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Pharmacological Options for Smoking Cessation in Heavy-Drinking Smokers

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Abstract

There is a high prevalence of comorbid tobacco use and alcohol use disorder (AUD), affecting more than 6 million people in the US. Globally, tobacco and alcohol use rank fourth and fifth, respectively, for disability-adjusted life-years lost. Levels of alcohol use are higher in smokers than nonsmokers, and the prevalence of smoking is higher in heavy drinkers compared with nondrinkers. This relationship is driven by many different factors, including genetics, neurobiological mechanisms, conditioning processes, and psychosocial influences. Although this unique population tends to experience more negative health consequences, more severe AUD, and poorer response to treatment than those with either AUD or tobacco use disorder alone, there are currently no available treatment protocols tailored to this comorbid condition. In this review, we provide a comprehensive review of ongoing clinical research into smoking cessation options for heavy-drinking smokers (HDS) through an evaluation of the effect of promising novel pharmacotherapies as well as combination therapies, including varenicline, naltrexone, the combination of varenicline and naltrexone, and the combination of naltrexone and nicotine replacement therapy (NRT). These treatments are considered in light of the standard of care for smoking cessation, and seek to improve upon the available guidelines for this sizeable subgroup of smokers, namely those smokers who drink heavily.

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References

  1. Anthony JC, Echeagaray-Wagner F. Epidemiologic analysis of alcohol and tobacco use. Alcohol Res Health. 2000;24(4):201–8.

    CAS  PubMed  Google Scholar 

  2. Dani JA, Harris RA. Nicotine addiction and comorbidity with alcohol abuse and mental illness. Nat Neurosci. 2005;8(11):1465–70.

    Article  CAS  PubMed  Google Scholar 

  3. US Department of Health and Human Services; National Institutes of Health; National Institute on Alcohol Abuse and Alcoholism. Alcohol and tobacco. Alcohol Alert. 2007;71:1–16. http://pubs.niaaa.nih.gov/publications/AA71/AA71.pdf.

  4. Sussman S, Lisha N, Griffiths M. Prevalence of the addictions: a problem of the majority or the minority? Eval Health Prof. 2011;34(1):3–56.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Schorling JB, Gutgesell M, Klas P, Smith D, Keller A. Tobacco, alcohol and other drug use among college students. J Subst Abuse. 1994;6:105–15.

    Article  CAS  PubMed  Google Scholar 

  6. Craig TJ, Van Natta PA. The association of smoking and drinking habits in a community sample. J Stud Alcohol. 1977;38(7):1434–9.

    Article  CAS  PubMed  Google Scholar 

  7. Dawson DA. Drinking as a risk factor for sustained smoking. Drug Alcohol Depend. 2000;59(3):235–49.

    Article  CAS  PubMed  Google Scholar 

  8. Marks JL, Hill EM, Pomerleau CS, Mudd SA, Blow FC. Nicotine dependence and withdrawal in alcohol and nonalcoholic ever-smokers. J Subst Abuse Treat. 1997;14(6):521–7.

    Article  CAS  PubMed  Google Scholar 

  9. Ockene JK, Adams A. Screening and intervention for smoking and alcohol use in primary care settings: similarities, differences, gaps, and challenges. In: Fertig JB, Allen JP, editors. Alcohol and tobacco: from basic science to clinical practice. Bethesda, MD: National Institutes of Health; 1995.

    Google Scholar 

  10. Toll BA, Cummings KM, O’Malley SS, Carlin-Menter S, McKee SA, Hyland A, et al. Tobacco quitlines need to assess and intervene with callers’ hazardous drinking. Alcohol Clin Exp Res. 2012;36(9):1635–8.

    Article  Google Scholar 

  11. Hymowitz N, Cummings K, Hyland A, Lynn W, Pechacek T, Hartwell T. Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control. 1997;6(Suppl 2):S57–62.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Kahler CW, Spillane NS, Metrik J. Alcohol use and initial smoking lapses among heavy drinkers in smoking cessation treatment. Nicotine Tob Res. 2010;12(7):781–5.

    Article  PubMed Central  PubMed  Google Scholar 

  13. National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined Available at: http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking. Accessed 10 May 2015.

