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NALTREXONE at Searidge Foundation

The road to recovering from addiction to alcohol is challenging but rewarding. Searidge Foundation strives to make it as easy and sustainable as possible. As such, we have a large team of researchers, counselors, and clinicians dedicated to providing you with the best treatments available based on comprehensive and up-to-date evidence.

Naltrexone follows suit. It is a versatile and effective form of pharmacotherapy with implications in a variety of dependencies (specifically alcohol), supported by clinical research.

What is NALTREXONE?

Naltrexone (aka: ReVia, Vivitrol) is a medication primarily used to treat alcohol dependence.1 Typically, it is taken orally or through injection. Both options are available at Searidge Foundation. It is not intended to replace proven, effective medical-based therapies such as cognitive-behavioural therapy, but instead, augment them when necessary.

How can NALTREXONE help my recovery?

To date, there is a large body of scientific evidence that points to the efficacy of naltrexone in treating alcohol dependence.1–7 However, it is important to remember that pharmacotherapies such as naltrexone are typically not meant to replace psychotherapy. Instead, they are often best prescribed as a conjunctive treatment.8

The entire spectrum of alcohol use disorder is complex. As such, everyone’s relationship with alcohol varies. Fortunately, the underlying causes can often be examined with the help of an experienced counselor. Counselors are key practitioners in the road to recovery by assisting with the psychological and emotional components of addiction. Despite being effective, psychotherapy can be challenging, and it is often a long-term endeavour. However, this is an essential piece in long-term recovery.

Naltrexone can act as a buffer in difficult situations – specifically with craving.4,7 Research indicates that it can provide real-time relief of heavy drinking in an individual’s natural environment (i.e., home, work, etc) when not already consuming alcohol.3,9 Specifically, naltrexone can eliminate some individuals’ urges or compulsions to drink, whether they typically consumed alcohol or not in these places in the past. In addition, a large body of evidence indicates that naltrexone indeed can reduce the amount of alcohol an individual drinks in a given sitting.

Is NALTREXONE safe?

A recent analysis published in the Journal of Biomedicine has determined that use of Naltrexone to treat alcohol use disorders does not increase the risk of serious adverse effects.10 In other words, individuals who take naltrexone as part of their treatment plan for any alcohol use disorder do not experience any serious consequences (i.e., death, cardiovascular/cerebrovascular events, cancer) above those who do not take the medication at all.

Evidence-based and informed practice is key is to your recovery. In the late 1980s, the FDA issued a “black-box warning” about possible liver failure caused by Naltrexone. This move was premature and misinformed. Today, there are no known cases of hepatic failure due to naltrexone.11,12 As such, the warning was removed. Despite this, it is still compulsory to speak to a physician about your health history in a transparent manner.

What are the side-effects associated with NALTREXONE?

Like all medications, there are some side-effects associated with naltrexone. There are even side-effects associated with psychotherapy.13 Despite this, it is necessary to examine the cost versus benefit for each therapy when undergoing treatment. If alcohol use disorder is the major barrier preventing you from living a fulfilling and happy life, then perhaps the side-effects associated with your treatment are tolerable, necessary, or minor. It is important to remember that not all users of naltrexone experience side-effects. The most common side-effects reported with naltrexone-use are gastrointestinal issues (e.g., diarrhea and abdominal cramps). Other lesser common side-effects may include nausea, headaches, or dizziness. A practitioner or pharmacist will be happy to assist you in understanding the full profile of side-effects associated with naltrexone. This list includes only the most common, serious, and pertinent.

How does NALTREXONE work?

Naltrexone is an opioid receptor antagonist. In other words, it blocks the activities of both the mu and kappa opioid receptors in the brain. These receptors are located on various neurons that make up a large, complex network involved in behaviour. Specifically, naltrexone serves as a blockade against a neurotransmitter in the brain called dynorphin, which is a naturally-occurring opioid within the brain that is heavily-involved in drug-seeking behaviour. When naltrexone binds to a kappa receptor in the brain, it blocks the ability of dynorphin to bind to the same receptor. As a result, it “locks” the neuron in an off-state until it is metabolized or broken down by the body, thereby curbing the urges and cravings associated with alcohol.

How can I be sure that NALTREXONE is right for me?

It is our duty to provide you with a thorough understanding of naltrexone so that you can make an informed decision with your practitioner. In our opinion, naltrexone is a low-risk medication where the benefits can (and have) far outweigh the costs (i.e., side-effects). As research indicates, naltrexone can be an effective addition to your therapy and it has improved the lives of many others in the past.

