Alcoholism: Use of Naltrexone

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Alcoholism: Use of Naltrexone




Guest:  Dr. Ray Anton – Psychiatry & Behavioral Sciences

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 it becomes?


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 that system?


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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