  14. Durazzo TC, Cardenas VA, Studholme C, Weiner MW, Meyerhoff DJ. Non-treatment-seeking heavy drinkers: effects of chronic cigarette smoking on brain structure. Drug Alcohol Depend. 2007;87(1):76–82.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Ebbert JO, Janney CA, Sellers TA, Folsom AR, Cerhan JR. The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history. J Gen Intern Med. 2005;20(1):14–20.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Daeppen JB, Smith TL, Danko GP, Gordon L, Landi NA, Nurnberger JI Jr, et al. Clinical correlates of cigarette smoking and nicotine dependence in alcohol-dependent men and women. Alcohol Alcohol. 2000;35(2):171–5.

    Article  CAS  PubMed  Google Scholar 

  17. Fucito LM, Park A, Gulliver SB, Mattson ME, Gueorguieva RV, O’Malley SS. Cigarette smoking predicts differential benefit from naltrexone for alcohol dependence. Biol Psychiat. 2012;72(10):832–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Littleton J, Barron S, Prendergast M, Nixon SJ. Smoking kills (alcoholics)! shouldn’t we do something about it? Alcohol Alcohol. 2007;42(3):167–73.

    Article  CAS  PubMed  Google Scholar 

  19. Drobes DJ. Concurrent alcohol and tobacco dependence. Available at: http://pubs.niaaa.nih.gov/publications/arh26-2/136-142.htm: National Institute on Alcohol Abuse and Alcoholism; 2002. Accessed 14 Apr 2015.

  20. Prescott CA, Kendler KS. Genetic and environmental influences on alcohol and tobacco dependence among women. In: Fertig JB, Allen JP, editors. Alcohol and tobacco: from basic science to clinical practice. Washington, DC: Government Printing Office; 1995. p. 59–87.

    Google Scholar 

  21. Bierut LJ, Dinwiddie SH, Begleiter H, Crowe RR, Hesselbrock V, Nurnberger JI Jr, et al. Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking. Arch Gen Psychiatry. 1998;55:982–8.

    Article  CAS  PubMed  Google Scholar 

  22. Bierut LJ, Rice JP, Goate A, Hinrichs AL, Saccone NL, Foroud T, et al. A genomic scan for habitual smoking in families of alcoholics: common and specific genetic factors in substance dependence. Am J Med Gen. 2004;124A:19–27.

    Article  Google Scholar 

  23. True WR, Xian H, Scherrer JF, Madden PAF, Bucholz KK, Heath AC, et al. Common genetic vulnerability for nicotine and alcohol dependence in men. Arch Gen Psychiatry. 1999;56:655–61.

    Article  CAS  PubMed  Google Scholar 

  24. Kendler KS, Myers KE, Prescott CA. Specificity of genetic and environmental risk factors for symptoms of cannabis, cocaine, alcohol, caffeine, and nicotine dependence. Arch Gen Psychiatry. 2007;64(11):1313–20.

    Article  PubMed  Google Scholar 

  25. Doyon WM, Thomas AM, Ostroumov A, Dong Y, Dani JA. Potential substrates for nicotine and alcohol interactions: a focus on the mesocorticolimbic dopamine system. Biochem Pharmacol. 2013;86(8):1181–93.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Pomerleau OF. Neurobiological interactions of alcohol and nicotine. In: Fertig JB, Allen HM, editors. Alcohol and tobacco: from basic science to clinical practice. Washington, DC: Government Printing Office; 1995. p. 145–58.

    Google Scholar 

  27. Burch JB, de Fiebre CM, Marks MJ, Collins AC. Chronic ethanol or nicotine treatment results in partial cross-tolerance between these agents. Psychopharmacology. 1988;95:452–8.

    Article  CAS  PubMed  Google Scholar 

  28. Weerts EM, Wand GS, Kuwabara H, Xu X, Frost JJ, Wong DF, et al. Association of smoking with mu-opioid receptor availability before and during naltrexone blockade in alcohol-dependent subjects. Addict Biol. 2012;19:733–42.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  29. Penland S, Hoplight B, Obernier J, Crews FT. Effects of nicotine on ethanol dependence and brain damage. Alcohol. 2001;24(1):45–54.

