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Alcoholics Do Well On Naltrexone Along With Skills Training

Alcoholics should be kept on naltrexone treatment for longer periods of time and also be encouraged to increase their compliance with it.

The drug clearly works, helping to reduce or even to prevent relapse in those who continue to take it, although it is probably underused, suggests this study.

Valuable adjuncts to this treatment are both coping- and communication-skills training, which help patients once they have begun recovery to maintain treatment gains.

Peter M. Monti and colleagues from the Providence VA Medical Center; Center for Alcohol and Addiction Studies, Brown University; Butler Hospital/Brown University; and Butler Hospital/Brown University School of Medicine, all in Providence, Rhode Island, United States, did this study.

Objective was to investigate the effects of combining naltrexone (NTX), cue exposure combined with urge-specific coping skills training (CET) and communication skills training (CST) as treatment adjuncts.

In a two-by-two design, researchers examined the effects of CET plus CST versus an education and relation control treatment over a two-week partial hospital program (165 patients) followed by 12 weeks of NTX (50 mg/day) or placebo during aftercare (128).

Patients were medically eligible alcohol dependents.

Drinking outcomes were assessed at three, six and 12 months after partial hospital discharge. Process measures included urge, self-efficacy (confidence about staying abstinent in risky situations) and self-reported coping skills.

Alcoholics who took the naltrexone for at least 70 percent of days, or two of the three months it was prescribed, had fewer heavy drinking days, fewer drinks if they did drink and fewer urges to drink.

However, naltrexone's beneficial effects lasted only while patients took it, suggesting outcomes would improve if the drug were prescribed for more than 90 days and compliance remained high.

Patients who received the coping- and communication-skills training versus control patients were significantly less likely to report a relapse day and reported fewer heavy drinking days at the six- and 12-month follow-ups.

Process measures showed NTX resulted in lower weekly urge ratings, and those in skills training used more of the prescribed coping skills after treatment and reported fewer cue-elicited urges and more self-efficacy.

Drinking reductions at three, six and 12 months correlated with more use of coping skills, lower urge and higher self-efficacy.
Alcoholism: Clinical and Experimental Research 2001;25:1634-1647.

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