There are multiple underlying factors to addiction. Typically, a combination of environmental, physiologically, and psychological influences. Naltrexone can be effective in helping individuals overcome the underlying physical or physiological dependencies by addressing issues of craving.1,3 It may or may not be a long-term treatment however each individual will be closely and periodically assessed by counselors and clinicians to ensure that naltrexone indeed is effective or not.

Mark Twain reiterates the law of the instrument in human-behaviour: “to a man with a hammer, everything looks like a nail.” We believe that this is relevant to most circumstances in our lives, including addictions. That is why we strive to provide a diverse and versatile treatment plan for all of our patients. Not all problems can be solved with only a hammer. Oftentimes, you need the whole toolbox. Adding safe, effective pharmacological interventions to pre-existing treatments such as psychotherapy may open up new opportunities of recovery for our patients.

Please feel comfortable to speak with your counselor at Searidge Foundation about naltrexone. We are interested in hearing why or why not you think naltrexone may be beneficial to your treatment. In addition, please ask your counselor for more information if necessary.

References

1. Hendershot CS, Wardell JD, Samokhvalov AV, Rehm J. Effects of naltrexone on alcohol self-administration and craving: meta-analysis of human laboratory studies. Addict Biol. 2017;22(6):1515-1527. doi:10.1111/adb.12425

2. Stewart SH, Walitzer KS, Blanco J, et al. Medication-enhanced behavior therapy for alcohol use disorder: Naltrexone, Alcoholics Anonymous Facilitation, and OPRM1 genetic variation. J Subst Abuse Treat. 2019;104:7-14. doi:10.1016/j.jsat.2019.05.004

3. Miranda R, Treloar Padovano H, Gray JC, Wemm SE, Blanchard A. Real-time assessment of alcohol craving and naltrexone treatment responsiveness in a randomized clinical trial. Addict Behav. 2018;83:72-78. doi:10.1016/j.addbeh.2018.01.009

4. Cook RL, Zhou Z, Miguez MJ, et al. Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo. Alcohol Clin Exp Res. 2019;43(8):1790-1800. doi:10.1111/acer.14130

5. Aboujaoude E, Salame WO. Naltrexone: A Pan-Addiction Treatment? CNS Drugs. 2016;30(8):719-733. doi:10.1007/s40263-016-0373-0

6. Ray LA, Green R, Roche DJO, Magill M, Bujarski S. Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta-analysis. Addict Biol. 0(0). doi:10.1111/adb.12747

7. Elton A, Dove S, Spencer CN, Robinson DL, Boettiger CA. Naltrexone Acutely Enhances Connectivity Between the Ventromedial Prefrontal Cortex and a Left Frontoparietal Network. Alcohol Clin Exp Res. 2019;43(5):965-978. doi:10.1111/acer.13999

8. Anton RF, Moak DH, Waid LR, Latham PK, Malcolm RJ, Dias JK. Naltrexone and Cognitive Behavioral Therapy for the Treatment of Outpatient Alcoholics: Results of a Placebo-Controlled Trial. Am J Psychiatry. 1999;156(11):1758-1764. doi:10.1176/ajp.156.11.1758

9. Ahmed R, Kotapati VP, Khan AM, et al. Adding Psychotherapy to the Naltrexone Treatment of Alcohol Use Disorder: Meta-analytic Review. Cureus. August 2018. doi:10.7759/cureus.3107

10. Bolton M, Hodkinson A, Boda S, et al. Serious adverse events reported in placebo randomised controlled trials of oral naltrexone: a systematic review and meta-analysis. BMC Med. 2019;17(1):10. doi:10.1186/s12916-018-1242-0

11. McDonough M. Naltrexone and liver disease. Aust Prescr. 2015;38(5):151. doi:10.18773/austprescr.2015.063

12. Brewer C, Wong VS. Naltrexone: report of lack of hepatotoxicity in acute viral hepatitis, with a review of the literature. Addict Biol. 2004;9(1):81-87. doi:10.1080/13556210410001674130

13. Schermuly-Haupt M-L, Linden M, Rush AJ. Unwanted Events and Side Effects in Cognitive Behavior Therapy. Cogn Ther Res. 2018;42(3):219-229. doi:10.1007/s10608-018-9904-y

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