    Article  CAS  PubMed  Google Scholar 

  30. Tizabi Y, Al-Namaeh M, Manaye KF, Taylor RE. Protective effects of nicotine on ethanol-induced toxicity in culured cerebellar granule cells. Neurotox Res. 2003;5(5):315–22.

    Article  PubMed  Google Scholar 

  31. Luhar RB, Sawyer KS, Gravitz Z, Ruiz SM, Oscar-Berman M. Brain volumes and neuropsychological performance are related to current smoking and alcoholism history. Neuropsychiat Dis Treat. 2013;9:1767–84.

    Article  Google Scholar 

  32. Pennington DL, Durazzo TC, Schmidt TP, Mon A, Abe C, Meyerhoff DJ. The effects of chronic cigarette smoking on cognitive recovery during early abstinence from alcohol. Alcohol Clin Exp Res. 2013;37(7):1220–7.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Leigh G, Tong JE. Effects of ethanol and tobacco on time judgment. Percept Mot Skills. 1976;43:899–903.

    Article  CAS  PubMed  Google Scholar 

  34. Dar MS, Li C, Bowman ER. Central behavioral interaction between ethanol, (−)-nicotine, and (−)-continine in mice. Brain Res Bull. 1993;32:22–8.

    Article  Google Scholar 

  35. Ceballos NA. Tobacco use, alcohol dependence, and cognitive performance. J Gen Psychol. 2006;133(4):375–88.

    Article  PubMed  Google Scholar 

  36. Hurley LL, Taylor RE, Tizabi Y. Positive and negative effects of alcohol and nicotine and their interactions: a mechanistic review. Neurotox Res. 2012;21(1):57–69.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Perkins KA, Sexton JE, DiMarco A, Grobe JE, Scierka A, Stiller RL. Subjective and cardiovascular responses to nicotine combined with alcohol in male and female smokers. Psychopharmacology. 1995;119:205–12.

    Article  CAS  PubMed  Google Scholar 

  38. Rose JE, Brauer LH, Behm FM, Cramblett M, Calkins K, Lawhon D. Psychopharmacological interactions between nicotine and ethanol. Nicotine Tob Res. 2004;6(1):133–44.

    Article  CAS  PubMed  Google Scholar 

  39. Piasecki TM, Jahng S, Wood PK, Robertson BM, Epler AJ, Cronk NJ, et al. The subjective effects of alcohol-tobacco co-use: an ecological momentary assessment investigation. J Abnorm Psychol. 2011;120(3):557–71.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Tizabi Y, Bai L, Copeland RL Jr, Taylor RE. Combined effects of systemic alcohol and nicotine on dopamine release in the nucleus accumbens shell. Alcohol Alcohol. 2007;42(5):413–6.

    Article  CAS  PubMed  Google Scholar 

  41. Acheson A, Mahler SV, Chi H, de Wit H. Differential effects of nicotine on alcohol consumption in men and women. Psychopharmacology. 2006;186:54–63.

    Article  CAS  PubMed  Google Scholar 

  42. Carter BL, Tiffany ST. Meta-analysis of cue-reactivity in addiction research. Addiction. 1999;94(3):327–40.

    Article  CAS  PubMed  Google Scholar 

  43. Gulliver SB, Rohsenow DJ, Colby SM, Dey AC, Abrams DB, Niaura RS, et al. Interrelationship of smoking and alcohol dependence, use and urges to use. J Stud Alcohol. 1995;56:202–6.

    Article  CAS  PubMed  Google Scholar 

  44. King A, McNamara P, Conrad M, Cao D. Alcohol-induced increases in smoking behavior for nicotinized and denicotinized cigarettes in men and women. Psychopharmacology. 2009;207(1):107–17.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Funk D, Marinelli M, Le AD. Biological processes underlying co-use of alcohol and nicotine: neuronal mechanisms, cross-tolerance, and genetic factors. Alcohol Res Health. 2006;29(3):186–92.

    PubMed  Google Scholar 

  46. Flay BR, Petraitis J, Hu FB. Theory of triadic influence: preliminary evidence related to alcohol and tobacco use. In: Fertig JB, Allen JP, editors. Alcohol and tobacco: from basic science to clinical practice. Washington, DC: Government Printing Office; 1995. p. 37–57.

