scholarly journals Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review

2017 ◽  
Vol 7 (8-9) ◽  
pp. 211-224 ◽  
Author(s):  
Martyna Sawicka ◽  
Derek K Tracy
Keyword(s):  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Evidence Base ◽  
Opioid Antagonist ◽  
Drinking Behaviour ◽  
Pharmaceutical Agent ◽  
Key Issues ◽  
Randomized Control ◽  
Long Acting ◽  
Study Designs

Background: Psychotic illnesses, such as schizophrenia, are typically enduring and disabling conditions, impacting individual, family, and societal outcomes. Individuals with these face greater vulnerabilities in developing alcohol-use disorder (AUD). Furthermore, the nature of psychoses, often manifesting with paranoia, cognitive impairment, a lack of insight, sub-optimal treatment adherence, and stigma from others, means that they can pose unique treatment challenges when these two conditions comorbidly occur. These challenges mean that the standard literature on the effectiveness of the opioid antagonist naltrexone in AUD does not necessarily translate to this vulnerable population. Methods: Following PRISMA guidelines, we herein systematically reviewed the evidence for naltrexone in individuals with both psychosis and AUD. Overall, there is a paucity of research in this important area, with only nine reports meeting search criteria, only four of which were randomized control trials. Studies compared naltrexone with: placebo, another pharmaceutical agent, or upon changes to baseline drinking behaviour. One study evaluated the long-acting injectable formulation of this drug. Results: Most studies, including the methodologically more robust ones, supported naltrexone’s effectiveness over placebo in terms of reduction in drinking days and numbers of drinks consumed on such days in this cohort. Work comparing naltrexone to other pharmaceutical interventions showed approximate equivalence with disulfiram, and modest superiority over acamprosate. Conclusions: On this limited evidence base, this review endorses the use of naltrexone as both safe and effective in those with both psychotic illnesses and AUD. Several key issues remain to be elucidated. Critically, study designs meant that they were limited to individuals with good engagement with services, and levels of adherence were attained that are unlikely to be replicated in this cohort in real-world settings. Finally, effects of specific psychosis symptomatology, not least paranoia and insight, upon naltrexone use, and the reverse directional potential of ‘double dysphoria’ from an opioid antagonist remain largely unexplored.

scholarly journals Examining sleep over time in a randomized control trial comparing two integrated PTSD and alcohol use disorder treatments

2020 ◽  
Vol 209 ◽  
pp. 107905
Author(s):  
Peter J. Colvonen ◽  
Laura D. Straus ◽  
Sean P.A. Drummond ◽  
Abigail C. Angkaw ◽  
Sonya B. Norman
Keyword(s):  
Alcohol Use ◽  
Randomized Control Trial ◽  
Alcohol Use Disorder ◽  
Randomized Control ◽  
Over Time

scholarly journals The following abstracts were presented as posters at the 2018 NEI Congress

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 175-175 ◽  
Keyword(s):  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Treatment Approaches ◽  
Adolescent Population ◽  
Scientific Poster ◽  
Long Acting

The 2018 NEI Congress would like to congratulate the following scientific poster winners:1stPlace:20 - The Need for Speed: Adjunctive Triple Chronotherapy. An Accelerated Intervention in the Treatment of Acute Depression in the Adolescent PopulationDiane Hurd, PMHNP; Mariela Herrera, MD; Nicholas Coombs, MS; Jeannine M. Brant, PhD, APRN, AOCN, FAAN; Eric Arzubi, MD2ndPlace:93 - Practical Outpatient Pharmacotherapy for Alcohol Use DisorderYoungjung Kim, MD, PhD; Laura Hack, MD, PhD; Elizabeth Ahn, MD; Jungjin Kim, MD3rdPlace:95 - Differential Aspects Between Schizophrenia Treatment Approaches: Oral Antipsychotics vs. Aripiprazole Long-Acting InjectableS Arques Egea; E Ros Cucurull; C Iranzo Tatay; C Parro-Torres; RF Palma-Álvarez; E Castrillo; MA Cantillo; P Aznar

scholarly journals Efficacy of long-acting, injectable versus oral naltrexone for preventing admissions for alcohol use disorder

