Anti-Craving-Substanzen bei Alkoholabhängigkeit

ZUSAMMENFASSUNG

Die Therapieerfolge von Anti-Craving-Substanzen bewegen sich im Bereich geringer bis moderater Effekte. Gleichzeitig macht die starke Heterogenität der Effekte innerhalb von Studien deutlich, dass sich Patienten im Ansprechen auf Anti-Craving-Substanzen unterscheiden und in bestimmten Patientengruppen stärkere Effekte als im Stichprobenmittel erzielt werden. Eine daraus ableitbare therapeutische Strategie basiert auf der Individualisierung der pharmakologischen Rückfallprophylaxe unter Berücksichtigung der zugrunde liegenden Wirkmechanismen [1]. Ein weiterer Ansatz besteht in der Modifikation von Faktoren, die für das Ansprechen von Patienten von Bedeutung sind. Voraussetzung dafür ist die Identifikation individueller Einflussfaktoren und die Etablierung von Methoden, diese in positiver Richtung zu verändern.

Der folgende Beitrag gibt einen Überblick über die aktuelle Befundlage zur Wirksamkeit von Anti-Craving-Substanzen, wobei der Schwerpunkt auf die Darstellung individueller Effektmoderatoren als Grundlage für die Ableitung optimierender Strategien gelegt wird.

Abstract

Effects of anti-craving-drugs range from low to moderate effect sizes. At the same time, the heterogeneity of effects indicates that patients respond different to the effects of anti-craving-drugs with certain patient subgroups benefiting more than others. Deducible relapse prevention strategies include the individualization of pharmacological strategies under consideration of the underlying mechanism of action [1]. A further option to increase effects is to modify individual factors that determine patients’ subjective response to anti-craving-drugs. This requires the identification of individual response predictors and the establishment of methods to modify them in a positive direction.

The publication at hand provides an overview of findings on the effectiveness of anti-craving-drugs focusing individual moderators of effectiveness as a base for deducing strategies for its modification.