    Google Scholar 

  47. Fiore MC, Baker TB. Treating smokers in the health care setting. N Engl J Med. 2011;365(13):1222–31.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Rockville (MD): US Department of Health and Human Services; 2008.

    Google Scholar 

  49. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;(5):CD009329.

  50. Kornitzer M, Boutsen M, Dramaix M, Thijs J, Gustavsson G. Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. Prev Med. 1995;24(1):41–7.

    Article  CAS  PubMed  Google Scholar 

  51. Warner C, Shoaib M. How does bupropion work as a smoking cessation aid? Addict Biol. 2005;10:219–31.

    Article  CAS  PubMed  Google Scholar 

  52. Kotlyar M, Golding M, Hatsukami DK, Jamerson BD. Effect of nonnicotine pharmacotherapy on smoking behavior. Pharmacotherapy. 2001;21(12):1530–48.

    Article  CAS  PubMed  Google Scholar 

  53. George TP, Vessicchio JC, Sacco KA, Weinberger AH, Dudas MM, Allen TM, et al. A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia. Biol Psychiat. 2008;63(11):1092–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  54. Piper ME, Federman EB, McCarthy DE, Bolt DM, Smith SS, Fiore MC, et al. Efficacy of bupropion alone and in combination with nicotine gum. Nicotine Tob Res. 2007;9(9):947–54.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  55. Jorenby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999;340(9):685–91.

    Article  CAS  PubMed  Google Scholar 

  56. Kalman D, Herz L, Monti P, Kahler CW, Mooney M, Rodrigues S, et al. Incremental efficacy of adding bupropion to the nicotine patch for smoking cessation in smokers with a recent history of alcohol dependence: results from a randomized, double-blind, placebo-controlled study. Drug Alcohol Depend. 2011;118(2–3):111–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  57. Stapleton J, West R, Hajek P, Wheeler J, Vangeli E, Abdi Z, et al. Randomized trial of nicotine replacement therapy (NRT), bupropion and NRT plus bupropion for smoking cessation: effectiveness in clinical practice. Addiction. 2013;108(12):2193–201.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Foulds J. The neurobiological basis for partial agonist treatment of nicotine dependence: varenicline. Int J Clin Prac. 2006;60(5):571–6.

    Article  CAS  Google Scholar 

  59. Chatterjee S, Steensland P, Simms JA, Holgate J, Coe JW, Hurst RS, et al. Partial agonists of the α3β4* neuronal nicotinic acetylcholine receptor reduce ethanol consumption and seeking in rats. Neuropsychopharmacol. 2011;36(3):603–15.

    Article  CAS  Google Scholar 

  60. Bordia T, Hrachova M, Chin M, McIntosh JM, Quik M. Varenicline is a potent partial agonist at α6β2* nicotinic acetylcholine receptors in rat and monkey striatum. J Pharmacol Exp Ther. 2012;342(2):327–34.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Mihalak KB, Carroll FI, Luetje CW. Varenicline is a partial agonist at α4β2 and a full agonist at α7 neuronal nicotinic receptors. Mol Pharmacol. 2006;70(3):801–5.

    Article  CAS  PubMed  Google Scholar 

  62. Elrashi MY, Ebbert JO. Emerging drugs for the treatment of tobacco dependence: 2014 update. Expert Opin Emerg Drugs. 2014;19(2):243–60.

    Article  CAS  Google Scholar 

  63. Ahijevych K. Review: all forms of nicotine replacement therapy are effective for smoking cessation. Evid Based Nurs. 2005;8(1):13.

    Article  PubMed  Google Scholar 

  64. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006;296(1):47–55.

    Article  CAS  PubMed  Google Scholar 

  65. Mills EJ, Wu P, Lockhart I, Thorlund K, Puhan M, Ebbert JO. Comparisons of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: a systematic review and multiple treatment meta-analysis. Ann Med. 2012;44(6):588–97.

    Article  CAS  PubMed  Google Scholar 

  66. Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006;296(1):56–63.

