Both preclinical and clinical studies are critical in the development of effective pharmacotherapeutic approaches for treating
alcoholism. Nowhere has this been more evident than in the development of
naltrexone for treating alcohol relapse. As studies continue on the use of
naltrexone for modifying alcohol intake, promising avenues for continued work on maximizing the efficacy of
naltrexone for treating
alcohol abuse and
alcoholism are emerging. Recent research suggests that
naltrexone can influence key components of
alcohol dependence, including loss of control over the decision to drink and the amount of alcohol consumed. Although not uniformly positive, the majority of clinical trials supports the hypothesis that
naltrexone can reduce the urge to drink, increase the number of days abstinent, and minimize the risk of relapse to heavy drinking. Human laboratory and preclinical paradigms that have investigated how
naltrexone alters patterns of drinking suggest that
naltrexone treatment results in earlier cessation of drinking within a session. In addition, preclinical data suggest that the amount of alcohol consumed declines during subsequent sessions in the presence of
naltrexone. Based on this analysis, future clinical trials should consider using analytic approaches that evaluate patterns of drinking (e.g., multiple event analysis) rather than single events (e.g., survival analysis). Furthermore, behavioral interventions and instructions can also be developed to take advantage of this effect. Additional preclinical and clinical work is warranted to identify dosing strategies that ensure adequate
drug levels while reducing the possibility of developing tolerance to
naltrexone. Finally, studies designed to identify the characteristics of drinking populations that are responsive to
naltrexone and studies investigating the potential advantage of combining
naltrexone with agents that alter a number of
neurotransmitter systems are exciting new avenues of research. Ultimately, these lines for research promise to provide critical information that can be used to maximize the efficacy of
naltrexone for treating
alcoholism.