Guest: Dr. Ray Anton – Psychiatry & Behavioral
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Ray Anton who is
Professor of Psychiatry in Behavioral Sciences here at the Medical University
of South Carolina. Dr. Anton, you are
certainly an expert in the area of substance abuse research. I wanted to talk with you, today, about a new
study, that just came out, that you published in Archives of General
Psychiatry about a medication that a lot of people still are not terribly
familiar with, called naltrexone, and, in particular, how certain people seem
to be much more responsive to this medication than others. First, let’s talk about naltrexone. Just what is that medication?
Dr. Ray Anton: Thank you, Dr. Austin. It’s a pleasure to be here and to answer your
questions about this very important topic.
Naltrexone is a medication that was actually approved by the Food and
Drug Administration in the mid 1990s. It
has been around for awhile, but many people do not know of it, as you
mentioned. It’s actually a generic
medication now, so it’s cheaper than it was when it first came out. Naltrexone is a medication that actually
blocks receptors in the brain. These are
proteins on the cells in the brain that are used for a communication system in
the brain. And these receptors, called
opiate receptors, in the brain are the receptors that morphine and heroine bind
to, as a matter of fact. And, therefore,
as most people know, people can get high on opiate drugs like morphine and
heroine. That’s because they bind to
these receptors in the brain.
What people probably
don’t know is that alcohol also causes a release of biological, or naturally
occurring, opiates in the brain that bind to these very same receptors that
cause people to have pleasure, euphoria and intoxication. And it’s clear that certain people that
develop alcohol-use disorders, alcoholism, seem to be very sensitive to that
affect of alcohol. They may release more
beta-endorphins, these synthetic natural opiates in the brain that bind to
these opiate receptors.
Dr. Linda Austin: So, in other words, those people who are
prone to alcoholism actually have a different sensation when they drink than
those people who do not, and that’s on the basis of these little protein
molecules on the cells, is that right?
Dr. Ray Anton: Well, that’s right. That’s one explanation. You know, there are probably many reasons why
people drink. But it’s getting more and
more clear that there are certain people that are sensitive to the stimulating
effects of alcohol, the euphoric effects of alcohol, and the more they drink,
the more sensitive they become. We call
that neuroadaptation, or a sensitization.
And maybe it’s the basis of habit, or habituation, to alcohol, and it
underlies one of the biological reasons why people become alcohol dependent.
Dr. Linda Austin: So, the more they do it, the more pleasurable
Dr. Ray Anton: That’s the thinking; or the more stimulating
it becomes. You know, when many people
drink, they get tired or fatigued. We’ve
done some other research that suggests that people who drink heavily will
eventually become alcoholics, may actually get more stimulation, and they don’t
get as sedated or fatigued. And that’s
oftentimes coupled with a feeling of euphoria which then leads to craving for
alcohol. And that gets worse over time. So, people in their 20s may have that effect
a little bit. But if they keep drinking
at that level, by the time they’re in their early 30s, it becomes almost a
needed and natural phenomenon which continues to cause them to drink heavily.
Dr. Linda Austin: So, what role, then, does naltrexone play in
Dr. Ray Anton: Well, this opiate system in the brain that I
referred to before, and there’s this natural compound beta-endorphin that’s
released when people drink, causes them to be euphoric and to want and desire
alcohol. So, theoretically, a medication
like naltrexone which blocks the binding of these beta-endorphins will block
that effect from happening.
Even more importantly, we
now know that you don’t have to drink alcohol once you become alcohol dependent
to get almost like a buzz out of it. You
can be in a natural situation where you normally drink it with drinking buddies
or friends, where alcohol is being served and where you normally drink, and
just being in that environment causes people to have an intense craving for
alcohol and maybe, actually, get a little high.
And that causes them to relapse and to drink heavily.
So, by blocking that with
a drug like naltrexone, we’re able to stop them from relapsing or from drinking
heavily. If they do slip, they don’t
have as much craving. They don’t get as
intoxicated. They’re not as high, or not
as euphoric. And it allows them to sort
of keep control over urges, and if they do slip, to moderate that slip and get
back to a more abstinent state.
Dr. Linda Austin: Naltrexone doesn’t work for everybody though.
Dr. Ray Anton: That’s correct. As we say, many times over the years,
naltrexone is not a magic bullet. We
haven’t found a medication yet that’s a magic bullet, or a silver bullet,
that’s going to go in and knock out the craving for alcohol or knock out the
desire to drink again. So, that’s
unfortunate. But it has led us to do
more studies to try to understand who might respond. And, more importantly, can we predict ahead
of time who might respond to this medication, or who might respond to a
different type of treatment, which would make the treatment of alcohol much
more efficient and better served to people who want treatment?
Dr. Linda Austin: And if people want to participate in those
studies, they could come here, to the Center for Drug and Alcohol Programs at
the medical university, correct?
Dr. Ray Anton: That’s correct. We’re doing a number of ongoing studies that
are continuing to work with naltrexone, but with other medication as well, as
we try to sort out who these medications might benefit the most.
Dr. Linda Austin: Dr. Anton, I want to talk about the results
of some of your studies, but let’s save that for another podcast.
Dr. Ray Anton: Thank you very much.
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