    Article  CAS  PubMed  Google Scholar 

  67. Nides M, Oncken C, Gonzales D, Rennard S, Watsky EJ, Anziano R, et al. Smoking cessation with varenicline, a selective alpha4beta2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up. Arch Intern Med. 2006;166(15):1561–8.

    Article  PubMed  Google Scholar 

  68. Oncken C, Gonzales D, Nides M, Rennard S, Watsky E, Billing CB, et al. Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation. Arch Intern Med. 2006;166(15):1571–7.

    Article  CAS  PubMed  Google Scholar 

  69. Williams KE, Reeves KR, Billing CBJ, Pennington AM, Gong J. A double-blind study evaluating the long-term safety of varenicline for smoking cessation. Curr Med Res Opin. 2007;23(4):793–801.

    Article  CAS  PubMed  Google Scholar 

  70. Chang PH, Chiang CH, Ho WC, Wu PZ, Tsai JS, Guo FR. Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: a systematic review and meta-analysis of randomized controlled trials. BMC Public Health. 2015;15:689.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2011;(2):CD006103.

  72. Roberts NJ, Kerr SM, Smith SMS. Behavioral interventions associated with smoking cessation in the treatment of tobacco use. Health Serv Insights. 2013;6:79–85.

    PubMed Central  PubMed  Google Scholar 

  73. Steensland P, Simms JA, Holgate J, Richards JK, Bartlett SE. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, selectively decreases ethanol consumption and seeking. Proc Natl Acad Sci USA. 2007;104(30):12518–23.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  74. Fucito LM, Toll BA, Wu R, Romano DM, Tek E, O’Malley SS. A preliminary investigation of varenicline for heavy drinking smokers. Psychopharmacology (Berl). 2011;215(4):655–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  75. Mitchell JM, Teague CH, Kayser AS, Bartlett SE, Fields HL. Varenicline decreases alcohol consumption in heavy-drinking smokers. Psychopharmacology. 2012;223(3):299–306.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  76. McKee SA, Harrison EL, O’Malley SS, Krishnan-Sarin S, Shi J, Tetrault JM, et al. Varenicline reduces alcohol self-administration in heavy-drinking smokers. Biol Psychiat. 2009;66(2):185–90.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  77. Soderpalm B, Ericson M, Olausson P, Blomqvist O, Engel JA. Nicotinic mechanisms involved in the dopamine activating and reinforcing properties of ethanol. Behav Brain Res. 2000;113(1–2):85–96.

    Article  CAS  PubMed  Google Scholar 

  78. Blomqvist O, Ericson M, Engel JA, Soderpalm B. Accumbal dopamine overflow after ethanol: localization of the antagonizing effect of mecamylamine. Eur J Pharmacol. 1997;334(2–3):149–56.

    Article  CAS  PubMed  Google Scholar 

  79. Blomqvist O, Ericson M, Johnson DH, Engel JA, Soderpalm B. Voluntary ethanol intake in the rat: effects of nicotinic acetylcholine receptor blockade or subchronic nicotine treatment. Eur J Pharmacol. 1996;314(3):257–67.

    Article  CAS  PubMed  Google Scholar 

  80. Bito-Onon J, Simms JA, Chatterjee S, Holgate J, Bartlett SE. Varenicline, a partial agonist at neuronal nicotinic acetylcholine receptors, reduces nicotine-induced increases in 20 % ethanol operant self-administration in Sprague-Dawley rats. Addict Biol. 2011;16(3):440–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  81. Childs E, Roche DJ, King AC, de Wit H. Varenicline potentiates alcohol-induced negative subjective responses and offsets impaired eye movements. Alcohol Clin Exp Res. 2012;36(5):906–14.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  82. Hartmann-Boyce J, Stead LF, Cahill K, Lancaster T. Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews. Addiction. 2013;108(10):1711–21.

    Article  PubMed  Google Scholar 

  83. Thomas KH, Martin RM, Knipe DW, Higgens JPT, Gunnell D. Risk of neuropsychiatric adverse events associated with varenicline: systematic review and meta-analysis. BMJ. 2015;350(h1109):1–11.

    Google Scholar 

  84. Cassels C. Chantix may lower alcohol tolerance, up seizure risk: FDA. Medscape; 2015. Available at: http://www.medscape.com/viewarticle/841147. Accessed 21 Apr 2015.

