Targeted opioid receptor antagonist therapy (TORAT) - list of research summary key points
‘Naltrexone, an opioid antagonist, has been shown to reduce heavy drinking in young adults compared to placebo and can be taken on a targeted (i.e. as needed basis)’ Experimental and clinical psychopharmacology.
‘Treatments requiring daily administration, such as naltrexone, are inconsistently adhered to in substance abusing populations, and constant medication exposure can increase risk of adverse outcomes, e.g., hepatotoxicity. This has fostered a 'targeted' or 'as needed' approach to opioid receptor antagonist treatment, in which medications are used only in anticipation of or during high-risk situations, including times of intense cravings.’ …. ‘In sum, the targeted or 'as-needed' approach to treatment with opioid antagonists is an efficacious harm-reduction strategy for problem drinking and alcohol dependence.’ CNS Drugs
‘Pharmacotherapy for alcohol dependence has been shown to be moderately efficacious with few safety concerns, but it is substantially underutilised. Concerted efforts must be made to remove the barriers to treatment in order to optimise the management of people with this condition.’ Alimentary pharmacology & therapeutics.
‘This study aimed to replicate and extend prior research showing that the targeted use of naltrexone is a useful strategy to reduce heavy drinking.’ … ‘These results support the use of a targeted approach to reduce drinking among heavy drinkers, particularly men, but argue for the use of additional strategies or more efficacious medications than naltrexone to increase the effects of such an intervention.’ Journal of clinical psychopharmacology.
‘To extend our previous findings that naltrexone reduced the likelihood of heavy drinking on a given day among problem drinkers, while targeted administration reduced the likelihood of any drinking, we examined the effects of naltrexone and targeted administration on the continuous outcome of drinks/day.’ … ‘Although in both genders, targeted treatments appeared to reduce the volume of drinking, treatment with targeted naltrexone was somewhat better. In contrast, heavy drinking women showed no benefit from daily naltrexone treatment.’ Alcoholism, clinical and experimental research.
‘...the results of the COMBINE study demonstrated that...naltrexone, when given with medical counselling that emphasises taking medications as prescribed, can yield clinically significant outcomes...that are either as compelling, and under some conditions, more compelling than those observed with specialty behavioural therapy.’… ‘Receiving treatment directly from their primary healthcare provider could greatly expand treatment options for persons with an alcohol disorder’ … ‘Alcohol dependence is the third leading preventable cause of morbidity and mortality and a major contributor to healthcare costs in this country.’ Psychiatry (Edgmont).
‘Furthermore, use of a targeted approach to medication treatment appears to be a useful strategy for reducing both drinking and heavy drinking. Efforts to replicate these findings are warranted, since they suggest that schedules of medication administration other than daily should be evaluated for treatment of problem drinking.’ Journal of clinical psychopharmacology.
‘Eight double-blind placebo-controlled clinical trials in five countries have demonstrated the safety and efficacy of naltrexone as an adjunct in alcoholism treatment.’ … ‘On this basis, it was proposed that: (1) naltrexone should be administered to patients who were still currently drinking; (2) the instructions should be to take naltrexone only when drinking was anticipated; (3) this treatment should continue indefinitely. Subsequently, clinical trials have found that naltrexone used in this manner is safe and effective.’ Alcohol & alcoholism.