Groundbreaking research for treatment of substance use disorders

Substance use disorders (SUDs) rage on, with 91,799 drug overdose deaths documented by the NIH in 2020.^[] Synthetic opioids (primarily fentanyl) resulted in 56,516 (62%) of these deaths that year; methamphetamine and other psychostimulants accounted for 23,837 (26%).

But there is potential hope in the form of emerging addiction treatments that show promise for patients with different SUDs.

Spironolactone to treat alcohol abuse

In a clinical trial published in Molecular Psychiatry, NIH researchers examined whether spironolactone decreased alcohol consumption in individuals who received the drug compared with those who did not take it. The greatest effect was seen in heavy drinkers.^[]

Mineralocorticoid receptors are primarily located in the kidney where they regulate fluid and electrolyte homeostasis, but they are also found in regions of the brain that may contribute to alcohol use/craving. Among its many actions, spironolactone blocks mineralocorticoid receptors, as documented in the ScienceDaily article.

Alternative pain pathways

International researchers are examining the analgesic potential of alpha 2A adrenergic receptor agonists, which bind to adrenaline. Although some drugs, such as dexmedetomidine, already target the alpha 2A adrenergic receptor, they have strong sedative properties.

An international consortium identified potential agonists that induced analgesia and did not cause sedation in animal models, as reported in the ScienceDaily article.

The investigators concluded that although separating analgesic properties from sedation represents a milestone in non-opioid pain medication, the development of potential therapeutics requires more than basic medical research. Further clinical trials are anticipated.

Non-psychedelic treatments

Researchers from UNC-Chapel Hill, UC San Francisco, Yale, Duke, and Stanford discovered a drug that binds to the same targets as psychedelic drugs (ie, the 5-HT2A serotonin receptor) but doesn’t result in psychedelic side effects, according to another article published by ScienceDaily.^[]

In an article published by Interesting Engineering, the authors wrote, “There is considerable interest in screening ultra-large chemical libraries for ligand discovery, both empirically and computationally. Efforts have focused on readily synthesizable molecules, inevitably leaving many chemotypes unexplored.”^[]

Virtual reality for SUD

Sustained remission from SUDs is challenging due, in part, to high relapse rates. Investigators from the Indiana University School of Medicine created age-progressed “future” avatars as part of recovery support, according to a study published by Discovery Mental Health.^[]

They found that 18 of 21 early-recovery participants were still sober at 31 days. The intervention also improved future self-continuity, delayed reward, and reduced cravings.

“Before and following the intervention, participants rated future self-continuity and performed delay discounting. Following the intervention, daily images of the Recovery Future Self were sent to participants’ smartphones for [30] days,” the authors wrote.

The research team has been awarded around $5 million by the National Institute of Drug Abuse and the National Institute of Alcohol Abuse and Alcoholism to advance their efforts, as reported by ScienceDaily.^[]