A 50-year-old chronic alcohol user is motivated to stop. He has no liver disease. Which pharmacological agent for alcohol use disorder works by REDUCING alcohol CRAVING through mu-opioid receptor blockade?
- A Acamprosate
- B Disulfiram
- C Topiramate
- D Naltrexone ✓
Explanation
Naltrexone is a mu-opioid receptor antagonist. Alcohol releases endogenous opioids (beta-endorphins), which activate the reward circuit via mu-opioid receptors in the nucleus accumbens, contributing to the euphoric and reinforcing effects of alcohol. Naltrexone blocks mu-opioid receptors, reducing alcohol-induced dopamine release and pleasure/reward—thereby reducing craving and the rewarding effects of drinking. Acamprosate modulates NMDA glutamate receptors to reduce protracted withdrawal symptoms (anxiety, restlessness) and is preferred in abstinent patients. Disulfiram creates aversion. Topiramate (off-label) reduces glutamate/GABA imbalance.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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