  85. Volpicelli JR, Alterman AI, Hayashida M, O’Brien CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. 1992;49(11):876–80.

    Article  CAS  PubMed  Google Scholar 

  86. O’Malley SS, Jaffe AJ, Chang G, Schottenfeld RS, Meyer RE, Rounsaville B. Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch Gen Psychiatry. 1992;49(11):881–7.

    Article  PubMed  Google Scholar 

  87. Litten RZ, Allen J, Fertig J. Pharmacotherapies for alcohol problems: a review of research with focus on developments since 1991. Alcohol Clin Exp Res. 1996;20(5):859–76.

    Article  CAS  PubMed  Google Scholar 

  88. Morris PL, Hopwood M, Whelan G, Gardiner J, Drummond E. Naltrexone for alcohol dependence: a randomized controlled trial. Addiction. 2001;96(11):1565–73.

    Article  CAS  PubMed  Google Scholar 

  89. Monti PM, Rohsenow DJ, Swift RM, Gulliver SB, Colby SM, Mueller TI, et al. Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1-year outcomes. Alcohol Clin Exp Res. 2001;25(11):1634–47.

    Article  CAS  PubMed  Google Scholar 

  90. Chick J, Anton R, Checinski K, Croop R, Drummond DC, Farmer R, et al. A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse. Alcohol Alcohol. 2000;35(6):587–93.

    Article  CAS  PubMed  Google Scholar 

  91. Anton RF, Moak DH, Waid LR, Latham PK, Malcolm RJ, Dias JK. Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. Am J Psychiatry. 1999;156(11):1758–64.

    CAS  PubMed  Google Scholar 

  92. Rubio G, Manzanares J, Lopez-Munoz F, Alamo C, Ponce G, Jimenez-Arriero MA, et al. Naltrexone improves outcome of a controlled drinking program. J Subst Abuse Treat. 2002;23(4):361–6.

    Article  PubMed  Google Scholar 

  93. Balldin J, Berglund M, Borg S, Mansson M, Bendtsen P, Franck J, et al. A 6-month controlled naltrexone study: combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence. Alcohol Clin Exp Res. 2003;27(7):1142–9.

    Article  CAS  PubMed  Google Scholar 

  94. Guardia J, Caso C, Arias F, Gual A, Sanahuja J, Ramirez M, et al. A double-blind, placebo-controlled study of naltrexone in the treatment of alcohol-dependence disorder: results from a multicenter clinical trial. Alcohol Clin Exp Res. 2002;26(9):1381–7.

    Article  CAS  PubMed  Google Scholar 

  95. Kiefer F, Jahn H, Tarnaske T, Helwig H, Briken P, Holzbach R, et al. Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2003;60(1):92–9.

    Article  CAS  PubMed  Google Scholar 

  96. Latt NC, Jurd S, Houseman J, Wutzke SE. Naltrexone in alcohol dependence: a randomised controlled trial of effectiveness in a standard clinical setting. Med J Aust. 2002;176(11):530–4.

    PubMed  Google Scholar 

  97. Heinala P, Alho H, Kiianmaa K, Lonnqvist J, Kuoppasalmi K, Sinclair JD. Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. J Clin Psychopharmacol. 2001;21(3):287–92.

    Article  CAS  PubMed  Google Scholar 

  98. Davidson D, Swift R, Fitz E. Naltrexone increases the latency to drink alcohol in social drinkers. Alcohol Clin Exp Res. 1996;20(4):732–9.

    Article  CAS  PubMed  Google Scholar 

  99. Krystal JH, Cramer JA, Krol WF, Kirk GF, Rosenheck RA. Naltrexone in the treatment of alcohol dependence. N Engl J Med. 2001;345(24):1734–9.

    Article  CAS  PubMed  Google Scholar 

  100. Kranzler HR, Modesto-Lowe V, Van Kirk J. Naltrexone vs. nefazodone for treatment of alcohol dependence. A placebo-controlled trial. Neuropsychopharmacol. 2000;22(5):493–503.

  101. Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–17.

    Article  CAS  PubMed  Google Scholar 

  102. Drews E, Zimmer A. Modulation of alcohol and nicotine responses through the endogenous opioid system. Prog Neurobiol. 2010;90(1):1–15.

