Alcohol Dependence is still a major cause of concern throughout UK. The issue of ‘minimum pricing’ is up for debate (probably for my next blog) but this post is about the use of Naltrexone in Alcohol Use Disorders. One of the mechanisms that Alcohol gives a pleasurable effect is through our Brain’s Opioid System. Naltrexone is an Opiate Blocker which is used for maintaining abstinence from Opiate Dependence and is licensed in UK in its Oral form. Several studies across the world have been done to demonstrate efficiency of other forms- Depot Naltrexone and Implants as well (most suited for motivated individuals).
Naltrexone has also been used over many years for Alcohol Use disorders for people in recovery, as it blocks the Opioid System, thus causing less pleasurable effects with drinking. The British Association of Pharmacology- Substance Misuse Guidelines have endorsed its use as well. Since it is not licensed in UK for this indication, only specialists in Addiction Psychiatry would generally prescribe this. Naltrexone has beneficial effects- one mechanism of ‘pharmacological extinction’ with Naltrexone and drinking alcohol may be possible but in my experience as a Consultant Psychiatrist in Wales, it has not caused a total extinction of the effects but has certainly helped people with reducing the amounts of alcohol they consume, the number of heavy drinking days and have reported that Alcohol does not affect them the same way as without the Naltrexone. One other effect is that the cravings to drink (which is a significant factor for relapse to heavy drinking) have reduced with Naltrexone.
The Naltrexone depot is a useful formulation which has its effect up to a month and aids concordance along with sustaining its effects. Vivitrol (US Preparation) is already licensed as a treatment for Alcohol Use Disorder in the USA. A similar preparation is available in UK, albeit in the Private Sector only.