title: Opioid antagonists in broadly defined behavioral addictions: a narrative review.
abstract: BACKGROUND
  Naltrexone (NTX), a mu-opioid receptor antagonist, has been approved for the treatment of alcoholism and opioid dependence. More recently, however, NTX and a related drug, nalmefene (NMF), have also shown positive results for the treatment of gambling disorders.
  
  
  METHODS
  In this study, we reviewed the trials testing the effect of opioid antagonists (OA) in gambling disorders and in other broadly defined behavioral addictions, including selected DSM-5 disruptive, impulse-control, and conduct disorders, obsessive-compulsive and related disorders, eating disorders, and other conditions not currently recognized by official classification schemes. We found six randomized controlled trials (RCTs) of OA in gambling disorder, two RCTs of OA in trichotillomania (hair pulling disorder), two RCTs of OA in binge eating disorder, and one RCT of OA for kleptomania. We also reviewed case reports on hypersexual disorder, compulsive buying and skin picking disorders.
  
  
  CONCLUSIONS
  The reviewed data supported the use of OA, namely NTX and NMF, in gambling disorder (both) and kleptomania (NTX). We did not find enough evidence to support the use of NTX or NMF in trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, compulsive buying disorder, hypersexual disorder, or binge eating disorder.
authors.affiliation: a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Piquet-Pessôa
authors.affiliation: a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil.|b D'Or Institute for Research and Education (IDOR) , Rio de Janeiro , Brasil.|c Monash Institute of Cognitive and Clinical Neurosciences (MICCN), School of Psychological Sciences & Monash Biomedical Imaging (MBI) Facility , Monash University , Victoria , Australia.
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
mesh_terms: D000437:Alcoholism / Q000188:drug therapy*; D002032:Bulimia / Q000188:drug therapy*; D003192:Compulsive Behavior / Q000188:drug therapy*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy*; D005715:Gambling / Q000188:drug therapy; D006801:Humans; D009271:Naltrexone / Q000031:analogs & derivatives / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014256:Trichotillomania / Q000188:drug therapy
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone; C038981:nalmefene
keywords: Behavioral addictions; nalmefene; naltrexone; opioid antagonists