Cambridge and London hospitals to pioneer brain implants to combat alcohol and opioid addiction

“If you don’t like taking Sober living home pills, you already take too many pills, or you aren’t good at remembering to take pills, then this would be a tricky one,” he says.

Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial

The FDA has historically favored abstinence as the endpoint in trials to develop medications for substance use disorders. Abstinence has been evaluated using absence of positive urine drug tests, absence of self-reported drug use, and regularly attending sessions where drug use is assessed. But abstinence is a high bar comparable to requiring that an antidepressant produce complete remission of depression or that an analgesic completely eliminate pain.

• A significant reduction in levels of distress, depression and craving with improved HRQL occurred for both arms, whereas self-efficacy and social support remained unchanged in both groups.
• Excessive activity of the neurotransmitter norepinephrine has been implicated in some symptoms of withdrawal, and medications that inhibit norepinephrine may help alleviate withdrawal (Litten et al. 1996).
• It uses medications that do not produce the euphoric effects of alcohol, helping manage withdrawal symptoms and cravings without creating new dependencies.

Moderation and Medication-Assisted Harm Reduction

If these studies confirm positive outcomes, GLP-1 receptor agonists will represent a groundbreaking new pharmacological approach to treating AUD. But they could be game changing when it comes to treating the complex disease of addiction. While Dr. Sarhan says it’s crucial to use these medications as part of a more comprehensive treatment plan, he says that he’s seen “pretty remarkable turnarounds, both in terms of craving and long-term abstinence.”

• A recent study found that naltrexone significantly reduces binge drinking among men with mild to moderate alcohol use disorder.
• In another study, long term treatment with a low dose of prazosin or duloxetine significantly decreased ethanol self-administration in adult male Long-Evans rats.
• Duloxetine, sold under the brand name Cymbalta (Drugs.com, 2016), a selective serotonin and norepinephrine re-uptake inhibitor (SNRI), is mostly prescribed for major depression and generalized anxiety disorder, fibromyalgia and neuropathic pain (Duloxetine Monograph, ASHSP, 2015).

Cambridge and London hospitals to pioneer brain implants to combat alcohol and opioid addiction

The prescribing healthcare professional can answer questions and provide guidance about the use of acamprosate for alcohol use disorder. For patients struggling with alcohol who already have liver damage and haven’t had much luck with acamprosate (the FDA approved AUD medication that is also broken down by the kidneys), baclofen can be a great choice. In addition to the FDA approved medications, there are many other medications available. These agents include Fluoxetine, Duloxetine, Tiagabine, Levitriacetam, Gabapentin, Pregabalin, Sertraline, Citalopram, Ritanserin, Aripiprazole, Ondansetron, Quetiapine, Nalmefene and Topiramate. Many supporting reports are available for the potential usage of these medications in the treatment of AUDs, although they are not approved by the FDA yet.

• “And primary care doctors tend to shy away from these meds because they weren’t trained to use them in med school.”
• Research suggests that ondansetron may be especially effective for those with certain genetic predispositions to alcohol overuse that are related to serotonin signaling.
• Quetiapine (8 & 16mg/kg, i.p) risperidone (1 & 2mg/kg, i.p) and ziprasidone (0.5 & 1mg/kg, i.p) were given and measured ethanol withdrawal symptoms after 1, 2, 4 and 6 hrs.
• The fiber-rich, complex carbohydrates in whole-grain breads and foods like brown rice, quinoa, barley, and farro are digested more slowly, which help keep blood sugar levels steady.
• Initially studied for diabetes management and obesity, GLP-1 receptor agonists (GLP-1RAs) have garnered interest for their potential in addressing substance use disorders.

Topiramate

Programs like Moderation Management and the Sinclair Method (which uses targeted naltrexone dosing) offer structured ways to reduce drinking without requiring total abstinence. This approach can be particularly appealing to patients who are resistant to traditional treatment or who do not meet criteria for severe AUD. Ghrelin, the orexigenic peptide, is an appetite-regulating peptide hormone released from the gut. Ghrelin controls the homeostatic system balancing energy expenditure and appetite in the hypothalamus. It is mainly synthesized and secreted by the entero-endocrine cells of the stomach and intestine as a precursor protein, preproghrelin (Tschop et al., 2000).

A higher dosage of ondansetron (16 μg/kg twice a day) combined with cognitive behavior therapy decreased depression, anxiety, and hostility (Johnson et al., 2003). In another randomized trial, men taking ondansetron (8 mg twice per day) had fewer heavy drinking days compared with those taking placebo, although they did not have increased abstinence rates. The combination of ondansetron (4 μg/kg twice a day) and naltrexone (25 mg twice a day) may be effective in treating early AUD (Correa-Filho et al., 2013). Han et al, reported that the combination of Escitalopram (a selective SSRI) with ARI improved depressive symptoms and reduced craving for alcohol and cue-induced brain activity in patients with co-morbid alcohol dependence and major depressive disorder (MDD). Thirty five subjects with co-morbid alcohol dependence and MDD were recruited in this study and divided into two groups. One received AR I+ escitalopram (ARI 5–15mg + reduce alcohol craving escitalopram 10–20mg/day for 6 weeks) and other escitalopram alone.