Hello all,

I received a message from Dr. Eskapa regarding updated clinical research. He's asked me to post it here. I was hoping to create a new category on the forum specifically for supporting data but until then....

"The clinical research database is now available on http://www.thecureforalcoholism.com (see the first page) or http://www.benbellabooks.com/cureforalc ... xtlist.doc
you are welcome to post this on the forum and elsewhere and would appreciate it if you did.

All the very best.

Roy"

I also have it here on Google docs:

https://docs.google.com/fileview?id=0B8 ... OGZj&hl=en

If anyone knows how to post a PDF on this forum please let me know

Nice! I wonder what James CT would say about all those double blind placebo trials in there. Any of you more science minded folks have a take on them? Glad to see they're there but don't have time to look into them.

Here you go: Results with Naltrexone and Nalmefene: Clinical Trials and Reviews.

Very cool to see! I also don't have time to review in detail. But I do notice that many of these studies show success along with CBT.

I wonder if, by participating in this forum, we are doing some CBT on some level. By reporting in, we have an extra level of accountability. And, I notice that simply having to wait an hour after taking Nal is a deterrant. If alchohol pops into my mind later in the evening, I can quickly make it go away because I decide it isn't really worth taking the Nal and waiting an hour.

These studies and the experiences of people on this board are so promising. Unfortunately, I still don't think this would help my brother. He drinks about 20 units a day, but does not see this as a problem. I think (as my doctor said), TSM works for people who are highly motived to make a change, and are willing to stick to the golden rule ... always take Nal an hour before drinking.

I think we are. I went through David Burns' The Feeling Good Handbook about seven times back when I was clinically depressed, and after that much reiteration, CBT almost comes automatically. There are a lot of tools to work with; one is a cost/benefit analysis that tells you if something you're thinking is in your best interest, but I find it also works in situations like deciding whether or not to drive to the store for another six-pack. Of course, you have to do it early in a drinking session, because large quantities of alcohol effectively stifle even the most dedicated cognitive therapy disciple.

Really, it's just a way of looking at reality rather than the distorted thought patterns we're so prone to, and sometimes doing that can even help us need that next drink a little less. Just my .02.

W-O

Here are some additional citations referencing naltrexone

1: Kranzler HR, Tennen H, Armeli S, Chan G, Covault J, Arias A, Oncken C.
Targeted naltrexone for problem drinkers. J Clin Psychopharmacol. 2009
Aug;29(4):350-7.

Abstract
This study aimed to replicate and extend prior research showing that the targeted use of naltrexone is a useful strategy to reduce heavy drinking. We compared the effects of naltrexone with those of placebo in a sample of 163 individuals (58.3% male) whose goal was to reduce their drinking to safe limits. Patients received study medication (ie, naltrexone 50 mg or placebo) and were instructed to use it daily or targeted to situations identified by them as being high risk for heavy drinking. An interactive voice response system was used to obtain daily reports of drinking and medication use during the 12-week trial. Analyses were conducted using hierarchical linear modeling, with sex as a potential moderator variable. On the primary outcome measure, mean drinks per day, at week 12, men in the targeted naltrexone group drank significantly less than patients in the other groups did. On a secondary outcome measure, drinks per drinking day, during week 12, the targeted naltrexone group drank significantly less than the other groups did, with no moderating effect of sex. These results support the use of a targeted approach to reduce drinking among heavy drinkers, particularly men, but argue for the use of additional strategies or more efficacious medications than naltrexone to increase the effects of such an intervention.


And here is an interesting case report. The doctors here were treating this guy's internet porn addiction with naltrexone but as a side effect his binge drinking went away. The authors discuss the neurophysiology of addiction in great detail. Interesting stuff for any of you science geeks out there.

http://www.mayoclinicproceedings.com/content/83/2/226.full

Mayo Clin Proc. 2008 Feb;83(2):226-30.

Internet sex addiction treated with naltrexone.
Bostwick JM, Bucci JA.

