title: Opioid modulators for alcohol dependence.
abstract: BACKGROUND
  Studies have shown that opioid antagonists like naltrexone are efficient in reducing heavy drinking. The neurobiological mechanism by which opioid modulators affect drinking behavior is based on the strong connection between the endogenous opioid system, the dopamine system and the influence of the CNS stress response.
  
  
  METHODS
  This review provides an overview of the pathophysiological role of the opioid system in alcohol dependence and the neurobiological mechanisms of possible pharmacological interventions. An extensive Medline and Internet research was performed to retrieve information on existing and currently investigated opioid modulators. The findings were assessed critically and interpreted with regard to an individualized therapy for alcohol dependence.
  
  
  CONCLUSIONS
  The opioid system is of crucial importance in the genesis and maintenance of alcohol dependence. Naltrexone- and to a lesser extent nalmefene- is an agent that modulates opioidergic transmission in the CNS and it shows a limited but well-studied efficacy in treating alcohol dependence. Several agents (LY2196044, ALKS-29, ALKS-33) that are currently undergoing Phase II and Phase III studies are of interest but first their efficacy must be proved in clinical practice.
authors.affiliation: Hannover Medical School, Center for Addiction Research (CARe) , Department for Psychiatry , Socialpsychiatry and Psychotherapy, Carl-Neuberg-Str. Germany. hillemacher.thomas@mh-hannover.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Hillemacher
authors.forename: Annemarie
authors.initials: A
authors.lastname: Heberlein
authors.forename: Marc An
authors.initials: MA
authors.lastname: Muschler
authors.forename: Stefan
authors.initials: S
authors.lastname: Bleich
authors.forename: Helge
authors.initials: H
authors.lastname: Frieling
mesh_terms: D000437:Alcoholism / Q000188:drug therapy* / Q000503:physiopathology; D000818:Animals; D002986:Clinical Trials as Topic; D006801:Humans; D009271:Naltrexone / Q000494:pharmacology* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000494:pharmacology* / Q000627:therapeutic use*
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone