title: Improving naltrexone response: an intervention for medical practitioners to enhance medication compliance in alcohol dependent patients.
abstract: The effectiveness of naltrexone, a FDA-approved medication for alcohol dependence, can be improved if we support and help patients to consistently take their medication. We illustrate how patient noncompliance with treatment negatively affects outcome, and, we describe a new intervention to enhance medication compliance. Outcome was evaluated for 196 alcohol dependent outpatients who were treated with 50 mg/day naltrexone or placebo for 12 weeks. For patients who adhered to the prescribed treatment, relapse rates were lower with naltrexone than placebo (10% vs. 38.6%, p < 0.001). For noncompliant patients, relapse rates were high and comparable between naltrexone- and placebo-treated patients (42.9% vs. 40%). In a second study of 100 alcohol dependent outpatients, we introduced an intervention that resulted in better medication compliance rates compared to a previous naltrexone study of patients who did not receive the intervention (77.0% vs. 60.8%, p < 0.01). This provided some support for the use of an intervention that targets medication compliance when prescribing naltrexone.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, The Philadelphia Medical Center for Veteran Affairs, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Pettinati
authors.forename: J R
authors.initials: JR
authors.lastname: Volpicelli
authors.forename: J D
authors.initials: JD
authors.lastname: Pierce
authors.forename: C P
authors.initials: CP
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D000553:Ambulatory Care; D003131:Combined Modality Therapy; D003631:Day Care, Medical; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000009:adverse effects / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D010349:Patient Compliance / Q000523:psychology*; D010817:Physician-Patient Relations; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone