Commentary |

Prospects for a Genomic Approach to the Treatment of Alcoholism

Charles P. O’Brien, MD, PhD
Arch Gen Psychiatry. 2008;65(2):132-133. doi:10.1001/archgenpsychiatry.2007.32.
Text Size: A A A
Published online


The article in this issue of the Archives by Anton et al1 is the latest chapter in the story of a treatment translated from animal models to successful clinical trials that, now with genomic evidence, may refine patient selection and improve outcome. A seminal alcoholism discovery was that alcohol significantly activates the endogenous opioid system in some but not all animal and human subjects, so that part of the reward from alcohol ingestion is mediated via opioid peptides. The evidence for this is that pharmacological blockade of opioid receptors reduces alcohol drinking in a dose-related fashion and blocks the increase in dopamine in the ventral striatum associated with alcohol ingestion. Altshuler et al2 reported the dose-related effect of naltrexone on decreasing ethanol drinking in 10 of 21 rhesus monkeys that were willing to self-administer alcohol. This report led to dose-ranging studies in persons with alcoholism beginning in 1983 and then a controlled clinical trial.3,4 Naltrexone was found to reduce alcohol cravings and relapses to heavy drinking, but it did not necessarily produce total abstinence. The finding of an association between alcohol and opiates was met with skepticism (and a rejection of the report by the Archives) in the 1980s, but the treatment results were perfectly replicated by O’Malley et al5 in 1992. In an unusual scenario, study of naltrexone received Food and Drug Administration approval on the basis that 2 academic studies had financial support from the Veterans Administration and later the National Institute on Alcohol Abuse and Alcoholism rather than from the pharmaceutical industry.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles

Users' Guides to the Medical Literature
Alcohol Abuse or Dependence

The Rational Clinical Examination
Make the Diagnosis: Alcohol Abuse