By the end of the 12-week study, those given naltrexone reported bingeing less frequently and consuming less alcohol than those who had been given a placebo, a change that lasted for up to six months. The most commonly reported side effect of naltrexone was nausea, although it was generally mild and resolved itself as people adjusted to taking the drug.
Glenn-Milo Santos, a professor at the University of California, San Francisco and the study’s lead author, said patients could discuss the treatment option with their clinicians, even if it was not suitable for all. “Increasing awareness that there are effective medicines that can help people with their alcohol use is important in and of itself,” he said.
Taking naltrexone on an as-needed basis rather than as a daily dose may be more tolerable for some people because it allows their dopamine levels to recover in between uses. The approach could also let people feel more in control of their treatment. The practice is more widely embraced in Europe, where regulators in 2013 approved the medication nalmefene for similarly targeted dosing by people trying to drink less alcohol.
Dr. Lorenzo Leggio, a physician-scientist at the National Institutes of Health, said the latest study was “very important” because, while alcohol treatments had traditionally been designed for people with severe addictions, far more people, like the study’s participants, had mild or moderate alcohol disorders.
Last year, N.I.H. officials proposed rebranding these stages as “preaddiction” to underscore the need for early intervention, much as the diabetes field improved care by identifying and treating prediabetes.
“If we attack the medical problem right away and early on, you cannot only treat the problem but prevent the development of the more severe forms of the disease,” Dr. Leggio said.
The recent study enrolled exclusively gay and transgender men, groups in which there is a higher prevalence of binge-drinking, so the findings might not be applicable to all binge drinkers. The participants were recruited “via street outreach, recruitment fliers, sexual health clinics, needle exchanges, community organizations, bars, websites and social media,” according to the study, and additional participants in an unrelated study were also invited to join. Nearly everyone involved in the study reported having some college education and a regular health care provider.
