- Addendum to this
document, 3/11/2005 -
See also these two documents representing a 2005 review
updating the older literature discussed below.
for the treatment of alcoholism: a meta-analysis of
Randomized Controlled Trials"
Srisurapanont et al.; Int J. Neuropsychopharmacology; 2005.
This peer-reviewed article was discussed in the following
medical news agency article:
[naltrexone] Helps Alcoholics Control Drinking"
Medical News Today item; 2/18/2005; from which the following
most effective, says Volpicelli, in a program 'designed to
support the notion that... what you really want to stop is
[END: 3/11/2005 addendum]
and dependence part of the same continuum of illness? Or do alcohol abusers tend NOT to become alcoholics?
Schuckitt article: "Five
Year Clinical Course Associated with DSM IV Alcohol Abuse or
2. Should alcohol abusers take naltrexone
only 'as needed?' instead of daily as in the abstinence
===> See article by Sinclair: "Evidence
about Use of Naltrexone and for Different ways of Using It..."
3. Are there different theories of naltrexone
===> See slide/lecture by DeLuca: "Alcohol
Abuse vs. Dependence and the Evolving Role of Adjunctive
===> 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
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.
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
-- Abstinence vs Extinction theories of naltrexone and
consequent very different medication regimens.
DeLuca, 2001, HTML Slide/Lecture presentation.
as HTML (ZIP)
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."
[Top of Page]
About the Use of Naltrexone and for the Different Ways of Using It
in the Treatment of Alcoholism.
Alcoholism, Vol. 36, No. 1, pp. 2-10.
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."
naltrexone treatment of early problem drinkers. Addictive
Behaviors, Vol 22, #3, pg 431
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."
Naltrexone in the Treatment of Alcohol Dependence
New England Journal of Medicine, Vol. 345, No. 24, pp
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."
to Editor Re: "Naltrexone in the Treatment of
Alcohol Dependence" NEJM,
Vol. 345, No. 24. 2001
[Top of Page]
And Alcoholism Treatment
- O'Malley; 1998; Treatment Improvement Protocol (SAMHSA TIP #28)
and Cognitive Behavioral Therapy for the Treatment of Outpatient
Alcoholics: Results of Placebo-Controlled Trial.
Journal of Psychiatry, Vol. 156, pp 758-64.
A Relapse Prevention Maintenance Treatment of Alcohol Dependence: A
Meta-Analysis of Randomized Controlled Trials.
Alcohol & Alcoholism, Vol. 36, No. 2, pp 544-52.
group had greater abstinence, fewer relapses, and drank less. There
difference between the naltrexone and placebo groups regarding adverse effects.
Vs. Acamprosate: 1 Year Follow-Up of Alcohol Dependence Treatment.
Alcohol & Alcoholism, Vol. 36, No. 5, pp 419-25.
Asked Questions about Naltrexone:
Dopey Doctors and Naltrexone Prescriptions
Simple Truths About Naltrexone
Naltrexone as an Aid to Controlled Drinking
References, Resources and Links