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Naltrexone for Patients who Wish to Moderate or Control Their Drinking:
An annotated guide to important clinical research, for patients and clinicians

 
Compiled by Alexander DeLuca,  adeluca@doctordeluca.com, December 2002. 
New! - Most recently updated: March 11, 2005 - New!
See also: Frequently Asked Questions About Addictions,  and:  Frequently Asked Questions About Naltrexone

 

[New! - Addendum to this document, 3/11/2005 - New! ]
 
See also these two documents representing a 2005 review updating the older literature discussed below.
"Naltrexone for the treatment of alcoholism: a meta-analysis of Randomized Controlled Trials"
by Srisurapanont et al.; Int J. Neuropsychopharmacology; 2005.
This peer-reviewed article was discussed in the following medical news agency article:
"Medication [naltrexone] Helps Alcoholics Control Drinking" Medical News Today item; 2/18/2005; from which the following is quoted:
"
Naltrexone is most effective, says Volpicelli, in a program 'designed to support the notion that... what you really want to stop is excessive drinking.
 
[END: 3/11/2005 addendum]


Important Questions:

1.  Are abuse and dependence part of the same continuum of illness? Or do alcohol abusers tend NOT to become alcoholics?
 

 ===>  See Schuckitt article: "Five Year Clinical Course Associated with DSM IV Alcohol Abuse or Dependence..."

2. Should alcohol abusers take naltrexone only 'as needed?' instead of daily as in the abstinence protocol?
 

 ===> See article by  Sinclair: "Evidence about Use of Naltrexone and for Different ways of Using It..."

3. Are there different theories of naltrexone pharmacotherapy?
 

 ===> See slide/lecture by DeLuca: "Alcohol Abuse vs. Dependence and the Evolving Role of Adjunctive Naltrexone"
 ===> Consider a discussion of the Extinction Theory  vs the Abstinence Theory of naltrexone pharmacotherapy as elucidated in the Sinclair article mentioned above, and in an article by Kranzler: "Targeted Naltrexone Treatment of Early Problem Drinkers"
 

Alcohol Abuse vs. Dependence and the Evolving Role of Naltrexone Pharmacotherapy.  An HTML slide / lecture by Alexander DeLuca presented to physicians at Columbia Psychiatric Institute in 2001, 2002, and 2003.

This lecture considers these questions and issues:                                                                      
-- Are alcohol abuse and alcohol dependence part of the same continuum of illness or are they distinct disorders?
--  Problems with 'radical abstinence' as a universal treatment suggestion.
-- Abstinence vs Extinction theories of naltrexone and consequent very different medication regimens.

DeLuca, 2001, HTML Slide/Lecture presentation.

View Online

Download as HTML (ZIP)

Five Year Clinical Course Associated with DSM IV Alcohol Abuse or Dependence in a Large Group of Men and Women. American Journal of Psychiatry, Vol. 158, No. 7, pp 1084-90.

CONCLUSIONS: "The data suggest that over 5 years the DSM IV diagnosis of alcohol dependence predicts a chronic disorder with a relatively severe course, while DSM IV alcohol abuse predicts a less persistent, milder disorder that does not usually progress to dependence."

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Schuckit, 7/2001
Evidence About the Use of Naltrexone and for the Different Ways of Using It in the Treatment of Alcoholism. Alcohol & Alcoholism, Vol. 36, No. 1, pp. 2-10.

From Abstract: "Naltrexone is most effective when paired with drinking but ineffective when given during abstinence ... naltrexone should be administered to patients who [are] still ... drinking ... and when drinking [is] anticipated; this treatment should continue indefinitely." 

Sinclair, 2001
Targeted naltrexone treatment of early problem drinkers. Addictive Behaviors, Vol 22, #3, pg 431

From Abstract: "Twenty-one subjects received brief coping skills training weekly for four weeks, along with naltrexone 50mg, which they were to use two to five times per week in anticipation of high-risk drinking situations. [Statistically] and clinically significant declines were observed across a variety of drinking-related outcomes... Beneficial effects of the intervention were still evident during the 3-month posttreatment period."

Kranzler, '97
Naltrexone in the Treatment of Alcohol Dependence  New England Journal of Medicine, Vol.  345, No. 24, pp 1734-1739. 

From Abstract: "Results: At 13 weeks, we found no significant difference in the number of days to relapse between patients in the two naltrexone groups and the placebo group. At 52 weeks, there were no significant differences among the three groups in the percentage of days on which drinking occurred and the number of drinks per drinking day."

Krystal, 2001
Letter to Editor Re: "Naltrexone in the Treatment of Alcohol Dependence"  NEJM, Vol. 345, No. 24. 2001

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Gordis, Fuller, 2001
Naltrexone And Alcoholism Treatment - O'Malley; 1998; Treatment Improvement Protocol (SAMHSA TIP #28)
 
O'Malley, 1998
Naltrexone and Cognitive Behavioral Therapy for the Treatment of Outpatient Alcoholics: Results of Placebo-Controlled Trial. American Journal of Psychiatry, Vol. 156, pp 758-64.
 
Anton, 1999
Naltrexone, A Relapse Prevention Maintenance Treatment of Alcohol Dependence: A Meta-Analysis of Randomized Controlled Trials. Alcohol & Alcoholism, Vol. 36, No. 2, pp 544-52.

Comment: Naltrexone group had greater abstinence, fewer relapses, and drank less. There was no difference between the naltrexone and placebo groups regarding adverse effects.

Streeton, 2001
Naltrexone Vs. Acamprosate: 1 Year Follow-Up of Alcohol Dependence Treatment. Alcohol & Alcoholism, Vol. 36, No. 5, pp 419-25.
 
Rubio, 2001
Frequently Asked Questions about Naltrexone:
Dopey Doctors and Naltrexone Prescriptions
Simple Truths About Naltrexone
Naltrexone as an Aid to Controlled Drinking
Naltrexone References, Resources and Links
DeLuca, 2003
[END]  
 

Dr. DeLuca's Addiction, Pain, and Public Health website

Alexander DeLuca, M.D., FASAM

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Originally posted:  1/12/2002

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Most recently revised: 3/11/2005
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