Theorizing The Dangers of Dopamine Antagonists and Dopamine Partial Agonists in Patients with a History of Alcohol Use Disorder
Richard Green1, Kenneth Blum2-4,23*, Kai-Uwe Lewandrowski4-6, Jean Lud Cadet7, Jag Khalsa8,9, David Baron2,10, Panayotis K Thanos 3,11, Catherine Dennen12, Alireza Sharafshah13, Igor Elman 3,14, Kenison Roy, lll15, Victor Romo1, Michael Blevins16, Abdalla Bowirrat3, Albert Pinhasov3, Rossano Kepler Alvim Fiorelli17, Sergio Schmidt18, Rajendra D. Badgaiyan19, Milan Makale20, Eric R Braverman21, Keerthy Sunder22, Kevin T Murphy20, Foojan Zeine23, Nicole Jafari24, Mark S Gold15, 25
1Division of Nutrigenomics and Personalized Translational Therapy Research, Precision Translational Medicine, LLC., San Antonio, TX., USA
2Division of Addiction Research and Education, Center for Sports, Exercise, and Mental Health, Western University of Health Sciences, Pomona, CA., USA
3Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel, Israel
4Division of Personalized Pain Therapy Research and Education, Center for Advanced Spine Care of Southern Arizona, Tucson, AZ., USA
5Department of Orthopaedics, Fundación Universitaria Sanitas Bogotá D.C. Colombia
6Department of Orthopaedics, Universidade Federal do Estado do Rio de Janeiro, Brazil
7Molecular Neuropsychiatry Research Branch, NIH/NIDA Intramural Research Program, Baltimore, MD., USA.
8National Institute on Drug Abuse, National Institutes of Health, Gaithersburg, MD., USA
9Department of Medicine, Maryland University, School of Medicne, Baltimore, MD., USA
10Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA
11Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY, USA
12Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
13Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
14Department of Psychiatry and Cambridge Health Alliance, Harvard Medical School, Cambridge, MA., USA
15Department of Psychiatry, Tulane University School of Medicine, New Orleans, LA., USA
16Cardinal Health, Inc., San Antonio, Tx., USA
17Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
18Department of Neurology, Federal University of Rio de Janeiro (UNIRIO), University Hospital, Rua Mariz e Barros, Tijuca, Rio de Janeiro, RJ, Brazil
19Department of Psychiatry, Texas Tech University Health Sciences, Midland, Tx.,USA
20Department of Radiation and Oncology, Medicine and Applied Sciences, UC San Diego, La Jolla, CA., USA
21Division of Clinical Neurology, The Blum Institute for Neurogenetics and Behavior, LLC., Austin, TX., USA
22Department of Psychiatry, University of California, Riverside School of Medicine, Riverside, CA, USA
23Department of Human Development, California State University at Long Beach, Long Beach, CA., USA
24Department of Applied Clinical Psychology, The Chicago School of Professional Psychology, Los Angeles, CA, USA
25Department of Psychiatry, Washington University School of Medicine, St. Louis, MO., USA
*Corresponding Author: Kenneth Blum, Division of Addiction Research and Education, Center for Sports, Exercise, and Mental Health, Western University of Health Sciences, Pomona, CA., USA.
Received:
August 20, 2024; Published: October 18, 2024
Abstract
The utilization of dopamine antagonists and dopamine partial agonists in patients with a history of alcohol use disorder (AUD) presents notable risks. This article delves into the pharmacological effects of these agents on alcohol consumption and highlights the associated dangers through a brief review of existing literature. The article describes, as an example, a case where a female prescribed a partial agonist involuntarily and unusual for this person overconsumes alcohol and causes an almost fatal accident under the influence. We explore the mechanisms by which these medications influence dopamine pathways, their potential to exacerbate alcohol consumption, and the implications for clinical practice.
Keywords: Dopamine; Antagonists; Partial Agonists; Alcohol Use Disorder (AUD)
References
- Blum K., et al. “Offering a putative neurobiological "dopamine homeostatic" solution to overcome the perils of the reward deficiency syndrome pandemic: emergence of "precision behavioral management". Annals of Translational Medicine 23 (2022): 1291.
- Drake RE., et al. “Schizophrenia and Co-Occurring Substance Use Disorder: A Review of the Literature”. Schizophrenia Bulletin4 (2004): 507-523.