2017 ◽  
Vol 7 (3) ◽  
pp. 106-110 ◽  
Author(s):  
Allison Beatty ◽  
Christopher Stock
Keyword(s):  
Health Care ◽  
Alcohol Use ◽  
Health Care Utilization ◽  
Alcohol Use Disorder ◽  
Randomized Trials ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Oral Naltrexone ◽  
Lower Health ◽  
Long Acting

Abstract Introduction: Approximately 17 million Americans and 300 000 veterans have an alcohol use disorder (AUD). Both oral naltrexone (NTX) and long-acting, injectable naltrexone (LAI NTX) are FDA-approved to treat AUD. LAI NTX is often reserved for patients with adherence concerns due to considerable differences in drug cost and administration requirements. To date, there are no randomized trials comparing efficacy of LAI NTX to oral NTX. This retrospective cohort study compared clinical outcomes in veterans treated with LAI NTX or oral NTX. Methods: Health care utilization in veterans at 1 Veterans Affairs facility treated for AUD with oral NTX and LAI NTX was compared. The primary outcome was 90-day alcohol-related hospital admissions per patient (ARA90). Secondary outcomes included 90-day outpatient clinic and emergency department visits and 30-day alcohol-related admissions (ARA30). Inclusion criteria included first-time prescription of NTX for AUD from January 1, 2015, through December 1, 2015. Veterans receiving concurrent acamprosate or disulfiram were excluded. Results: Seventy-nine patients were included with 65 in the oral NTX group and 14 in the LAI NTX group. The ARA90 was 0.17 for the oral NTX group and 0.64 for the LAI NTX group (P = .06). The oral NTX group had significantly fewer ARA30 than the LAI NTX group (P < .01). Oral NTX also had significantly lower health care utilization for all other parameters. Discussion: Oral NTX was associated with lower health care utilization compared to LAI NTX in this veteran population. This indicates that LAI NTX may not provide additional benefit justifying the cost. This study had several limitations. Randomized trials comparing efficacy between oral NTX and LAI NTX are needed.

scholarly journals First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder

2021 ◽  
pp. 026988112199179
Author(s):  
Ben Sessa ◽  
Laurie Higbed ◽  
Steve O’Brien ◽  
Claire Durant ◽  
Chloe Sakal ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Psychosocial Functioning ◽  
Alcohol Use Disorder ◽  
Therapeutic Potential ◽  
Well Being ◽  
Drinking Behaviour ◽  
Open Label ◽  
Alcohol Detoxification ◽  
Mental Well Being

Background: 3,4-methylenedioxymethamphetamine (MDMA) therapy has qualities that make it potentially well suited for patients with addictions, but this has never been explored in a research study. We present data from the Bristol Imperial MDMA in Alcoholism (BIMA) study. This is the first MDMA addiction study, an open-label safety and tolerability proof-of-concept study investigating the potential role for MDMA therapy in treating patients with alcohol use disorder (AUD). Aims: This study aimed to assess if MDMA-assisted psychotherapy can be delivered safely and can be tolerated by patients with AUD post detoxification. Outcomes regarding drinking behaviour, quality of life and psychosocial functioning were evaluated. Methods: Fourteen patients with AUD completed a community alcohol detoxification and received an eight-week course of recovery-based therapy. Participants received two sessions with MDMA (187.5 mg each session). Psychological support was provided before, during and after each session. Safety and tolerability were assessed alongside psychological and physiological outcome measures. Alcohol use behaviour, mental well-being and functioning data were collected for nine months after alcohol detoxification. Results: MDMA treatment was well tolerated by all participants. No unexpected adverse events were observed. Psychosocial functioning improved across the cohort. Regarding alcohol use, at nine months post detox, the average units of alcohol consumption by participants was 18.7 units per week compared to 130.6 units per week before the detox. This compares favourably to a previous observational study (the ‘Outcomes’ study) by the same team with a similar population of people with AUD. Conclusions: This study provides preliminary support for the safety and tolerability of a novel intervention for AUD post detox. Further trials to examine better the therapeutic potential of this approach are now indicated.

scholarly journals NALTREXONE ASSOCIATED SEIZURE: A CASE REPORT

2021 ◽  
pp. 1-2
Author(s):  
Rajdip Barman ◽  
Pradipta Majumder ◽  
Varun Sharma
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Oral Naltrexone ◽  
Rare Side Effect ◽  
Gastrointestinal Side Effects ◽  
Long Acting

