Taking a dose of naltrexone, a medication used to treat alcohol dependence, before drinking may help binge drinkers consume less alcohol and binge less frequently, according to a new study published in the American Journal of Psychiatry. And health experts say this approach may be a way to treat alcohol disorders before they get more severe.

Study details and key findings

According to a federal health survey, almost half of U.S. drinkers reported bingeing alcohol in the past month. Binge drinking is defined as more than three drinks in one sitting for women and more than four drinks for men.

Although some people consider binge drinking relatively harmless, it is still a major risk factor for alcohol-related illnesses and injuries. It also increases the possibility that someone will develop an alcohol disorder later on.

One treatment for alcohol dependence is naltrexone, which blocks endorphins and decreases the euphoria people experience while intoxicated. The drug was originally approved to treat alcohol dependence almost 30 years ago and is usually prescribed for patients with severe alcohol disorders to help them abstain from drinking.

However, there is growing interest in using a more targeted approach with naltrexone among individuals with more mild or moderate alcohol use disorders to help them reduce their alcohol intake and prevent their conditions from progressing.

For the study, researchers tested the effect of naltrexone on 120 men who wanted to reduce their binge drinking but were not severely dependent on alcohol. All participants were gay and transgender men, groups that have been found to have a higher prevalence of binge drinking.

Half of the participants received naltrexone, and half received a placebo. All participants also received counseling to help them reduce their alcohol use. Because the study was double-blinded, neither the participants nor the researchers knew who received which treatment.

During the 12-week study, patients were told to take the medication an hour before they expected to drink. In the end, those who received naltrexone reported they binged less frequently and consumed less alcohol than those who received the placebo. This change lasted up to six months.

Commentary

According to Lorenzo Leggio, a physician-scientist at NIH, the study's findings were "very important" since they showed that alcohol treatments could be beneficial to more patients than just those with severe alcohol disorders.

"If we attack the medical problem right away and early on, you [can not] only treat the problem but prevent the development of the more severe forms of the disease," Leggio said. Last year, NIH officials proposed reframing mild to moderate alcohol disorders as "preaddiction" to emphasize the need for early intervention, much like providers already identify and treat prediabetes.

In Europe, this targeted approach to alcohol treatment has already been embraced. In 2013, European regulators approved nalmefene for targeted dosing among people who wanted to drink less alcohol.

Glenn-Milo Santos, a professor at the University of California, San Francisco and the study's lead author, noted that patients concerned about their drinking habits can discuss naltrexone as a treatment option with their physicians, even if it ends up not being suitable.

"Increasing awareness that there are effective medicines that can help people with their alcohol use is important in and of itself," he said.

However, some health experts say that targeted doses of naltrexone may not work for everyone since people have to be able to anticipate their cravings and medicate before they occur.

According to Henry Kranzler, a professor of psychiatry at the University of Pennsylvania, the targeted dosing approach is mostly a "niche opportunity," and using the medication effectively "takes a level of awareness that many people don't have."

In general, health experts say that naltrexone and other medications approved to treat alcohol dependence are significantly underused and more education is needed in the medical community.

In a 2019 survey, less than 10% of people with an alcohol use disorder said they received any treatment, and less than 2% said they were offered any medication. Many physicians are also unaware that any medication to treat alcohol disorders exists.

"There's a real gap in the medical community," said Katie Witkiewitz, director of the Center on Alcohol, Substance Use and Addictions at the University of New Mexico. (Alcorn, New York Times, 2/14; Santos et al., American Journal of Psychiatry, 12/2022)