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About
This study will determine whether naltrexone, a medicine used to treat alcoholism, can lessen the craving for alcohol during alcohol withdrawal and examine how the drug affects brain activity during alcohol infusion.
People between 21 and 50 years of age who are right-handed, alcohol-dependent, and have at least one family member with a history of alcoholism, may be eligible for this study.
Participants are admitted to the NIH Clinical Center for 1 month for the following procedures:
Screening
Days 1-7
Days 7 through 28
Follow-up
Subjects are asked to participate in a 3-month outpatient assessment program involving five outpatient visits (at 1, 2, 4, 8 and 12 weeks after discharge). At each visit, they fill out questionnaires and to take a breathalyzer test and blood and urine tests for drugs. They may continue naltrexone therapy and weekly group therapy sessions during this time. Subjects who do not participate in the assessment program are contacted at home by phone once a week for 1 month and then every other week for the next 2 months to monitor alcohol abstinence.
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Full description
Alcoholism is a chronic, progressive, brain disorder with a profound impact on individuals' lives and economic cost to society. The positive reinforcing effect of alcohol is a key element in the transitional development from alcohol intake to alcohol addiction. Findings from animal and human studies indicate that the rewarding properties of ethanol arise in part from a complex interaction between alcohol, endogenous opioids, and dopamine (DA) systems. Acute administration of ethanol increases the release of opioid peptides, which in turn, increases the release of DA in the mesocorticolimbic system. Naltrexone (NTX), an opioid receptor antagonist, has been studied widely in both preclinical and clinical research for the treatment of alcoholism. Numerous clinical studies have shown that short-term use of NTX on alcohol-dependent patients effectively prevents relapse and reduces the level of craving. Genetic studies have suggested that individuals with mu-opioid receptors (OPRMs) encoded by the 118G gain-of function variant allele experience a greater therapeutic response to NTX. There are no data utilizing functional Magnetic Resonance Imaging (fMRI) to study the effect of NTX on brain activity during an intravenous (IV) infusion of ethanol.
Objectives:
To study the effect of NTX on the blood oxygen level dependent (BOLD) response in the ventral striatum area of the brain in response to an ethanol infusion.
To study the effect of NTX on cue reactivity (CR) to alcohol-associated cues.
Study population:
Alcohol-dependent patients between the ages of 21-50 years.
Design:
All participants will complete a screening telephone interview before coming to the NIAAA Inpatient Unit. The interviewer will inform eligible participants about the requirements and procedures associated with current protocols. Following admission to NIAAA Inpatient Unit, all participants will be enrolled in the Assessment and Treatment of People with Alcohol Drinking Problems protocol (#05-AA-0121). Protocol 05-AA-0121 will allow us to evaluate each participant's general medical and psychiatric conditions and provide standard of care for treatment seeking alcoholics.
Participants, who fulfill the specific requirements of the NTX protocol, will be thoroughly informed about the nature of the study before obtaining an informed consent. Consented participants will be randomized, using a double-blind design, to receive either 50 mg of NTX per day or placebo. Medications will be administered at 8:00 AM on a daily basis by the nursing staff.
Prior to the challenge procedures (CR on Day 7 and fMRI/ethanol infusion on Day 9), a clinical nurse specialist who is not involved with the protocol will re-consent each participant when they are not in acute withdrawal. The re-consenting process will provide reassurance that participants understand the requirements and implications associated with participation in the CR and fMRI/ethanol infusion procedures. Individuals who elect not to participate in the CR and fMRI/ethanol infusion sessions will be discharged from the in-patient unit and encouraged to continue treatment in the NIAAA Outpatient Clinic for the next three months.
Participants who elect to remain in the study will take part in the CR session on Day 7 and fMRI/ethanol infusion session on Day 9 (procedures are described on Page 13 under study procedures). Following the fMRI/ethanol infusion session, participants will remain in the hospital for approximately three weeks to monitor their craving and take part in our inpatient treatment program for alcoholism. During the post-challenge hospitalization, all participants will be offered 50 mg of NTX once a day. Following discharge from the hospital, participants will be encouraged to continue treatment in NIAAA Outpatient Clinic for three months.
Outcome Measures:
BOLD response during the ethanol infusion challenge.
BOLD brain response to emotional facial stimuli.
Self-reported Alcohol Urge Questionnaires (AUQ), Penn Alcohol Craving Scale (PACS), Obsessive Compulsive Drinking Scale (OCDS) and Profile of Mood Status (POMS).
Hormonal responses to the ethanol challenge: plasma ACTH, cortisol, and beta-endorphin.
Subjective responses to the ethanol challenge as rated by stimulation, sedation, high, and intoxication questionnaires.
Cue-induced craving during the CR session.
Enrollment
Sex
Ages
Volunteers
Inclusion and exclusion criteria
All participants must:
In addition, female participants:
EXCLUSION CRITERIA:
General exclusion criteria for the NIAAA Intramural treatment program:
Specific exclusion criteria for this protocol include:
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Data sourced from clinicaltrials.gov
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