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Randomized Controlled Trial
. 2012 Jun;20(3):181-90.
doi: 10.1037/a0027379. Epub 2012 Mar 19.

Understanding naltrexone mechanism of action and pharmacogenetics in Asian Americans via behavioral economics: a preliminary study

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Randomized Controlled Trial

Understanding naltrexone mechanism of action and pharmacogenetics in Asian Americans via behavioral economics: a preliminary study

Spencer Bujarski et al. Exp Clin Psychopharmacol. 2012 Jun.

Abstract

A behavioral economic approach to understanding the relative value of alcohol may be useful for advancing medication development for alcoholism. Naltrexone is a heavily researched and moderately effective treatment for alcohol dependence making it a good candidate for a proof-of-concept study of behavioral economics and alcoholism pharmacotherapy. This study examines naltrexone efficacy and pharmacogenetics in terms of the relative value of alcohol, assessed via demand curve analysis. Participants were 35 heavy drinking (AUDIT ≥8) Asian Americans. A within-subjects cross-over medication design was used along with an intravenous alcohol challenge completed after 4 days of both naltrexone and placebo. At baseline and BrAC = 0.06g/dl, participants completed an Alcohol Purchase Task, which assessed estimated alcohol consumption along escalating prices. Behavioral economic demand curve analysis yielded measures of intensity, elasticity, maximum expenditure (O(max)), proportionate price insensitivity (P(max)) and breakpoint. Compared to placebo, naltrexone significantly reduced intensity, O(max) and breakpoint. There were also trend-level medication effects on P(max). BrAC was associated with increases in P(max) and breakpoint. A significant naltrexone × OPRM1 genotype interaction was observed for intensity of demand. The present study extends the literature on naltrexone's mechanisms through the application of a novel behavioral economic paradigm. These results indicate that naltrexone reduces several indices of demand for alcohol. This preliminary report provides further evidence for the effectiveness of naltrexone and supports the utility of a behavioral economic approach to alcoholism pharmacotherapy development.

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Conflict of interest statement

Disclosure/Conflict of Interest

None of the authors have any conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Empirical alcohol demand curves for the two medication conditions and two BrAC conditions showing average self-reported consumption along rising price. Note that Intensity is not presented because zero price cannot be depicted on a logarithmic axis and the last two prices are not depicted because all responses were zeros.
Figure 2
Figure 2
Intensity of alcohol demand (i.e. consumption at zero cost) as a function of medication condition (Naltrexone vs. Placebo) and BrAC (0.00 vs. 0.06).
Figure 3
Figure 3
Pmax (i.e. proportionate price insensitivity) as a function of medication condition (Naltrexone vs. Placebo) and BrAC (0.00 vs. 0.06).
Figure 4
Figure 4
Breakpoint for alcohol (i.e. price at which estimated consumption equals zero) as a function of medication (Naltrexone vs. Placebo) and BrAC (0.00, vs. 0.06).

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