The Effectiveness of Naltrexone for Alcohol Use Disorder May Be Limited to Those Who Also Use Nicotine

Naltrexone has been shown to be an effective treatment for alcohol use disorder, but it is not effective for everyone and there may be other factors that account for some of the variation in response. There has been interest in genetic polymorphisms, particularly polymorphisms of the mu opioid receptor gene, OPRM1. Moreover, observational data suggest that people who use nicotine may benefit more from naltrexone. In this study, researchers conducted a secondary analysis of data from a study evaluating the differential effect of naltrexone by OPRM1 polymorphisms to investigate the role of nicotine use on treatment response. Participants (N=146; 88 with nicotine use) who met criteria for DSM-IV alcohol dependence were stratified by polymorphisms and randomly assigned to naltrexone or placebo and followed for 16 weeks.

• Participants who used nicotine had more drinks per day and drinks per drinking day at baseline, compared with those who did not.
• The primary outcome measure, percentage of heavy drinking days, was significantly reduced in the naltrexone group among participants who used nicotine, but not among those who did not.
• Other alcohol consumption variables similarly showed a beneficial effect of naltrexone limited to participants with nicotine use.

Comments: This study suggests that nicotine use might be a factor to consider when choosing pharmacotherapy for alcohol use disorder. The reason for this is not clear; the authors hypothesize that the dopamine release caused by nicotine may make these individuals more sensitive to naltrexone’s effect.

Darius A. Rastegar, MD

Reference: Anton RF, Latham PK, Voronin KE, et al. Nicotine use/smoking is associated with the efficacy of naltrexone in the treatment of alcohol dependence. Alcohol Clin Exp Res. 2018;42(4):751–760.