Am Fam Physician. 2000 Feb 15;61(4):1134.
Small studies have suggested that the opiate antagonist naltrexone is effective as an adjuvant therapy for treating alcohol addiction. These studies found that naltrexone reduced relapse rates, number of drinking days and craving sensations in alcoholics. However, these were small studies, and results could not be generalized to the entire population. In addition, cognitive behavior therapy has shown a reduction in these parameters. Anton and colleagues studied the effectiveness of naltrexone along with cognitive behavior therapy in treating alcoholics who are attempting to recover sobriety.
The study was a double-blinded, randomized clinical trial. Recently abstaining alcohol-dependent subjects who were in an outpatient treatment program were enrolled in the study. All received cognitive behavior therapy during the study. The patients were divided into two groups. The first group received naltrexone in a dosage of 50 mg per day along with riboflavin, and the second group received placebo with riboflavin. Alcohol consumption, cravings and adverse events were monitored weekly. Urine riboflavin levels were assessed to determine compliance with the treatment regimens, and blood markers for alcohol abuse were also measured.
Cognitive behavior therapy and medication compliance was high for treatment and placebo groups. The group treated with naltrexone drank less, took longer to relapse and had more time between relapses. They also exhibited more resistance to and control over alcohol urges. Of the naltrexone group, 62 percent did not relapse into heavy drinking, while only 40 percent of the placebo group did not relapse into heavy drinking. No significant adverse events were reported in either of the groups.
The authors conclude that naltrexone in combination with cognitive behavior therapy is effective in treating motivated persons with moderate alcohol dependency. Naltrexone increased their feeling of control over alcohol urges and improved cognitive resistance to thoughts about drinking. The combination of naltrexone with cognitive behavior therapy appears to be synergistic in treating alcohol dependency.
Anton RF, et al. Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. Am J Psychiatry. November 1999;156:1758–64.
Copyright © 2000 by the American Academy of Family Physicians.
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