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Alcohol Use Disorder
Yolanda Yvette Smith
Louisiana Tech University
Alcohol use disorder impacts millions of people and is associated with significant morbidity and mortality. Various neuroanatomical pathways and neurotransmitters, including the opioidergic system and endogenous opioids,contribute to the development and persistence of alcohol use disorder. The opiate receptor antagonists nalmefene and naltrexone are effective in decreasing alcohol consumption and drinking relapse by modulating the opioidergic system. this may be advantageous for individuals who have certain alleles of the u-opioid receptor, but further research is needed.
Keywords: Alcohol use, morbidity, mortality
Alcohol Use Disorders
Formerly classified as alcohol abuse or alcolhol dependence, alcohol use disorder (AUD) is defined as a pattern of drinking ethanol that leads to impairment or distress. It is manifested by at least two of the following symptoms within one year: unintended increased quantity or duration of consumption; desire or unsuccessful efforts to decrease use; spending time to obtain, use, or recover from its effects; craving; failure to fulfill obligations; social or interpersonal problems; loss of social, occupational, or recreational activities; use in hazardous situations; physical or psychological problems caused or exacerbated by alcohol; tolerance; or withdrawal. 1 In the United States, AUD has
a 12-month prevalence of 8.5% among adults ages 18 and older, and rates are greater in men as compared to women. 1 It is most prevalent in Native Americans and Alaskan Natives, followed by whites, Hispanic, African-Americans, and then Asian Americans or Pacific Islanders. 1
The Opioidergic System
Endogenous opioids are synthesized in various parts of the central nervous system, and each group of endogenous opioid peptides is derived from precursor hormones: endorphins from B-endorphins, adrenocorticotropic hormone (ACTH) and pro-opiomelanocortin (POMC); enkephalins from pro-enkephalin; and dynorphins from pro-dynorphins. 8,9 Each peptide binds ot mu, delta, or kappa opioid receptors: B-endorphin binds with equal affinity to u and o-receptors, enkephalin binds with a 20-fold greater affinity to o-receptors as compared to u-receptors, and prodynorphins bind to k-receptors.10 While B-endorphins and enkephalins increase dopamine release and are important in rewarding and reinforcing behaviors, prodynorphins decrease dopamine release and produce aversive feelings.
Opioid Antagonists for AUD
Acamprosate, baclofen, disulfiram, gabapentin, nalmefene, naltrexone, ondansetron, and topiramate have demonstrated efficacy decreasing alcohol consumption and lengthening abstinence periods. 15-17 However, only nalmefene and naltrexone modulate the opioidergic system to target opiate receptors in reward pathways.
Not available in the United States, nalmefene is a non-selective opiate receptor antagonist. whether taken on a schedule or "as needed," it reduced the number of heavy drinking days more than placebo. 18-22 Naltrexone is available in the United States and is a non-selective opioid receptor antagonist. By blocking endogenous opioid activity, it causes decreased dopamine release and may result in subsequent reductions in alcohol craving and usage. 15
Dosing and Contraindications
Naltrexone is available as a tablet and a depot injection. Before prescribing, clinicians should check liver function and toxicology screening. To prevent withdrawal, patients should abstain from opioids from 7-10 days prior to starting naltrexone. The initial dose is 25 mg daily. Alternative dosing may improve compliance, such as 50 mg each weekday and 100 mg every other day, or 150 mg every three days. 29 The starting dose for the naltrexone injection is 380 mg intramuscularly every four weeks in alternate gluteus muscles. 30 Naltrexone should not be administered to anyone a who is receiving opioid medications or who has hepatic or renal disease. It is classified as Category C drug and it is not known whether it crosses into breast milk. 30
My Conclusion of this Article
I was interested in this article because I wanted to learn things about alcohol uses that I was not familiar with although I am aware that alcoholism is an epidemic that many individuals face in the society we live in today. Shockingly, I found out that Nalmefene and naltrexone is used as a treatment in reducing alcohol consumption as well as aiding in prolonging abstinence in individuals who have had this form of medication therapy. I also learned as well that this form of treatment was effective for patients who was diagnosed with AUD. Doing research on this particular subject has made me aware of some of the benefits that can be obtained in individuals who have Alcohol Use Disorders (AUD).
American Psychiatric Association: Alcohol Use Disorder.In: Diagnostic and Statisical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, (2013). Web. [access date August 3, 2014 at dsm. psychiatryonline.org.
Lippmann, S, Aureshi, B, Scarff, J R, (2015). Alcohol Use Disorder And Genetic Variability In The Opioiodergic System. The Internet Journal of Psychiatry. Volume 4, Number 1. retreived from http//ispub.com/IJPSY/4/1/24291
Mann, K. Bladstrom a, Torup L, et al. Extending the treatment options in alcohol dependence: a randomized conrolled study of as-needed nalmefene. Biol Psychiatry. (2013); 73(8):706-713.
Srisurapanout M, Jarusuraisin N.Naltrexone of the treatment of alcoholism: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmoacol 2005;8(2):2 67-280.
Running head: Alcohol Use Disorder
1ans, and then Asian Americans or Pacific Islanders. 1
Naltrexone is available as a tablet and a depot injection. Before prescribing, clinicians should check liver function and toxicology screening. To prevent withdrawal, patients should abstain from opioids from 7-10 days prior to starting naltrexone. The initial dose is 25 mg daily. Alternative dosing may improve compliance, such as 50 mg each weekday and 100 mg every other day, or 150 mg every three days. 29 The starting dose for the naltrexone injection is 380 mg intramuscularly every four weeks in alternate gluteus muscles. 30 Naltrexone should not be administered to anyone a who is receiving opioid medications or who has hepatic or renal disease. It is classified as Category C drug and it is not known whether it crosses int