Schlüsselwörter

Alkohol - Anti-Craving-Substanzen - individuelles Ansprechen

Key words

Alcohol - anti-craving substances - subjective response

Publication History

Article published online:
04 August 2021

• Literatur

• 1 Rösner S, Soyka M. Update zu Substanzen und Wirkmechanismen. Anti-Craving-Medikamente. Lead Opin Neur Psych 2020; 3: 38-41
• 2 Tabakoff B, Hoffman PL. The neurobiology of alcohol consumption and alcoholism: an integrative history. Pharmacol Biochem Behav 2013; 113: 20-37
• 3 Childress AR et al.. Role of conditioning factors in the development of drug dependence. Psychiatric Clinics of North America 1986; 9: 413-25
• 4 Robinson TE, Berridge KC. The neural basis of drug craving: An incentive sensitization theory of addiction. Brain Research Reviews 1993; 18 (03) 247
• 5 Berridge KC, Robinson TE. Liking, wanting, and the incentive-sensitization theory of addiction. Am Psychol 2016; 71 (08) 670-9
• 6 O’Malley SS, Froehlich JC. Advances in the use of naltrexone: An integration of preclinical and clinical findings. Recent Developments in Alcoholism 2003; 16: 217-43
• 7 Barahona-Corrêa JB et al.. From Thought to Action: How the Interplay Between Neuroscience and Phenomenology Changed Our Understanding of Obsessive-Compulsive Disorder. Front Psychol 2015; 23: 1798
• 8 Berglund M. A better widget? Three lessons for improving addiction treatment from a meta-analytical study. Addiction 2005; 100 (06) 742-50
• 9 Miller W, Wilbourne P. Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol disorders. Addiction 2002; 97: 265-277
• 10 Rösner S, Hackl-Herrwerth A, Leucht S et al.. Acamprosate for alcohol dependence. Cochrane Database Syst Rev 2010; 8 (09) CD004332
• 11 Rösner S, Hackl-Herrwerth A, Leucht S et al.. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 2010; 8 (012) CD001867
• 12 Maisel NC et al.. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction 2013; 108 (02) 275-93
• 13 Littleton J, Zieglgansberger W. Pharmacological mechanisms of naltrexone and acamprosate in the prevention of relapse in alcohol dependence. Am J Addict 2003; 12 Suppl (01) 3-11
• 14 Littleton J. Acamprosate in alcohol dependence: How does it work?. Addiction 1995; 90 (09) 1179-1188
• 15 Mason BJ, Heyser CJ. Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence. CNS Neurol Disord Drug Targets 2010; 9 (01) 23-32
• 16 Maisel NC et al.. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction 2013; 108 (02) 275-93
• 17 Jonas DE, Amick HR, Feltner C et al.. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014; 311 (018) 1889-900
• 18 Donoghue K. et al. The efficacy of acamprosate and naltrexone in the treatment of alcohol dependence, Europe versus the rest of the world: a meta-analysis. Addiction 2015; 110 (06) 920-30
• 19 Cheng HY et al.. Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis. BMJ 2020; 25: 371
• 20 Regitz-Zagrosek V. Geschlecht und Herz-Kreislauf-Erkrankungen: Warum wir Gendermedizin brauchen. Der Internist 2017; 58: 336-343
• 21 Herbeck DM. Gender differences in treatment and clinical characteristics among patients receiving extended release naltrexone. J Addict Dis 2016; 35 (04) 305-14
• 22 Pettinati HM et al.. Efficacy of extended-release naltrexone in patients with relatively higher severity of alcohol dependence. Alcohol Clin Exp Res 2011; 35 (010) 1804-11
• 23 Tidey JW et al.. Moderators of naltrexone’s effects on drinking, urge, and alcohol effects in non-treatment-seeking heavy drinkers in the natural environment. Alcohol Clin Exp Res 2008; 32 (01) 58-66
• 24 Rösner S, Soyka M. Update zu Substanzen und Wirkmechanismen. Anti-Craving-Medikamente. Lead Op Neur Psych 2020; 3: 38-41
• 25 Heinz A et al.. Reward craving and withdrawal relief craving: assessment of different motivational pathways to alcohol intake. Alcohol Alcohol 2003; 38 (01) 35-9
• 26 Glöckner-Rist A et al.. Reward and relief craving tendencies in patients with alcohol use disorders: results from the PREDICT study. Addict Behav 2013; 38 (02) 1532-40
• 27 Verheul R. A three-pathway psychobiological model of craving for alcohol. Alcohol Alcohol 1999; 34 (02) 197-222
• 28 McCaul ME. Naltrexone alters subjective and psychomotor responses to alcohol in heavy drinking subjects. Neuropsychopharmacology 2000; 22 (05) 480-92
• 29 Drobes DJ et al.. Effects of naltrexone and nalmefene on subjective response to alcohol among non-treatment-seeking alcoholics and social drinkers. Alcohol Clin Exp Res 2004; 28 (09) 1362-70
• 30 Peterson JB et al.. Differential effects of naltrexone on cardiac, subjective and behavioural reactions to acute ethanol intoxication. J Psychiatry Neurosci 2006; 31 (06) 386-93
• 31 Ray LA et al.. Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta-analysis. Addict Biol 2019; 24 (06) 1138-52
• 32 Ray LA, Hutchison KE. Effects of naltrexone on alcohol sensitivity and genetic moderators of medication response: a double-blind placebo-controlled study. Arch Gen Psychiatry 2007; 64 (09) 1069-77
• 33 Ashenhurst JR, Bujarski S, Ray LA. Delta and kappa opioid receptor polymorphisms influence the effects of naltrexone on subjective responses to alcohol. Pharmacol Biochem Behav 2012; 103 (02) 253-9
• 34 Anton RF et al.. An evaluation of mu-opioid receptor (OPRM1) as a predictor of naltrexone response in the treatment of alcohol dependence: results from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study. Arch Gen Psychiatry 2008; 65 (02) 135-44
• 35 Rohsenow DJ et al.. Predictors of compliance with naltrexone among alcoholics. Alcohol Clin Exp Res 2000; 24 (010) 1542-9
• 36 Sharp C et al.. Facilitation of internal locus of control in adolescent alcoholics through a brief biofeedback-assisted autogenic relaxation training procedure. J Subst Abuse Treat 1997; 14 (01) 55-60
• 37 Litten RZ et al.. The placebo effect in clinical trials for alcohol dependence: an exploratory analysis of 51 naltrexone and acamprosate studies. Alcohol Clin Exp Res 2013; 37 (012) 2128