Event-Driven Dosing: Rethinking Binge Drinking Treatment - PsyQ Episode 30

In this episode, we dissect a landmark 2022 randomized controlled trial published in the American Journal of Psychiatrythat challenges the traditional "daily dose" paradigm for treating Alcohol Use Disorder (AUD). We review the efficacy of targeted, event-driven oral naltrexone—taken only in anticipation of heavy drinking or cravings—specifically for sexual and gender minority (SGM) men with mild-to-moderate AUD.We analyze how this "chemical shield" approach yielded a Number Needed to Treat (NNT) of just 2 to prevent a binge-drinking day , significantly reduced overall consumption volume , and demonstrated sustained therapeutic effects six months post-treatment through likely pharmacological extinction. Join us as we explore how decoupling alcohol from its neurobiological reward can bridge the massive treatment gap for binge drinkers who are resistant to total abstinence. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit upathak.substack.com