EXPLORE THE ASSOCIATION OF SWEET PREFERENCE WITH THE TREATMENT RESPONSE TO NALTREXONE IN PATIENTS WITH ALCOHOL USE DISORDER

Abstract Background Alcohol use disorder (AUD) is a prevalent psychiatric issue worldwide, contributing to the global burden of morbidity and mortality. While pharmacological interventions have been developed to manage AUD, the efficacy of Naltrexone, the first-line treatment, varies among individuals. Identifying phenotypes associated with naltrexone response is essential for optimizing treatment plans. Naltrexone functions by attenuating the reward signals from the endogenous opioid system, which is also linked to the hedonic response to sweet tastes. Naltrexone has been observed to have a better response in patients with a preference for sweet tastes in Western populations. However, it remains unknown whether sweet preference serves as a predictive phenotype for therapeutic response in Taiwan. Aim and Objective The study aimed to examine the association between sweet preference and naltrexone response in Taiwanese patients with AUD. Method A total of 56 patients diagnosed with AUD as per DSM-5 criteria participated in this study. They underwent a sweet preference test, rating their pleasurableness of various concentrations of sucrose. Following the preference test, they underwent a 12-week treatment, with evaluations at the end of weeks 2, 4, 8, and 12 to assess drinking outcomes. The drinking outcomes were measured by days to first drink after treatment initiation, maximum daily drinks, average daily drinks, and craving severity measured by Visual Analogue Scale (VAS). The generalized estimating equation and the Mann-Whitney test were applied to investigate the difference in drinking outcomes between sweet-liking and sweet- disliking groups. Result Participants were dichotomously classified into the sweet-liking (SL) group (n =28) and the sweet- disliking (SDL) group (n = 28) by comparing their pleasurableness ratings at 0.2M to the median pleasurableness ratings of all participants at 0.2M. We observed no significant differences in demographics between the SL and SDL groups. The time to their first drink was significantly longer in the SL group compared to the SDL group (57.8 days vs. 42 days, p = 0.03). Participants in the SL group also reported a lower daily drinking amount, both maximal (1.1 drinks vs. 5.4 drinks, p = 0.02) and average (1.5 drinks vs. 5.8 drinks, p = 0.01), after four weeks of treatment. By the end of the 12-week period, the SL group also exhibited lower VAS scores compared to the SDL group. Discussion and Conclusion Ours is the first study in Taiwan to indicate that patients with AUD with a preference for sweet taste responded better to naltrexone treatment in terms of drinking outcomes, specifically, a longer period of abstinence, reduced craving, and an earlier reduction in drinking amount. Future studies should focus on expanding the understanding of precision medicine in AUD treatment.