Pharmacological challenge with naloxone and cue exposure in alcohol dependence:
results of a randomized, double-blind placebo-controlled trial.
Author(s): Lieb M(1), Palm U, Chiang S, Laubender RP, Nothdurfter C, Sarubin N,
Mokhtari-Nejad R, Koller G, Soyka M.
Affiliation(s): Author information:
(1)Department of Psychiatry, Bezirksklinikum Regensburg , Regensburg , Germany.
Publication date & source: 2013, World J Biol Psychiatry. , 14(7):539-46
OBJECTIVES: Animal and clinical studies implicated opioid dysfunction in the
pathogenesis of alcohol abuse and dependence. The π-opioid antagonist naltrexone
reduces craving, eventually modulated by hypothalamic-pituitary-adrenal axis.
Altered cortisol response to opioid receptor blockade not only in alcohol
dependent persons, but also in persons with a family history of alcohol
dependency was reported.
METHODS: Twenty patients with alcohol dependence who had undergone detoxification
were recruited. Naloxone (3.2 mg/70 kg body weight) having a very similar
receptor profile to naltrexone and placebo were administered in cross-over
fashion on two separate days 48 h apart. Mood and craving was assessed with
well-established instruments (Alcohol Craving Questionnaire (ACQ), Profile of
Mood Scale (POMS)). Both patients and raters were blind to all treatments. Twelve
patients were first treated with naloxone, eight were first treated with placebo.
RESULTS: No significant differences were found between the placebo and naloxone
groups according to ACQ and POMS. Cortisol levels were significantly higher in
naloxone group.
CONCLUSIONS: We could not replicate the result, that blocking of the endogenous
opioid system leads to reduced craving in alcohol-dependent individuals, while
increase of cortisol after naloxone challenge is the expected biological effect
of opioid receptor blockade on the hypothalamic-pituitary-adrenal (HPA) axis.
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