Alcohol use is a major problem in today’s society as it can negatively affect an individual’s health, impair the ability to form and maintain healthy relationships, and lowers productivity. Naltrexone hydrochloride, an FDA-approved drug, is often indicated to assist alcohol abusers to limit or abstain from alcohol use. Recent research has demonstrated that sweet-liking alcohol users, and high alcohol craving individuals, benefit more from Naltrexone. Identifying populations of patients that benefit most from a particular therapy is a cost-effective and efficacious approach to adopt.
Alcohol use and binge drinking is a common trend in the younger and older generations of today’s society. Excessive drinking has been associated with a plethora of pathologies including liver disease, fetal alcohol syndrome, ulcers, and others. In addition, improper alcohol use can lead to family problems, the inability to maintain relationships, and an overall loss of productivity. Health care professionals and non-profit organizations, like Alcoholics Anonymous, aim at assisting alcohol addicts remain sober. One major issue in the treatment of alcohol addiction is alcohol dependence, which occurs when the body is suddenly deprived of alcohol, leading to a rebound withdrawal. Alcohol dependence clinically presents with hand tremors, insomnia, anxiety, violent tendencies, and seizures. The economical and individual health burden of excessive alcohol use and alcohol dependence is monumental. Therefore, the identification of efficacious and cost-effective strategies is rigorously sought after.
A recently published article in The Journal of the American Medical Association – Psychiatry, aimed at investigating the effectiveness of naltrexone hydrochloride, an FDA-approved drug, for alcohol dependence. Studies have suggested that whether a patient likes or dislikes sweets may be associated with the efficacy of naltrexone hydrochloride. To test the notion, researchers conducted a twelve-week, placebo-controlled clinical trial consisting of 80 patients, aged 18-65, that wanted to change their drinking habits. The 80 participants were split equally into either the placebo or the naltrexone hydrochloride treatment group. Within each group, they were further subdivided based on whether they were sweet-liking (SL) or sweet-disliking (SDL). In addition, each participant’s craving level for alcohol was determined, and classified as either having a low craving or high craving for alcohol. Following baseline, participants were monitored weekly for the first three weeks, and then biweekly for a total of twelve weeks.
The research demonstrated that SL-phenotype individuals with high alcohol craving drank significantly more over the course of the study in comparison to low-craving individuals and SDL-phenotype high-craving individuals. Naltrexone-treated individuals with an SL-phenotype and high alcohol craving drank significantly less compared to the SL-phenotype, high craving placebo group. Moreover, it was shown that high alcohol craving individuals with an SL-phenotype had fewer alcohol abstinent days compared to all other groups. With Naltrexone hydrochloride, the number of alcohol abstinent days significantly increased. Overall, the results demonstrated that naltrexone hydrochloride is most effective for patients with high alcohol craving and patients that have an SL-phenotype.
The study highlights the importance of precision medicine. Identification of whether someone is sweet-liking or sweet-disliking can assist healthcare providers in determining the most effective course of action. Specifically, the researchers highlight that naltrexone hydrochloride is most effective for alcoholics that are sweet-liking, and have a high craving for alcohol. Further studies can determine other markers or cues that can assist in identifying patient populations that may or may not respond to particular drugs. Finally, elucidating the molecular mechanisms regarding why a therapy may be efficacious for a specific population, but not another, could assist in development of more patient-specific approaches.
Written By: Haisam Shah, BSc