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Opioid antagonists for alcohol dependence.

Susanne Rösner¹, Andrea Hackl-Herrwerth, Stefan Leucht

¹Psychiatric Hospital, University of Munich, Nußbaumstr. 7, Munich, Germany, 80336.

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Area of Science:

Pharmacology
Clinical Medicine
Addiction Psychiatry

Background:

Alcohol dependence is a major global health risk.
Psychosocial relapse prevention programs show moderate success.
Opioid antagonists like naltrexone and nalmefene may enhance treatment outcomes.

Purpose of the Study:

To evaluate the effectiveness and tolerability of opioid antagonists for alcohol dependence treatment.
To synthesize evidence from randomized controlled trials on naltrexone and nalmefene.

Main Methods:

Systematic review of double-blind randomized controlled trials (RCTs).
Searched major databases (PubMed, EMBASE, CINAHL) and contacted manufacturers.
Included trials comparing naltrexone or nalmefene against placebo or active controls.

Main Results:

Naltrexone reduced heavy drinking days by 17% (RR 0.83) and decreased drinking days by approximately 4%.
Significant improvements observed in heavy drinking days, alcohol consumption, and liver enzymes (GGT).
Naltrexone's side effects were primarily gastrointestinal and sedative; injectable forms and nalmefene showed non-significant effects.

Conclusions:

Naltrexone is an effective and safe strategy for treating alcoholism.
The moderate effect sizes are significant given the chronic and relapsing nature of alcohol dependence.
Naltrexone represents a valuable addition to limited therapeutic options for alcohol use disorder.