Fine-tuning naltrexone treatment for ...( decreases alcohol consumption slows th...),Health

decreases alcohol consumption, slows the onset of relapse, and reduces craving for alcohol in recently abstinent alcohol-dependent patients. Yet researchers couldn't quite determine why some alcoholics were helped and others were not, despite their equal commitment to quit drinking. McCaul's findings may help resolve this mystery.

"This paper is especially important on two fronts," said Volpicelli. "First, it begins to identify that, for at least blocking the pleasure associated with drinking, doses higher than 50 milligrams may be helpful for some people. There seems to be a huge individual variability in how naltrexone is metabolized, so those people who may be the more rapid metabolizers may benefit from higher doses of the medication." He explained that the usual 50-milligrams-per-day dose of naltrexone for treatment of alcoholism was based on the dosage formerly given to heroin addicts. "Furthermore," he said, "this study also shows us that we can and measure blood levels and know if this person needs a higher dose. We can now dose people specifically to get the best level of beta-naltrexol in their systems in order to have the best clinical effect."

McCaul is planning to continue her studies in this area. "Currently," she said, "we are using positron emission tomography to scan brain opioid receptors to determine the extent of opioid receptor blockade by naltrexone. This may vary among individual patients as a function of possible genetic differences, effects of chronic alcohol consumption, and differences in naltrexone blood levels. We expect that those patients with greater receptor blockade will experience greater alcoholism treatment effectiveness than patients with lower blockade. If so, this will help further elucidate the mechanisms of naltrexone's effectiveness in alcoholism treatment."

"McCaul's study as well as other studies showing how alcohol affects the brain are very important," said Volpicelli. "They provide more eviden
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Contact: Mary E. McCaul, Ph.D.
betsymc@jhmi.edu
410-955-5439
Alcoholism: Clinical & Experimental Research
13-Sep-2000

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