- De Fruyt J., et al. “Clinical Use of Aripiprazole in the Treatment of Schizophrenia and Schizoaffective Disorder”. The International Journal of Neuropsychopharmacology 1 (2002): 1-19.
- Engleman EA., et al. “Haloperidol Increases Alcohol Consumption in Rats”. Neuropsychopharmacology4 (2008): 900-910.
- Tomkins DM., et al. “Dopamine D2 Antagonists Increase Alcohol Consumption in Rats”. Psychopharmacology1 (1997): 53-57.
- Wang SM., et al. “Investigational dopamine antagonists for the treatment of schizophrenia”. Expert Opinion on Investigational Drugs 6 (2017): 687-698.
- Pidathala S., et al. “Mechanisms of neurotransmitter transport and drug inhibition in human VMAT2”. Nature7989 (2023): 1086-1092.
- Yun S., et al. “Antipsychotic drug efficacy correlates with the modulation of D1 rather than D2 receptor-expressing striatal projection neurons”. Nature Neuroscience 8 (2023): 1417-1428.
- Tyler J., et al. “High intensity interval training exercise increases dopamine D2 levels and modulates brain dopamine signaling”. Frontiers in Public Health 11 (2023): 1257629.
- Bach P., et al. “Molecular Imaging Studies of Alcohol Use Disorder”. Current Topics in Behavioral Neurosciences (2023).
- Walter H., et al. “Dopamine and alcohol relapse: D1 and D2 antagonists increase relapse rates in animal studies and in clinical trials”. Journal of Biomedical Science 1 (2001): 83-88.
- Jangard S., et al. “Striatal dopamine D2 receptor availability as a predictor of subsequent alcohol use in social drinkers”. Addiction6 (2023): 1053-1061.
- Bulwa ZB., et al. “Increased consumption of ethanol and sugar water in mice lacking the dopamine D2 long receptor”. Alcohol 7 (2011): 631-639.
- Caine SB., et al. “Role of dopamine D2-like receptors in cocaine self-administration: studies with D2 receptor mutant mice and novel D2 receptor antagonists”. Journal of Neuroscience 7 (2002): 2977-2988.
- Xiao T., et al. “A role for circuitry of the cortical amygdala in excessive alcohol drinking, withdrawal, and alcohol use disorder”. Alcohol 4 (2024): 151-159.
- Agoglia AE and Herman MA. “The center of the emotional universe: Alcohol, stress, and CRF1 amygdala circuitry”. Alcohol 72 (2018): 61-73.
- Blum K., et al. “Should Reward Deficiency Syndrome (RDS) Be Considered an Umbrella Disorder for Mental Illness and Associated Genetic and Epigenetic Induced Dysregulation of Brain Reward Circuitry?” Journal of Personalized Medicine 10 (2022): 1719.
- Mohr P., et al. “Dopamine Receptor Partial Agonists: Do They Differ in Their Clinical Efficacy?” Frontiers in Psychiatry 12 (2022): 781946.
- Ferraiolo M., et al. “Receptor density influences the recruitment bias of aripiprazole and brexpiprazole at the dopamine D2Lreceptor”. Fundamental and Clinical Pharmacology 6 (2022): 976-984.
- Williams BD., et al. “Aripiprazole and Other Third-Generation Antipsychotics as a Risk Factor for Impulse Control Disorders: A Systematic Review and Meta-Analysis”. Journal of Clinical Psychopharmacology 1 (2024): 39-48.
- Frankel JS and Schwartz TL. “Brexpiprazole and cariprazine: distinguishing two new atypical antipsychotics from the original dopamine stabilizer aripiprazole”. Therapeutic Advances in Psychopharmacology 1 (2017): 29-41.
- Kikuchi T., et al. “Discovery research and development history of the dopamine D2receptor partial agonists, aripiprazole and brexpiprazole”. Neuropsychopharmacology Reports 2 (2021): 134-143.
- Frampton JE. “Brexpiprazole: A Review in Schizophrenia”. Drugs 2 (2019): 189-200.
- Azorin JM and Simon N. “Dopamine Receptor Partial Agonists for the Treatment of Bipolar Disorder”. Drugs15 (2019): 1657-1677.