Department of Psychiatry and Psychology, 200 First St SW, Rochester, MN 55905, USA. bostwick.john@mayo.edu

Abstract
Malfunctioning of the brain's reward center is increasingly understood to underlie all addictive behavior. Composed of mesolimbic incentive salience circuitry, the reward center governs all behavior in which motivation has a central role, including acquiring food, nurturing young, and having sex. To the detriment of normal functioning, basic survival activities can pale in importance when challenged by the allure of addictive substances or behaviors. Dopamine is the neurotransmitter driving both normal and addictive behavior. Other neurotransmitters modulate the amount of dopamine released in response to a stimulus, with the salience determined by the intensity of the dopamine pulse. Opiates (either endogenous or exogenous) exemplify such modulators. Prescribed for treating alcoholism, naltrexone blocks opiates' capacity to augment dopamine release. This article reviews naltrexone's mechanism of action in the reward center and describes a novel use for naltrexone in suppressing a euphorically compulsive and interpersonally devastating addiction to Internet pornography.

very interesting stuff! To me this looks like a series of legit studies, many of which are DBP studies at that. Where is that asshole JamesCT now that we have this info up? and I wonder what Bob would think of it? can e post it in general discussions too? I don't know how many people visit this section.

Interestingly, there is one thing that's missing from this list. It's a paper by Hannu Alho and co-workers, an active clinical addiction researcher and a co-author of David Sinclair on a number of papers (including the now famous 2001 paper in Journal of Clinical Psychopharmacology). Here it is:

http://alcalc.oxfordjournals.org/content/43/1/53.long

Alcohol and Alcoholism, 2008, 43(1):53-61.
A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence.
Laaksonen E, Koski-Jännes A, Salaspuro M, Ahtinen H, Alho H.

It's free access, so I am not pasting the abstract. Very briefly, the paper compares Antabuse, Naltrexone and Campral (acamprosate) in the continuous use paradigm and targeted medication (quasi-TSM) on a variety of criteria. In most respects, they find Antabuse to be way better than the other two. There is very little, if any, difference between NAL and Campral. The TSM-like use of these three drugs for weeks 13-52 produced apparent benefits for all three groups with no significant difference between any of them (with the exception of slightly more abstinent days for Antabuse, see Table 4). And here is how the authors cite the 2001 TSM study: "There is some evidence of the effect of targeted usage of NTX in preventing relapsing heavy drinking among alcoholics and heavy drinkers".

All in all, I find it very surprising that this work is not included in the list.

As Saint Vincent indicated and posted the abstract above, there is another paper on naltrexone that is omitted from the updated list:

http://www.ncbi.nlm.nih.gov/pubmed/19593174

Journal of Clinical Psychopharmacology. 2009 Aug;29(4):350-7. Targeted naltrexone for problem drinkers. Kranzler HR, Tennen H, Armeli S, Chan G, Covault J, Arias A, Oncken C.

I have now read it, so few notes: The study compared TSM and non-TSM, both placebo-controlled and attempted analysis of the results separately for men and women. The study lasted only 12 weeks, the patients were almost all of European descent and they were relatively lightly addicted (DSM-IV score only 3.6 and 5 US units drinks on average).

Overall results indicate a very modest effect of NAL. It was definitely better than placebo and targeted (i.e., TSM) NAL was better than daily but under the best of it “the targeted naltrexone group drank 19% less on drinking days than the other groups”. I feel that this number should be higher for men because this study shows that NAL has statistically significant effect for men but no effect or a very small one for women. (Do we have women on the “cured list”, by the way?). Quotes: “Women’s drinking was generally the same across study conditions”, “women treated with naltrexone showed no decrease in drinking over the course of the study”, “women treated with naltrexone showed no study week effect”.

Needless to say, none of it looks at all similar to the picture that Eskapa’s book paints. Although, I suppose, it is possible that Finnish alcoholics are genetically different from other Europeans and are more receptive to naltrexone/TSM.