Groundbreaking research for treatment of substance use disorders

By Naveed Saleh, MD, MS | Medically reviewed by Kevin Kennedy, MD
Published November 17, 2022

Key Takeaways

  • Repurposing of spironolactone could help fight alcohol use disorder.

  • The targeting of alternative pathways, including those involving adrenaline, could help treat pain without causing sedation.

  • Virtual reality can help reify the future for patients with substance use disorder.

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.[]

Notably, spironolactone is commonly prescribed only for its cardiac indications, such as high blood pressure, according to an article published by ScienceDaily.[]

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.

Related: Phenibut exposure in the US has risen: What to know

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.

Related: Relapse after successful therapy: How physicians can encourage long-term recovery

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.[]

The antidepressant effect is reportedly long-lasting after just one dose.

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.

"The future selves’ interactive monologs include personalized details and voice for a lifelike interaction within a time travel vignette."

Shen, et al., Discovery Mental Health

“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.[]

What this means for you

Although overdose deaths continue to rise, and SUDs remain a public-health threat, investigators are working to repurpose and discover potential drug candidates that target depression and the underpinnings of drug dependence. These pharmacotherapies warrant further clinical testing, according to the experts.

Read Next: Opioid crisis update: What's changed and where are we?
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