significant and didn’t affect the results.

Furthermore, the positive change in the naltrexone group lasted for weeks after the trial concluded and participants stopped taking the pills.

“We also found sustained reductions in heavy alcohol use six months after the treatment phase," Santos said.

Treating binge drinking as ‘preaddiction’ could prevent full-blown alcoholism

Dr. Lorenzo Leggio, a physician-scientist at the National Institutes of Health (NIH), told The New York Times, that the study is “very important,” as alcohol treatments are usually designed for those with severe addictions.^[6]

Treating patients with less severe drinking problems could prevent the from escalating to addiction. “If we attack the medical problem right away and early on, you cannot only treat the problem but prevent the development of the more severe forms of the disease,” he said.

The NIH has proposed labeling these early stages of problem drinking as “preaddiction,” much like the branding of early-stage diabetes as “prediabetes,” to emphasize the need for early intervention.^[7]

Naltrexone won’t work for all binge drinkers

But outside observers said the use of naltrexone as needed may not work for all heavy episodic drinkers. 

While the study participants were diverse, with 46% from racial and ethnic minorities, nearly all reported having at least some college education and a regular health care provider.

Not all binge drinkers are able to anticipate cravings and medicate for them, Dr. Henry Kranzler, a professor of psychiatry at the University of Pennsylvania told The New York Times. 

“It takes a level of awareness that many people don’t have,” he said.

Santos said that the study could encourage patients to discuss medication for alcohol use with their doctors, even if as-needed naltrexone isn’t the right solution for them.

“Increasing awareness that there are effective medicines that can help people with their alcohol use is important in and of itself,” he said.