Binge Drinking May Be Curbed With a Pill

A recent study suggested the use of a decades-old medicine taken before imbibing could reduce the amount of alcohol consumed.

Ever wake up regretting the last round of drinks from the previous night? There’s a medicine that might help.

A recent study adds to the evidence that people who binge-drink may benefit from taking a dose of the medication naltrexone before consuming alcohol, a finding that may be welcomed now that alcohol-related deaths in the United States have surpassed 140,000 a year.

Nearly half of American drinkers reported bingeing, defined as more than four drinks in a sitting for men and more than three for women, in the previous month, according to a U.S. government health survey.

Some may view binge-drinking as harmless because the habit is widespread and a low percentage of binge drinkers are dependent on alcohol, according to experts.
ADVERTISEMENT

But it is considered a major risk factor for alcohol-related illness and injuries, and it heightens the possibility that an individual will develop an alcohol disorder.

In the study, which was published in December in the American Journal of Psychiatry, 120 men who wanted to reduce bingeing but were not severely dependent on alcohol were given naltrexone to take whenever they felt a craving for alcohol or anticipated a period of heavy drinking.

Naltrexone, which blocks endorphins and reduces the euphoria of intoxication, was approved in the United States for the treatment of alcohol dependence nearly 30 years ago. But it is typically prescribed for patients with more severe alcohol disorders to take daily to abstain from drinking.

The new study’s targeted approach, in which patients were advised to take the pill one hour before they expected to drink, is less common, although studies going back decades have also demonstrated the effectiveness of the as-needed dosing method.
ADVERTISEMENT

The randomized control trial was double-blinded, so half of the men received naltrexone and half received a placebo, and neither the participants nor the scientists knew who had received which. Each week, participants also received counseling on how to reduce their alcohol use.

By the end of the 12-week study, those given naltrexone reported bingeing less frequently and consuming less alcohol than those who had been given a placebo, a change that lasted for up to six months. The most commonly reported side effect of naltrexone was nausea, although it was generally mild and resolved itself as people adjusted to taking the drug.

Glenn-Milo Santos, a professor at the University of California, San Francisco and the study’s lead author, said patients could discuss the treatment option with their clinicians, even if it was not suitable for all. “Increasing awareness that there are effective medicines that can help people with their alcohol use is important in and of itself,” he said.

Taking naltrexone on an as-needed basis rather than as a daily dose may be more tolerable for some people because it allows their dopamine levels to recover in between uses. The approach could also let people feel more in control of their treatment. The practice is more widely embraced in Europe, where regulators in 2013 approved the medication nalmefene for similarly targeted dosing by people trying to drink less alcohol.
ADVERTISEMENT

Dr. Lorenzo Leggio, a physician-scientist at the National Institutes of Health, said the latest study was “very important” because, while alcohol treatments had traditionally been designed for people with severe addictions, far more people, like the study’s participants, had mild or moderate alcohol disorders.

Last year, N.I.H. officials proposed rebranding these stages as “preaddiction” to underscore the need for early intervention, much as the diabetes field improved care by identifying and treating prediabetes.

“If we attack the medical problem right away and early on, you cannot only treat the problem but prevent the development of the more severe forms of the disease,” Dr. Leggio said.

The recent study enrolled exclusively gay and transgender men, groups in which there is a higher prevalence of binge-drinking, so the findings might not be applicable to all binge drinkers. The participants were recruited “via street outreach, recruitment fliers, sexual health clinics, needle exchanges, community organizations, bars, websites and social media,” according to the study, and additional participants in an unrelated study were also invited to join. Nearly everyone involved in the study reported having some college education and a regular health care provider.

Dr. Henry Kranzler, a professor of psychiatry at the University of Pennsylvania who led earlier trials of targeted dosage of naltrexone, said the approach provided a “niche opportunity” because not all people found it easy to anticipate their cravings and to self-medicate in advance of them.

“It takes a level of awareness that many people don’t have,” he said.

Researchers agree that while there is no one-size-fits-all approach to treating alcohol disorders, naltrexone and other approved medications are vastly underused.

Katie Witkiewitz, the director of the Center on Alcohol, Substance Use and Addictions at the University of New Mexico, said the drugs’ patents had expired, so cheap generic versions were available — but their original makers no longer advertise them.

In a 2019 government health survey on alcohol and drug use, fewer than one in 10 people with an alcohol use disorder reported having received any treatment, and less than 2 percent of those individuals said they had been offered medication. Many physicians do not even know about the drugs.

Dr. Witkiewitz said that two months ago she was supervising a patient she thought would benefit from naltrexone. But she said that the patient’s primary care doctor mistakenly believed that prescribing the medication required additional training in addiction medicine and refused to write a prescription.

“There’s a real gap in the medical community,” she said.

article by NYtimes