5MinuteConsult Journal Club

Naltrexone reduces Binge Drinking in High-Risk Population

Reference

Am J Psychiatry: 26 Oct 2022 https://doi.org/10.1176/appi.ajp.20220335

Study Summary

This is a randomized controlled trial on the influence of naltrexone in sexual and gender minority men (SGM) who binge drink and have mild to moderate alcohol use disorder. The researchers randomized this cohort whose risk for binge drinking is greater than the general population.

The study compared oral naltrexone (50 mg) or placebo; all participants received weekly counseling for 12 weeks.

Using intention to treat analysis, they found naltrexone:

--reduced reported number of binge-drinking days (incidence rate ratio [IRR]=0.74, 95% CI=0.56, 0.98; number needed to treat [NNT]=2),

--weeks with any binge drinking (IRR=0.83, 95% CI=0.72, 0.96; NNT=7.4),

--number of drinks per month (IRR=0.69, 95% CI=0.52, 0.91; NNT=5.7 for 10 drinks),

--alcohol craving scores (coefficient=−9.25, 95% CI=−17.20, −1.31).

In those who took the medication at least 2.5 days/week, the benefit persisted.

Conclusions

In a population at high risk for binge drinking, taking 50 mg of naltrexone per day lowered the risk of binge drinking and cravings. The medication plus counseling benefit found was greater than in the group who just received weekly counseling session.

Critical to successful changing of behavior is BOTH the neurochemical ability to choose and the awareness of those behaviors and the rationale of its benefit.

Naltrexone is extremely safe, with few side effects and high efficacy for alcohol use disorders and obesity. Recommend its use to patients who might benefit, and encourage some behavioral modification counseling, like CBT.

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