Extended naltrexone and broad spectrum treatment or motivational enhancement therapy

BACKGROUND: Randomized clinical trials on the effectiveness of naltrexone (NTX) in the treatment of alcohol dependence have produced conflicting results. One possible explanation for these discrepancies may lie in the various psychosocial treatments for which NTX is an adjunct. The goal of this study was to examine the interplay between psychosocial treatment and duration of NTX. METHODS: One hundred and seventy-four alcohol-dependent outpatients participated in a double-blind trial where they were randomly assigned to 12 vs. 24 weeks NTX duration and to one of two psychosocial treatments: motivational enhancement therapy (MET) and broad spectrum treatment (BST), a cognitive behavioral therapy tailored to the patient's specific needs. After an initial 12-week period of NTX and psychosocial treatment, half of each psychotherapy condition was assigned to continue NTX for an additional 12 weeks while the other half was assigned to placebo. Patient drinking outcomes were measured for the year following treatment completion. It was hypothesized that the combination of extended duration of NTX and the moderate intensity of BST would be predictive of longer time to a first heavy drinking day than any of the three alternative combinations: MET with short or extended NTX administration or BST with short NTX administration. RESULTS: The median time to first drink and time to first heavy drinking day were found to be significantly longer for patients who received BST and extended NTX than for patients in the other three groups. CONCLUSIONS: These results may suggest that the kind of psychosocial treatment delivered in combination with duration of NTX administration may partially explain the inconsistent findings regarding the efficacy of NTX in the treatment of alcohol dependence.