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Incubation of neural alcohol cue reactivity after withdrawal and its blockade by naltrexone.

Authors
  • Bach, Patrick1, 2
  • Weil, Georg1
  • Pompili, Enrico1
  • Hoffmann, Sabine1, 2
  • Hermann, Derik1, 2
  • Vollstädt-Klein, Sabine1
  • Mann, Karl1
  • Perez-Ramirez, Ursula3
  • Moratal, David3
  • Canals, Santiago4
  • Dursun, Serdar M5
  • Greenshaw, Andrew J5
  • Kirsch, Peter6
  • Kiefer, Falk1, 2
  • Sommer, Wolfgang H1, 7
  • 1 Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany. , (Germany)
  • 2 Feuerlein Center on Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany. , (Germany)
  • 3 Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain. , (Spain)
  • 4 Instituto de Neurociencias, Consejo Superior de Investigaciones Científicas and Universidad Miguel Hernández, San Juan de Alicante, Spain. , (Spain)
  • 5 Department of Psychiatry, University of Alberta, Edmonton, Canada. , (Canada)
  • 6 Department for Clinical Psychology, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany. , (Germany)
  • 7 Institute of Psychopharmacology, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany. , (Germany)
Type
Published Article
Journal
Addiction Biology
Publisher
Wiley (Blackwell Publishing)
Publication Date
Jan 01, 2020
Volume
25
Issue
1
Identifiers
DOI: 10.1111/adb.12717
PMID: 30748046
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

During the first weeks of abstinence, alcohol craving in patients may increase or "incubate." We hypothesize that Naltrexone (NTX) blocks this incubation effect. Here, we compared NTX effects on neural alcohol cue reactivity (CR) over the first weeks of abstinence and on long-term clinical outcomes to standard treatment. Male alcohol-dependent patients (n = 55) and healthy controls (n = 35) were enrolled. Participants underwent baseline psychometric testing and functional magnetic resonance imaging (fMRI) assessment of mesolimbic alcohol CR. Patients participated in a standard treatment program with the option of adjuvant NTX. They received another scan after 2 weeks of treatment. We found higher CR in several brain regions in patients versus healthy controls. CR significantly increased over 2 weeks in the standard treatment group (n = 13) but not in the NTX group (n = 22). NTX significantly attenuated CR in the left putamen and reduced relapse risk to heavy drinking within 3 months of treatment. Additionally, increased CR in the left putamen and its course over time predicted both NTX response and relapse risk. Carrier status for the functional OPRM1 variant rs1799971:A > G was considered but had no effect on NTX efficacy. In conclusion, NTX was most effective in patients with high CR in the left putamen. While the results from our naturalistic study await further confirmation from prospective randomized trials, they support a potential role of neural CR as a biomarker in the development of precision medicine approaches with NTX. © 2019 Society for the Study of Addiction.

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