The Gold Standard in Addiction Treatment

In the third installment of Psychiatric Times’ interview with Joseph Volpicelli, MD, PhD, he discussed treating alcohol use disorder (AUD) with naltrexone and others.

Volpicelli said he thinks Naltrexone is the gold standard for medications to treat AUD, having been around for 30 years and proven to be safe and effective. Markers in patients who would be a good candidate for Naltrexone include an individual who find that they have a hard time controlling how much they drink. He said a study done with college students who have a family history of alcohol problems found that after 3 drinks, the craving for alcohol increased. He said those involved had increased energy, unlike the students who did not have a family history, who felt tired and were not interested in having more.

“I found that if I gave people naltrexone before they had the alcohol, the people who had that strong family history, people at risk for alcohol addiction, their response to alcohol looked like the people who did not have the risk for alcohol problems,” Volpicelli said. It broke the cycle creating the need for the next drink. He said people who use alcohol for sedative effects tend to not be good responders to naltrexone.

Patients who drink to avoid withdrawal symptoms will have to address the symptoms in their treatment, which would be the first step in treatment. Those who drink for its sedative effects might need to learn how the short-term effect will impact the long term. “People who use alcohol as a way of reducing anxiety, it may seem like it is helping anxiety but in the long run it just increases your anxiety because part of the withdrawal symptoms is that you feel irritable or anxious,” Volpicelli said. Addressing the underlying issue, whether it be anxiety, sleep disturbance, or something else, will help in addressing the AUD.

This is part 3 of a 5-part interview with Joseph Volpicelli, MD, PhD. You can watch the full interview here.

Dr Volpicelli is the executive director of the Institute of Addiction Medicine.