Targeted naltrexone was also used by Heinala et al. (30), who compared 50 mg/d of the medication with placebo, paired with either coping skills or supportive therapy. During an initial 12 weeks of treatment, this study showed an advantage for naltrexone in preventing relapse to heavy drinking but only when combined with coping skills therapy. During a subsequent 20-week period, subjects were told to use the medication only when they craved alcohol (i.e., targeted treatment). The beneficial effect of naltrexone on the risk of relapse was generally sustained during the period of targeted treatment. Based on these findings, it appears that targeted medication administration may be useful both for the initial treatment of problem drinking and for maintenance of the beneficial effects of an initial period of daily naltrexone. O’Malley et al. (31) conducted a sequence of randomized trials in which subjects with alcohol use disorder were first treated with 10 weeks of open-label naltrexone 50 mg, combined with either CBT or primary care management (PCM; a less intensive, supportive approach). Treatment responders from the PCM group and from the CBT group continued in separate 24-week, placebo-controlled studies of maintenance naltrexone. No difference was observed with respect to persistent heavy drinking, with more than 80% of both groups having a positive outcome. However, the percentage of days abstinent declined more over time for the PCM group. In the follow-up studies, there was a greater maintenance response for naltrexone than placebo when combined with PCM, but the advantage for naltrexone did not reach significance when combined with CBT. These findings suggest that the beneficial effects of treatment with naltrexone can be maintained during an extended period through the use of either a more intensive, skills-oriented treatment (i.e., CBT)
References
Ries, Richard, Shannon C. Miller, Richard Saitz, and David A. Fiellin, eds. 2014. The ASAM principles of addiction medicine. Fifth edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.