- Fusaroli M., et al. “Impulse Control Disorders by Dopamine Partial Agonists: A Pharmacovigilance-Pharmacodynamic Assessment Through the FDA Adverse Event Reporting System”. International Journal of Neuropsychopharmacology 9 (2022): 727-736.
- Huang M., et al. “The Role of Dopamine D3Receptor Partial Agonism in Cariprazine-Induced Neurotransmitter Efflux in Rat Hippocampus and Nucleus Accumbens”. Journal of Pharmacology and Experimental Therapeutics 2 (2019): 517-525.
- George SR., et al. “Low endogenous dopamine function in brain predisposes to high alcohol preference and consumption: reversal by increasing synaptic dopamine”. Journal of Pharmacology and Experimental Therapeutics 1 (1995): 373-379.
- Hodge CW., et al. “Alcohol self-administration: further examination of the role of dopamine receptors in the nucleus accumbens”. Alcohol, Clinical and Experimental Research 6 (1997): 1083-1091.
- Sciascia JM., et al. “Blocking dopamine d1-like receptors attenuates context-induced renewal of pavlovian-conditioned alcohol-seeking in rats”. Alcohol, Clinical and Experimental Research 2 (2014): 418-427.
- El-Ghundi M., et al. “Disruption of dopamine D1 receptor gene expression attenuates alcohol-seeking behavior”. European Journal of Pharmacology2-3 (1998): 149-158.
- McBride WJ and Li TK. “Animal models of alcoholism: neurobiology of high alcohol-drinking behavior in rodents”. Critical Reviews in Neurobiology 4 (1998): 339-369.
- George SR., et al. “Low endogenous dopamine function in brain predisposes to high alcohol preference and consumption: reversal by increasing synaptic dopamine”. Journal of Pharmacology and Experimental Therapeutics 1 (1995): 373-379.
- Dennen CA., et al. “Genetic Addiction Risk Severity Assessment Identifies Polymorphic Reward Genes as Antecedents to Reward Deficiency Syndrome (RDS) Hypodopaminergia's Effect on Addictive and Non-Addictive Behaviors in a Nuclear Family”. Journal of Personalized Medicine 11 (2022): 1864.
- Blum K., et al. “Should We Embrace the Incorporation of Genetically Guided "Dopamine Homeostasis" in the Treatment of Reward Deficiency Syndrome (RSD) as a Frontline Therapeutic Modality?” Acta Scientific Neurology 2 (2021): 17-24.
- Blum K., et al. “Enhancement of alcohol withdrawal convulsions in mice by haloperidol”. Clinical Toxicology 3 (1976): 427-434.
- Lu C., et al. “Large-scale real-world data analysis identifies comorbidity patterns in schizophrenia”. Translational Psychiatry 1 (2022): 154.
- Green AI., et al. “Clozapine for comorbid substance use disorder and schizophrenia: do patients with schizophrenia have reward-deficiency syndrome that can be ameliorated by clozapine?”
Harvard Review of Psychiatry 6 (1999): 287-296.
- Anton RF., et al. “Efficacy of Aripiprazole for Alcohol Dependence: A Randomized Controlled Trial”. Alcoholism: Clinical and Experimental Research5 (2008): 1017-1025.
- Cervenka S and Farde L. “Dopamine D (2) receptor occupancy by aripiprazole in schizophrenia patients and in healthy subjects”. International Journal of Neuropsychopharmacology2 (2008): 207-216.
- Bergman J., et al. “Modification of cocaine and alcohol self-administration by aripiprazole: Comparison with typical and atypical antipsychotics in rats”. Neuropsychopharmacology 11 (2008): 2824-2836.
- Vassoler FM., et al. “The effects of aripiprazole on alcohol intake in female rats”. Behavioural Brain Research 261 (2014): 31-37.
- Salling MC and Martinez D. “Brain Stimulation in Addiction: Mechanisms and Targets”. Current Opinion in Neurobiology 40 (2016): 1-8.
- Rodd ZA., et al. “Effects of aripiprazole on ethanol self-administration in alcohol-preferring (P) rats”. Alcoholism: Clinical and Experimental Research 10 (2003): 1582-1589.
- Haney M., et al. “Aripiprazole maintenance decreases alcohol self-administration in humans”. Drug and Alcohol Dependence2 (1999): 181-190.
- Wiers CE., et al. “Effects of aripiprazole on neural alcohol cue-reactivity in alcohol-dependent patients”. Psychopharmacology (Berl)8 (2014): 1541-1550.