    Article  CAS  PubMed  Google Scholar 

  103. O’Malley SS, Robin RW, Levenson AL, GreyWolf I, Chance LE, Hodgkinson CA, et al. Naltrexone alone and with sertraline for the treatment of alcohol dependence in Alaska natives and non-natives residing in rural settings: a randomized controlled trial. Alcohol Clin Exp Res. 2008;32(7):1271–83.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  104. King A, Cao D, Zhang L, Rueger SY. Effects of the opioid receptor antagonist naltrexone on smoking and related behaviors in smokers preparing to quit: a randomized controlled trial. Addiction. 2013;108(10):1836–44.

    Article  PubMed Central  PubMed  Google Scholar 

  105. Ray LA, Miranda R Jr, Kahler CW, Leventhal AM, Monti PM, Swift R, et al. Pharmacological effects of naltrexone and intravenous alcohol on craving for cigarettes among light smokers: a pilot study. Psychopharmacology. 2007;193:449–56.

    Article  CAS  PubMed  Google Scholar 

  106. Epstein AM, King AC. Naltrexone attenuates acute cigarette smoking behavior. Biochem Behav. 2004;77(1):29–37.

    Article  CAS  Google Scholar 

  107. King AC, Cao D, O’Malley SS, Kranzler HR, Cai X, deWit H, et al. Effects of naltrexone on smoking cessation outcomes and weight gain in nicotine-dependent men and women. J Clin Psychopharmacol. 2012;32(5):630–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. King A, Cao D, Vanier C, Wilcox T. Naltrexone decreases heavy drinking rates in smoking cessation treatment: an exploratory study. Alcohol Clin Exp Res. 2009;33(6):1044–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  109. King A, de Wit H, Riley RC, Cao D, Niaura R, Hatsukami D. Efficacy of naltrexone in smoking cessation: a preliminary study and an examination of sex differences. Nicotine Tob Res. 2006;8(5):671–82.

    Article  CAS  PubMed  Google Scholar 

  110. Byars JA, Frost-Pineda K, Jacobs WS, Gold MS. Naltrexone augments the effects of nicotine replacement therapy in female smokers. J Addict Med. 2005;24(2):49–60.

    Google Scholar 

  111. David SP, Chu IM, Lancaster T, Stead LF, Evins AE, Prochaska JJ. Systematic review and meta-analysis of opioid antagonists for smoking cessation. BMJ Open. 2014;4(3):e004393.

    Article  PubMed Central  PubMed  Google Scholar 

  112. David SP, Lancaster T, Stead LF, Evins AE, Prochaska JJ. Opioid antagonists for smoking cessation. Cochrane Database Syst Rev. 2013;(6)CD003086.

  113. Wong GY, Wolter TD, Croghan GA, Croghan IT, Offord KP, Hurt RD. A randomized trial of naltrexone for smoking cessation. Addiction. 1999;94(8):1227–37.

    Article  CAS  PubMed  Google Scholar 

  114. O’Malley SS, Cooney JL, Krishnan-Sarin S, Dubin JA, McKee SA, Cooney NL, et al. A controlled trial of naltrexone augmentation of nicotine replacement therapy for smoking cessation. Arch Intern Med. 2006;166(6):667–74.

    Article  PubMed  Google Scholar 

  115. Krishnan-Sarin S, Meandzija B, O’Malley S. Naltrexone and nicotine patch smoking cessation: a preliminary study. Nicotine Tob Res. 2003;5(6):851–7.

    Article  PubMed  Google Scholar 

  116. Lerman CF, Patterson F, Berrettini W. Treating tobacco dependence: state of the science and new directions. J Clin Oncol. 2005;23(2):311–23.

    Article  PubMed  Google Scholar 

  117. Ray LA, Courtney KE, Ghahremani DG, Miotto K, Brody A, London ED. Varenicline, low dose naltrexone, and their combination for heavy-drinking smokers: human laboratory findings. Psychopharmacology (Berl). 2014;231(19):3843–53.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  118. Ray LA, Courtney KE, Ghahremani DG, Miotto K, Brody A, London ED. Varenicline, naltrexone, and their combination for heavy-drinking smokers: preliminary neuroimaging findings. Am J Drug Alcohol Abuse. 2015;41(1):35–44.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Roche DJO, Bujarski S, Hartwell E, Green R, Ray LA. Combined varenicline and naltrexone treatment reduces smoking topography intensity in heavy-drinking smokers. Pharmacol Biochem Behav. 2015;134:92–8.

