CC Nov 2015 Naltrexone for Alcohol Use Disorder (AUD)

echoecho's version from 2015-11-16 13:42


Question Answer
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer has separate categories for alcohol abuse and dependence but measures alcohol use disorder (AUD) how?on a continuum from mild to severe
Alcohol Use Disorder (AUD) affects ___% of the world's population?10
AUD in which gender is twice that of the other gender?men
There is a significant burder of illness from AUD with potentially fatal consequences from more than ___ conditions? 30
There is a ___ to ___ fold increased rate of early mortality in AUD?3; 4
No single aprpoach has yet proven best among the wide variety of available treatment options, name 6 of these options?1) pharmacotherapy 2) cognitive behavioral therapy (CBT) 3) motivational enhancement therapy 4) 12-step programs 5) medical management 6) combined behavioral intervention (CBI)
Most treatment are delieved in what settings?specialty
What treatment option of the 6 named above,while it is the basis of most rehabilitation programs in the US, generally do not fare well in studies of effectiveness?12-step programs
AUD is one of the most _______ disorders in the US healthcare systme?undertreated
Fewer than ___ in 3 patients receives any treatment and < ____% receive medications?1; 10
The Substance Abuse and Mental Health Services Administration (SAMHSA) describes pharmacologic treatment as in this country as grossly _____ despite evidence of benefit in studies?underused
Why is it difficult to generalize study results to all AUD patients?1) due to the complex nature of AUD 2) due to the significant variation in studies (pt characteristics, various types of co-addiction, treatment settings)
Much work has been done to try and identify characteristics that may lead certain patients to respond better to one type of therapy than others, but this aspect of treatment is still in development, true or false?true
All studies of medications included some type of ____ treatment?psychosocial
What plays a significant role in both research results and clinical practice?goal of treatment
In the US, the goal of treatment is what? Why is this so?1) complete abstinence 2) due to the powerful influence of AA (Alcoholics Anoymous)
In Europe, there is more emphasis on what as the desired goal (both in research and practice)?controlled drinking
Europeans are much more likely than Americans to receive what medications?prescription
Medications for AUD first appeared in the 1950s. Give an example of a medications and these have been studied extensively since the 1970s?disulfiram
List the 5 medications?1) disulfiram (Antabuse) 2) oral naltrexone (ReVia) 3) injectable naltrexone (Vivitrol) 4) implantable naltrexone 5) acamprosate (Campral)
One of the major barries to succesful medication treatment of AUD is what?compliance
What systems are implicated in addiction?neurotransmitter
Naltrexone primarily targets what receptors?u-opioid receptors (OPRM1)
The OPRM1 receptor gene has 2 alleles, what are they?G and A
Alcohol dependent patients with at least one copy of type ____ allele have a significantly lower risk of relapse and a longer time to return to heavy alcohol use compared with those who are homozygous for type ____?G; A
African Americans carry the type G allele at a rate of ____%? European Americans at ___ % and Asians at ____%1.3; 15.5; 42
The above suggests that Naltrexone might have a greater efficacy in what ethnic group and less in what ethnic group?Asians; African Americans
Why do some patients respond to treatment and others do not?because of the highly variable results of treatment options
In what type of patient is Naltrexone most appropriate?where controlled drinking is the desired outcome
List 4 clinical measures that Naltrexone is able to significantly improve?1) increased time to alcohol relapse 2) fewer numbers of drinks per drinking day 3) improved liver function indicators (GGT, aspartate aminotransferase) 4) reduced craving
Naltrexone may be significantly more effective in moderating heavy drinking with what 6 patient types?1) those with a family hx of drug problems 2) those with an early onset of alcohol problems 3) those with a high degree of antisocial traits 4) those with a high baseline craving 5) those with more frequent familial alcohol problems 6) those with comorbid drug use
Do more socialized patients have benefits from Naltrexone regardless of compliance?no
Naltrexone was associated with reductions in what OVER placebo in 70%of clincal trials that measured reduction, but in only 36% that measured abstinence?heavy or excessive drinking
The COMBINE data suggest that Naltrexone can be effective in the context of ____ management without ______ behavioral treatment?medical; specialized
Was there any evidence found that Naltrexone (compared to other medicines) was more or less effective for men or women, older adults, young adults, racial or ethnic minorities, smokers or those with co-occurring disorders?no
What was the number needed to treat (NNT) to prevent returning to any drinking? what was the number needed to treat (NNT) for return to heavy drinking?20; 12
What form of Naltrexone can partially overcome the compliance problem with research over the past decade suggesting improved clinical outcomes as a result?sustained-release depot form
Comment on the cost of AUD?the cost of AUD in dollars, illness, disability and quality of life measures is immense
Comment on medication in combination with behavioral interventions for AUD?there is evidence that several medications, in combination with behavorial interventions are safe and can be effective
Comment on medication treatment in the outpatient setting?it can be beneficial in a OP, primary care environment w/o the necessity for specialty psychotherapy or medical management
*** SUMMARY = Naltrexone is most appropriate where ____ _____ is the desired outcome?controlled drinking
*** SUMMARY = List the 6 patient types that Naltrexone may be significantly more effective in moderating heavy drinking?1) patient with a family hx of drug problems 2) patient with early onset of alcohol problems 3) patient with a high degree of antisocial traits 4) patient with high baseline craving 5) patient with more frequent familial alcohol problems 6) patient with comorbid drug use
*** SUMMARY = What type of treatment for AUD in the US is grossly underused despite evidence of benefit in studies?pharmacologic