Miranda Robert, Ray Lara, Blanchard Alexander, Reynolds Elizabeth K, Monti Peter M, Chun Thomas, Justus Alicia, Swift Robert M, Tidey Jennifer, Gwaltney Chad J, Ramirez Jason
Brown University, Providence, RI, USA.
Addict Biol. 2014 Sep;19(5):941-54. doi: 10.1111/adb.12050. Epub 2013 Mar 13.
Adolescent alcohol use is associated with myriad adverse consequences and contributes to the leading causes of mortality among youth. Despite the magnitude of this public health problem, evidenced-based treatment initiatives for alcohol use disorders in youth remain inadequate. Identifying promising pharmacological approaches may improve treatment options. Naltrexone is an opiate receptor antagonist that is efficacious for reducing drinking in adults by attenuating craving and the rewarding effects of alcohol. Implications of these findings for adolescents are unclear; however, given that randomized trials of naltrexone with youth are non-existent. We conducted a randomized, double-blinded, placebo-controlled cross-over study, comparing naltrexone (50 mg/daily) and placebo in 22 adolescent problem drinkers aged 15-19 years (M = 18.36, standard deviation = 0.95; 12 women). The primary outcome measures were alcohol use, subjective responses to alcohol consumption, and alcohol-cue-elicited craving assessed in the natural environment using ecological momentary assessment methods, and craving and physiological reactivity assessed using standard alcohol cue reactivity procedures. Results showed that naltrexone reduced the likelihood of drinking and heavy drinking (P's ≤ 0.03), blunted craving in the laboratory and in the natural environment (P's ≤ 0.04), and altered subjective responses to alcohol consumption (P's ≤ 0.01). Naltrexone was generally well tolerated by participants. This study provides the first experimentally controlled evidence that naltrexone reduces drinking and craving, and alters subjective responses to alcohol in a sample of adolescent problem drinkers, and suggests larger clinical trials with long-term follow-ups are warranted.
青少年饮酒会带来无数不良后果，也是导致青少年死亡的主要原因之一。尽管这一公共卫生问题严重，但针对青少年酒精使用障碍的循证治疗措施仍然不足。确定有前景的药物治疗方法可能会改善治疗选择。纳曲酮是一种阿片受体拮抗剂，通过减轻渴望和酒精的奖赏效应，对减少成年人饮酒有效。这些研究结果对青少年的影响尚不清楚；然而，鉴于尚无针对青少年的纳曲酮随机试验。我们进行了一项随机、双盲、安慰剂对照的交叉研究，比较了纳曲酮（50毫克/天）和安慰剂对22名年龄在15至19岁的青少年问题饮酒者的效果（M = 18.36，标准差 = 0.95；12名女性）。主要结局指标包括饮酒情况、对饮酒的主观反应，以及使用生态瞬时评估方法在自然环境中评估的酒精线索诱发的渴望，还有使用标准酒精线索反应程序评估的渴望和生理反应。结果显示，纳曲酮降低了饮酒和大量饮酒的可能性（P值≤0.03），减弱了实验室和自然环境中的渴望（P值≤0.04），并改变了对饮酒的主观反应（P值≤0.01）。参与者对纳曲酮的耐受性总体良好。这项研究提供了首个实验对照证据，表明纳曲酮可减少青少年问题饮酒者的饮酒量和渴望，并改变对酒精的主观反应，提示有必要开展更大规模的长期随访临床试验。