Naltrexone is an opioid antagonist prescribed to treat opioid use disorder and as an anti-craving medication for alcohol use disorder. Gastrointestinal side effects are considered the most common, and liver damage is a serious and rare side effect of naltrexone. In this case report, we describe a 40-year-old patient who developed a seizure after initiating treatment with naltrexone. Although the mechanism is not clear as naltrexone is not a well-known pro-convulsant medication, a few hypotheses for association with seizure have been postulated based on the studies on opioid agonists and similar opioid antagonist naloxone. Based on this case report, we strongly recommend that clinicians should thoroughly assess the risk factors for seizures in patients before using naltrexone and start long-acting injectable naltrexone only after an adequate trial of oral naltrexone to minimize the risk of seizure.

Nurse-Led Delivery of Brief Interventions for At-Risk Alcohol Use: An Integrative Review

2019 ◽  
Vol 26 (1) ◽  
pp. 27-42 ◽  
Author(s):  
Yovan Gonzalez ◽  
Sharon L. Kozachik ◽  
Bryan R. Hansen ◽  
Michael Sanchez ◽  
Deborah S. Finnell
Keyword(s):  
At Risk ◽  
Alcohol Consumption ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Alcohol Screening ◽  
Brief Interventions ◽  
Randomized Control Trials ◽  
Identification Test ◽  
Disorder Identification ◽  
Randomized Control

BACKGROUND: Nurses are in key positions to reduce the global burden associated with alcohol, yet many are ill-prepared to screen for alcohol use and intervene accordingly. The purpose of this integrative review was to identify best practices for educating nurses to work with patients who are at risk for alcohol-related adverse consequences, implement alcohol screening, and deliver alcohol brief interventions (ABIs). AIMS: To identify and synthesize findings from randomized control trials of ABIs delivered by nurses to patients identified through screening to be at risk because of alcohol use. METHOD: The results of 11 published randomized control trials identified from a multi-database search were synthesized. RESULTS: The Alcohol Use Disorder Identification Test was used for alcohol screening in more than half of the studies. Most of the ABIs were based on motivational interviewing and delivered in 30 minutes or less. While there was limited information on the characteristics of nurses who delivered the interventions and how nurses were prepared to deliver the ABIs, the exemplar was a full day workshop teaching nurses on an evidence-based framework for the ABI. All studies measured alcohol consumption as an outcome, yet few used rigorous methods for obtaining this self-reported data. CONCLUSIONS: A 1-day workshop is recommended as an educational modality to prepare nurses to implement the Alcohol Use Disorder Identification Test for identification of persons who are at risk because of alcohol use, deliver a structured brief intervention in less than 30 minutes, and utilize a standard measure of alcohol consumption for evaluation.

scholarly journals First study of safety and tolerability of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in patients with alcohol use disorder: preliminary data on the first four participants

2019 ◽  
Vol 12 (7) ◽  
pp. e230109 ◽  
Author(s):  
Ben Sessa ◽  
Chloe Sakal ◽  
Steve O’Brien ◽  
David Nutt
Keyword(s):  
Alcohol Use ◽  
Preliminary Data ◽  
Alcohol Use Disorder ◽  
Controlled Study ◽  
Drinking Behaviour ◽  
Open Label ◽  
Serious Adverse Events ◽  
Before And After ◽  
Complete Treatment ◽  
Project Data

We present the preliminary data in an ongoing open-label safety and tolerability proof of concept study exploring the potential role for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in treating patients with alcohol use disorder. At this stage, seven participants have completed the full 8-week MDMA-assisted psychotherapy course, including two therapy sessions each with MDMA. This paper focuses on the safety and tolerability of the therapeutic course for the first four participants to complete treatment. Longer-term outcomes of drinking behaviour will be presented later when the full project data are published. Results show all four participants have successfully tolerated the treatment. There have been no serious adverse events related to MDMA, no unexpected physiological responses to the MDMA sessions or changes to blood results or electrocardiograms, measured before and after the 8-week course. We conclude that the treatment is well- tolerated and are making plans to expand the project into a randomised placebo-controlled study.

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