- Blum K., et al. “Summary Document Research on RDS Anti-addiction Modeling: Annotated Bibliography”. Journal of Addiction Psychiatry 1 (2024): 1-33.
- Espeso-Gil S., et al. “A chromosomal connectome for psychiatric and metabolic risk variants in adult dopaminergic neurons”. Genome Medicine 12 (2020): 19.
- Szoke A., et al. “Multimorbidity and the Etiology of Schizophrenia”. Current Psychiatry Reports 5 (2024): 253-263.
- Miller AP., et al. “Generalized genetic liability to substance use disorders”.
Journal of Clinical Investigation 11 (2024): e172881.
- Blum K., et al. “TO BE OR NOT TO BE" GWAS Ends the Controversy about the DRD2 Gene as a Determinant of Reward Deficiency Syndrome (RDS)”. Psychology Research and Behavior Management 16 (2023): 4287-4291.
- Levey DF., et al. “Bi-ancestral depression GWAS in the million veteran program and meta-analysis in >1.2 million individuals highlight new therapeutic directions”.Nature Neuroscience 24 (2021): 954-963.
- Kimbrel NA., et al. “A genome-wide association study of suicide attempts in the million veterans program identifies evidence of pan-ancestry and ancestry-specific risk loci”. Molecular Psychiatry 27 (2022): 2264-2272.
- Hatoum AS., et al. “Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders”. Nature Mental Health 1 (2023): 210-223.
- Blum K., et al. “Activation instead of blocking mesolimbic dopaminergic reward circuitry is a preferred modality in the long term treatment of reward deficiency syndrome (RDS): a commentary”. Theoretical Biology and Medical Modelling 5 (2008): 24.
- Boundy VA., et al. “Differential coupling of rat D2 dopamine receptor isoforms expressed in Spodoptera frugiperda insect cells”. Journal of Pharmacology and Experimental Therapeutics 2 (1996): 784-794.
- Braverman ER and Blum K. “Substance use disorder exacerbates brain electrophysiological abnormalities in a psychiatrically ill population”. Clinical Electroencephalography 4 (1996): 5-27.
- Paus T., et al. “Why do many psychiatric disorders emerge during adolescence?” Nature Reviews Neuroscience 12 (2008): 947-957.
- Solmi M., et al. “Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies”. Molecular Psychiatry 1 (2022): 281-295.
- Casey BJ., et al. “DSM-5 and RDoC: progress in psychiatry research?” Nature Reviews Neuroscience 11 (2013): 810-814.
- Williams LM., et al. “Precision psychiatry and Research Domain Criteria: Implications for clinical trials and future practice”. CNS Spectrums 1 (2024): 26-39.
- Gold MS., et al. “Molecular role of dopamine in anhedonia linked to reward deficiency syndrome (RDS) and anti- reward systems”. Frontiers in Bioscience (Schol Edition) 2 (2018): 309-325.
- Zeine F., et al. “Solving the Global
Opioid Crisis: Incorporating Genetic Addiction Risk Assessment with Personalized Dopaminergic Homeostatic Therapy and Awareness Integration Therapy”. Journal of Addiction Psychiatry 8.1 (2024): 50-95.
- Cronje F., et al. “Hypothesizing Enhanced Brain Activity as A Function of Dopamine Homeostasis as Observed with KB220 in A Male with Delayed Cognitive Performance". Acta Scientific Neurology7 (2024): 49-56.
- Blum K., et al. “Reward Deficiency Syndrome (RDS): A Cytoarchitectural Common Neurobiological Trait of All Addictions”. International Journal of Environmental Research and Public Health 21 (2001): 11529.
- Blum K., et al. “Introducing Precision Addiction Management of Reward Deficiency Syndrome, the Construct That Underpins All Addictive Behaviors”. Frontiers in Psychiatry 9 (2018):
- Blum K., et al. “Should Reward Deficiency Syndrome (RDS) Be Considered an Umbrella Disorder for Mental Illness and Associated Genetic and Epigenetic Induced Dysregulation of Brain Reward Circuitry?” Journal of Personalized Medicine 10 (2022): 1719.
- Zeine F. “Awareness integration: a new therapeutic model”. International Journal of Emergency Mental Health 2 (2018): 278-283.
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