    Article  CAS  PubMed  Google Scholar 

  120. Hosking JD, Cisler RA, Couper DJ, Gastfriend DR, Kivlahan DR, Anton RF. Design and analysis of trials of combination therapies. J Stud Alcohol Suppl. 2005;15:34–42.

    Article  PubMed  Google Scholar 

  121. Litten RZ, Ryan ML, Fertig JB, Falk DE, Johnson B, Dunn KE, et al. A double-blind, placebo-controlled trial assessing the efficacy of varenicline tartrate for alcohol dependence. J Addict Med. 2013;7(4):277–86.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  122. US FDA Center for Drug Evaluation and Research. Chantix and serious neuropsychiatric adverse events. Briefing document from the Joint Meeting of the Psychopharmacologic Drugs Advisory Committee and Drug Safety and Risk Management Advisory Committee. October 16, 2014. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/PsychopharmacologicDrugsAdvisoryCommittee/UCM418705.pdf.

  123. Perkins AC, Scott J. Sex differences in long-term smoking cessation rates due to nicotine patch. Nicotine Tob Res. 2008;10(7):1245–50.

    Article  CAS  PubMed  Google Scholar 

  124. Lerman C, LeSage MG, Perkins KA, O’Malley SS, Siegel SJ, Corrigall WA. Translational research in medication development for nicotine dependence. Nat Rev Drug Discov. 2007;6:746–62.

    Article  CAS  PubMed  Google Scholar 

  125. Kahler CW, Metrik J, LaChance HR, Ramsey SE. Addressing heavy drinking in smoking cessation treatment: a randomized clinical trial. J Consult Clin Psychol. 2008;76(5):852–62.

    Article  PubMed Central  PubMed  Google Scholar 

  126. Toll BA, Martino S, O’Malley SS, Fucito LM, McKee SA, Kahler CW, et al. A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. J Consult Clin Psychol. 2015;83(3):445–54.

    Article  PubMed  Google Scholar 

  127. Ericson M, Löf E, Stomberg R, Soderpalm B. The smoking cessation medication varenicline attenuates alcohol and nicotine interactions in the rat mesolimbic dopamine system. J Pharmacol Exp Ther. 2009;329(1):225–30.

    Article  CAS  PubMed  Google Scholar 

  128. Liu X, Palmatier MI, Caggiula AR, Sved AF, Donny EC, Gharib M, et al. Naltrexone attenuation of conditioned but not primary reinforcement of nicotine in rats. Psychopharmacology. 2009;202(4):589–98.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  129. Rukstalis M, Jepson C, Strasser A, Lynch KG, Perkins K, Patterson F, et al. Naltrexone reduces the relative reinforcing value of nicotine in a cigarette smoking choice paradigm. Psychopharmacology. 2005;180(1):41–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA

    Megan M. Yardley & Lara A. Ray

  2. Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA

    Michael M. Mirbaba

  3. Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA

    Lara A. Ray

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  1. Megan M. Yardley
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  2. Michael M. Mirbaba
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  3. Lara A. Ray
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Correspondence to Lara A. Ray.

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Funding

This work was supported by the following grants: F32 AA023449 (Megan M. Yardley), R01 AA021744 (Lara A. Ray), R21 AA022214 (Lara A. Ray), and R21 AA022752 (Lara A. Ray).

Conflicts of interest

Lara A. Ray has consulted for GlaxoSmithKline and has received study medication from Pfizer and Medicinova. Megan M. Yardley and Michael M. Mirbaba have no conflicts of interest to disclose.

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Yardley, M.M., Mirbaba, M.M. & Ray, L.A. Pharmacological Options for Smoking Cessation in Heavy-Drinking Smokers. CNS Drugs 29, 833–845 (2015). https://doi.org/10.1007/s40263-015-0284-5

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