Naltrexone Combined With Either Cognitive Behavioral or Motivational Enhancement Therapy for Alcohol Dependence

Abstract

Although naltrexone has been shown to be effective in the treatment of alcohol dependence, less is known about its efficacy when combined with different behavioral therapies. Previous work has suggested that naltrexone works best when combined with weekly cognitive behavioral therapy (CBT). This study examined the efficacy of naltrexone when combined with CBT or a motivational enhancement therapy involving less patient contact. Outpatient alcoholics (N = 160) were randomly assigned to either naltrexone (50 mg/d) or placebo and either CBT (12 sessions) or motivational enhancement therapy (4 sessions), in a 4-cell design, and treated over a 12-week period. Subjects were evaluated periodically for alcohol consumption, craving, and biologic markers of drinking (carbohydrate-deficient transferrin and gamma-glutamyltransferase). There was high retention and adherence to therapy and medication in the trial with no significant difference across the treatment groups. Naltrexone, independent of therapy assignment, increased the time to first relapse. However, the CBT-naltrexone group did better than the other groups on a variety of outcome measures. Fewer CBT-naltrexone-treated subjects relapsed, and those that did had both fewer, and more time between, subsequent relapses. This randomized controlled trial is consistent with previous reports about the utility of combining naltrexone with CBT. Despite being more efficient to administer, the combination of motivational enhancement therapy and naltrexone is less effective than CBT and naltrexone. Because CBT and naltrexone share common mechanisms of action, such as craving reduction and relapse prevention, these therapies are likely to be well suited to use in combination.

Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials

“…= pharmacological; CI = confi dence interval. a The trimmed estimate with three outlying (Kelly et al, 2000;O'Malley et al, 1992;Sandahl et al, 2004) and two high weight (Anton et al, 2006;Project MATCH, 1997) trials removed was larger, signifi cant, and homogeneous (g = 0.14, p < .05, Q > .05); b the estimate with one high-weight study (MTRP, 2004) removed was 0.38 (p < .005, Q > .05); c the trimmed estimate with two outlying trials (Carroll et al, 1991;Rawson et al, 2006) removed was slightly larger but remained heterogeneous (g = 0.19, p < .05, Q < .05); d the trimmed estimate with one outlying trial (Sandahl et al, 2004) removed was slightly higher (g = 0.18, p < .005, Q < .05) but remained heterogeneous; e the trimmed estimate with two outlying studies (Kelly et al, 2001;MTRP, 2004) removed was lower and homogeneous (g = 0.20, p < .005, Q > .05); f the trimmed estimate with one outlying study (Heinälä et al, 2001) removed was slightly lower (g = 0.19, p < .05, Q > .05); Anton et al (2006) not included in analyses because it qualifi es as both a psychosocial and pharmacological combined intervention; g positive effect comparisons include interpersonal psychotherapy (Carroll et al, 1991(Carroll et al, , 2004Donovan and Ito, 1988), twelve-step facilitation (Brown et al, 2002;Maude-Griffi n et al, 1998), motivational interviewing (Anton et al, 2005;Stephens et al, 2000), and contingency management (Budney et al, 2006); h the trimmed estimate with one outlying trial (Rawson et al, 2006) removed was larger, signifi cant but remained heterogeneous (g = 0.22, p < .05, Q < .05). *p < .05; § p < .005. or similar no-treatment control.…”

Withdrawal from free-choice high-fat high-sugar diet induces craving only in obesity-prone animals

“…There are also overlaps in the treatment of addiction and obesity. Cognitive behavioural therapy, a successful treatment for alcoholism in combination with naltrexone (Anton et al 2005), is also effective in promoting weight loss in clinical populations (Eichler et al 2007;McTigue et al 2003). Substantial evidence supports the concept that food intake and addictive substances activate similar parts of the brain, namely the mesolimbicdopaminergic system ('reward pathway'), but this activation differs in several respects (Bassareo et al 2002;Bassareo and Di Chiara 1997;1999;Rada et al 2005).…”

Gender differences with high-dose naltrexone in patients with co-occurring cocaine and alcohol dependence

“…Another potentially important factor may be the type of psychosocial intervention provided with pharmacotherapy, because the type of psychosocial treatment may influence outcomes in cocaine dependent patients (Anton et al, 2005;Schmitz et al, 2001). While the traditional "platform" treatments that are used in cocaine treatment studies have been based on the principles of cognitive-behavioral relapse prevention therapy (Marlatt & Gordon, 1985), medical management --a supportive treatment that can be provided when prescribing pharmacotherapy, has been successfully provided in treatment studies of alcohol dependent patients (Garbutt et al, 2005;O'Malley et al, 2003;Pettinati, Volpicelli, Pierce, & O'Brien, 2000;Pettinati et al, 2005;Volpicelli, Pettinati, McLellan, & O'Brien C, 2001).…”