Is Naltrexone More Effective in Alcohol-Dependent Patients with a Sweet Tooth?

Naltrexone has modest efficacy for alcohol dependence. Sweet preference may reflect endogenous opioid activity and predict the efficacy of naltrexone. A 32-week double-blind placebo-controlled trial examined the relationship between sweet preference and naltrexone efficacy among 78 alcohol-dependent subjects (45 were assigned to the naltrexone group). Subjects ranked 6 concentrations of sucrose solution, results of which were used to generate a “sweet score” based on the correlation between preference and sweetness (sucrose concentration).

  • The effect of naltrexone on the number of relapses to heavy drinking* was significantly different for those with higher versus lower sweet scores. Higher sweet scores were associated with fewer relapses to heavy drinking in the naltrexone group but not in the placebo group: For every 1-unit increase in sweet score in the naltrexone group, there were 1.2 fewer relapses reported during the study period.
  • The effect of naltrexone on weekly alcohol consumption and craving was not significantly affected by sweet preference.

*Defined as a) ≥5 drinks on at least 1 occasion in the 1–4 week period between follow-up visits, b) ≥5 drinking occasions per week since the previous follow-up visit, or c) arriving intoxicated to a follow-up visit.

Comments:

It would have been useful if the article quantified the differential efficacy of naltrexone in participants with high versus low sweet scores. Although sweet scores did not seem to modify naltrexone’s effect on craving or mean weekly consumption, results suggest naltrexone may reduce relapse in patients with a preference for sweets. Future study may clarify whether asking alcohol-dependent patients about sweet preference could help providers prescribe naltrexone to those more likely to benefit from it.

Christine Pace, MD† & Richard Saitz, MD, MPH

†Contributing Editorial Intern and Fellow in General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston, MA.

Reference:

Laaksonen E, Lahti J, Sinclair JD, et al. Predictors for the Efficacy of Naltrexone Treatment in Alcohol Dependence: Sweet Preference. Alcohol Alcohol. January 25, 2011 (E-pub ahead of print).

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